{"hospital_name":"Adventhealth Port Charlotte","last_updated_on":"2026-04-01","version":"3.0.0","location_name":["Adventhealth Port Charlotte"],"hospital_address":["2500 Harbor Blvd, Port Charlotte, FL 33952"],"license_information":{"license_number":"4340","state":"FL"},"type_2_npi":["1760299093"],"attestation":{"attestation":"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.","confirm_attestation":true,"attester_name":"Tim Reiner"},"standard_charge_information":[{"description":"NULOJIX 250 MG IV SOLR","drug_information":{"unit":0.1,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0485","type":"HCPCS"},{"code":"00003037113","type":"NDC"}],"standard_charges":[{"gross_charge":2026.4,"discounted_cash":2026.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"00409426401","type":"NDC"}],"standard_charges":[{"gross_charge":391.3,"discounted_cash":391.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"00409128337","type":"NDC"}],"standard_charges":[{"gross_charge":386.58,"discounted_cash":386.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE HCL PF 2 MG/ML IJ SOLN","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"63323085325","type":"NDC"}],"standard_charges":[{"gross_charge":334.16,"discounted_cash":334.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"00409336510","type":"NDC"}],"standard_charges":[{"gross_charge":363.01,"discounted_cash":363.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"00641615125","type":"NDC"}],"standard_charges":[{"gross_charge":347.37,"discounted_cash":347.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"00409131230","type":"NDC"}],"standard_charges":[{"gross_charge":385.23,"discounted_cash":385.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"00409131236","type":"NDC"}],"standard_charges":[{"gross_charge":112.22,"discounted_cash":112.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OPDUALAG 240-80 MG/20ML IV SOLN","drug_information":{"unit":40.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9298","type":"HCPCS"},{"code":"00003712511","type":"NDC"}],"standard_charges":[{"gross_charge":65880.96,"discounted_cash":65880.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VISIPAQUE 320 MG/ML IV SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00407222316","type":"NDC"}],"standard_charges":[{"gross_charge":12.87,"discounted_cash":12.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NAROPIN 2 MG/ML IJ SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028523","type":"NDC"}],"standard_charges":[{"gross_charge":362.18,"discounted_cash":362.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NAROPIN 2 MG/ML IJ SOLN","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028528","type":"NDC"}],"standard_charges":[{"gross_charge":391.01,"discounted_cash":391.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NAROPIN 2 MG/ML IJ SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028565","type":"NDC"}],"standard_charges":[{"gross_charge":116.2,"discounted_cash":116.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NAROPIN 10 MG/ML IJ SOLN","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028821","type":"NDC"}],"standard_charges":[{"gross_charge":125.2,"discounted_cash":125.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NAROPIN 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028635","type":"NDC"}],"standard_charges":[{"gross_charge":331.23,"discounted_cash":331.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NAROPIN 5 MG/ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028627","type":"NDC"}],"standard_charges":[{"gross_charge":337.87,"discounted_cash":337.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NAROPIN 5 MG/ML IJ SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028638","type":"NDC"}],"standard_charges":[{"gross_charge":356.16,"discounted_cash":356.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NAROPIN 5 MG/ML IJ SOLN","drug_information":{"unit":24.6,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028600","type":"NDC"}],"standard_charges":[{"gross_charge":178.85,"discounted_cash":178.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NAROPIN 5 MG/ML IJ SOLN","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028623","type":"NDC"}],"standard_charges":[{"gross_charge":406.64,"discounted_cash":406.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NAROPIN 5 MG/ML IJ SOLN","drug_information":{"unit":24.6,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028631","type":"NDC"}],"standard_charges":[{"gross_charge":158.19,"discounted_cash":158.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MILK OF MAGNESIA CONCENTRATE 2400 MG/10ML PO SUSP","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00121094000","type":"NDC"}],"standard_charges":[{"gross_charge":23.72,"discounted_cash":23.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CORVERT 1 MG/10ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1742","type":"HCPCS"},{"code":"00009379401","type":"NDC"}],"standard_charges":[{"gross_charge":1802.56,"discounted_cash":1802.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACTATED RINGERS IV SOLN","drug_information":{"unit":900.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"00264775007","type":"NDC"}],"standard_charges":[{"gross_charge":354.7,"discounted_cash":354.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE-SODIUM CHLORIDE 5-0.9 % IV SOLN","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"00990794109","type":"NDC"}],"standard_charges":[{"gross_charge":394.0,"discounted_cash":394.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE-SODIUM CHLORIDE 5-0.45 % IV SOLN","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7121","type":"HCPCS"},{"code":"00990792609","type":"NDC"}],"standard_charges":[{"gross_charge":394.0,"discounted_cash":394.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 10 % IV SOLN","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00990793009","type":"NDC"}],"standard_charges":[{"gross_charge":394.0,"discounted_cash":394.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE IN LACTATED RINGERS 5 % IV SOLN","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7121","type":"HCPCS"},{"code":"00338012504","type":"NDC"}],"standard_charges":[{"gross_charge":394.0,"discounted_cash":394.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KCL IN DEXTROSE-NACL 20-5-0.45 MEQ/L-%-% IV SOLN","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00338067104","type":"NDC"}],"standard_charges":[{"gross_charge":394.0,"discounted_cash":394.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACTATED RINGERS IV SOLN","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"00338011702","type":"NDC"}],"standard_charges":[{"gross_charge":361.8,"discounted_cash":361.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEQVIO 284 MG/1.5ML SC SOSY","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1306","type":"HCPCS"},{"code":"00078100060","type":"NDC"}],"standard_charges":[{"gross_charge":67495.35,"discounted_cash":67495.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VISIPAQUE 320 MG/ML IV SOLN","drug_information":{"unit":175.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00407222321","type":"NDC"}],"standard_charges":[{"gross_charge":238.38,"discounted_cash":238.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VYVGART 400 MG/20ML IV SOLN","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9332","type":"HCPCS"},{"code":"73475304105","type":"NDC"}],"standard_charges":[{"gross_charge":349333.36,"discounted_cash":349333.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VISIPAQUE 320 MG/ML IV SOLN","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00407222317","type":"NDC"}],"standard_charges":[{"gross_charge":67.6,"discounted_cash":67.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VISIPAQUE 270 MG/ML IV SOLN","drug_information":{"unit":55.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9966","type":"HCPCS"},{"code":"00407222217","type":"NDC"}],"standard_charges":[{"gross_charge":66.76,"discounted_cash":66.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRELEGY ELLIPTA 200-62.5-25 MCG/ACT IN AEPB","drug_information":{"unit":28.0,"type":"UN"},"code_information":[{"code":"259","type":"RC"},{"code":"00173089314","type":"NDC"}],"standard_charges":[{"gross_charge":1060.12,"discounted_cash":1060.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ANORO ELLIPTA 62.5-25 MCG/ACT IN AEPB","drug_information":{"unit":14.0,"type":"UN"},"code_information":[{"code":"259","type":"RC"},{"code":"00173086906","type":"NDC"}],"standard_charges":[{"gross_charge":452.95,"discounted_cash":452.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLORASEPTIC SORE THROAT 6-10 MG MT LOZG","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"259","type":"RC"},{"code":"78112001106","type":"NDC"}],"standard_charges":[{"gross_charge":21.09,"discounted_cash":21.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NARCAN 4 MG/0.1ML NA LIQD","drug_information":{"unit":2.0,"type":"UN"},"code_information":[{"code":"259","type":"RC"},{"code":"69547062702","type":"NDC"}],"standard_charges":[{"gross_charge":359.61,"discounted_cash":359.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HURRICAINE ONE 20 % MT SOLN","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"259","type":"RC"},{"code":"00283061011","type":"NDC"}],"standard_charges":[{"gross_charge":872.03,"discounted_cash":872.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HURRICAINE ONE 20 % MT SOLN","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"259","type":"RC"},{"code":"00283061026","type":"NDC"}],"standard_charges":[{"gross_charge":101.74,"discounted_cash":101.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEPACOL EXTRA STRENGTH 15-2.6 MG MT LOZG","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"259","type":"RC"},{"code":"63824073216","type":"NDC"}],"standard_charges":[{"gross_charge":20.58,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRELEGY ELLIPTA 100-62.5-25 MCG/ACT IN AEPB","drug_information":{"unit":28.0,"type":"UN"},"code_information":[{"code":"259","type":"RC"},{"code":"00173088714","type":"NDC"}],"standard_charges":[{"gross_charge":1071.89,"discounted_cash":1071.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NALOXONE HCL 4 MG/0.1ML NA LIQD","drug_information":{"unit":2.0,"type":"UN"},"code_information":[{"code":"259","type":"RC"},{"code":"45802057884","type":"NDC"}],"standard_charges":[{"gross_charge":234.32,"discounted_cash":234.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SORE THROAT 15-3.6 MG MT LOZG","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"259","type":"RC"},{"code":"00904625549","type":"NDC"}],"standard_charges":[{"gross_charge":6.28,"discounted_cash":6.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BACITRACIN ZINC 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"259","type":"RC"},{"code":"00904702367","type":"NDC"}],"standard_charges":[{"gross_charge":16.11,"discounted_cash":16.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BACITRACIN ZINC 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"259","type":"RC"},{"code":"57896014514","type":"NDC"}],"standard_charges":[{"gross_charge":13.44,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BACITRACIN 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"259","type":"RC"},{"code":"67777011611","type":"NDC"}],"standard_charges":[{"gross_charge":20.32,"discounted_cash":20.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INCRUSE ELLIPTA 62.5 MCG/ACT IN AEPB","drug_information":{"unit":7.0,"type":"UN"},"code_information":[{"code":"259","type":"RC"},{"code":"00173087306","type":"NDC"}],"standard_charges":[{"gross_charge":301.79,"discounted_cash":301.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARNUITY ELLIPTA 100 MCG/ACT IN AEPB","drug_information":{"unit":14.0,"type":"UN"},"code_information":[{"code":"259","type":"RC"},{"code":"00173087414","type":"NDC"}],"standard_charges":[{"gross_charge":470.3,"discounted_cash":470.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BACITRACIN 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"259","type":"RC"},{"code":"45802006070","type":"NDC"}],"standard_charges":[{"gross_charge":18.94,"discounted_cash":18.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BACITRACIN 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"259","type":"RC"},{"code":"00904740267","type":"NDC"}],"standard_charges":[{"gross_charge":16.28,"discounted_cash":16.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BACITRACIN 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"259","type":"RC"},{"code":"68001047748","type":"NDC"}],"standard_charges":[{"gross_charge":20.41,"discounted_cash":20.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIPLE ANTIBIOTIC 3.5-400-5000 EX OINT","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"259","type":"RC"},{"code":"45802014370","type":"NDC"}],"standard_charges":[{"gross_charge":19.89,"discounted_cash":19.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERTAPENEM SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"44567082010","type":"NDC"}],"standard_charges":[{"gross_charge":585.09,"discounted_cash":585.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN 20-200 MG/10ML PO SYRP","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"60687082856","type":"NDC"}],"standard_charges":[{"gross_charge":13.2,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DURAMORPH 1 MG/ML IJ SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"00641601910","type":"NDC"}],"standard_charges":[{"gross_charge":400.81,"discounted_cash":400.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIABNI 100 MG/10ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5123","type":"HCPCS"},{"code":"55513022401","type":"NDC"}],"standard_charges":[{"gross_charge":9286.18,"discounted_cash":9286.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIABNI 500 MG/50ML IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5123","type":"HCPCS"},{"code":"55513032601","type":"NDC"}],"standard_charges":[{"gross_charge":46389.95,"discounted_cash":46389.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RUXIENCE 100 MG/10ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5119","type":"HCPCS"},{"code":"00069023801","type":"NDC"}],"standard_charges":[{"gross_charge":10016.54,"discounted_cash":10016.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RUXIENCE 500 MG/50ML IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5119","type":"HCPCS"},{"code":"00069024901","type":"NDC"}],"standard_charges":[{"gross_charge":49539.2,"discounted_cash":49539.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VYEPTI 100 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3032","type":"HCPCS"},{"code":"67386013051","type":"NDC"}],"standard_charges":[{"gross_charge":36502.73,"discounted_cash":36502.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VISIPAQUE 270 MG/ML IV SOLN","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9966","type":"HCPCS"},{"code":"00407222216","type":"NDC"}],"standard_charges":[{"gross_charge":29.2,"discounted_cash":29.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VISIPAQUE 270 MG/ML IV SOLN","drug_information":{"unit":125.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9966","type":"HCPCS"},{"code":"00407222219","type":"NDC"}],"standard_charges":[{"gross_charge":149.13,"discounted_cash":149.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VISIPAQUE 320 MG/ML IV SOLN","drug_information":{"unit":110.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00407222319","type":"NDC"}],"standard_charges":[{"gross_charge":115.6,"discounted_cash":115.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"STYE 31.9-57.7 % OP OINT","drug_information":{"unit":3.5,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"63736014308","type":"NDC"}],"standard_charges":[{"gross_charge":62.24,"discounted_cash":62.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TEZSPIRE 210 MG/1.91ML SC SOSY","drug_information":{"unit":1.91,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2356","type":"HCPCS"},{"code":"55513011201","type":"NDC"}],"standard_charges":[{"gross_charge":82181.96,"discounted_cash":82181.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE SULFATE 4 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"00641612525","type":"NDC"}],"standard_charges":[{"gross_charge":378.25,"discounted_cash":378.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM IN NACL 500 MG/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"43598063510","type":"NDC"}],"standard_charges":[{"gross_charge":99.1,"discounted_cash":99.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"23155047344","type":"NDC"}],"standard_charges":[{"gross_charge":345.99,"discounted_cash":345.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE HCL (PF) 0.5 % IJ SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00143933110","type":"NDC"}],"standard_charges":[{"gross_charge":339.39,"discounted_cash":339.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE 2 GM/50ML IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"44567042024","type":"NDC"}],"standard_charges":[{"gross_charge":65.55,"discounted_cash":65.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":0.18,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00143959525","type":"NDC"}],"standard_charges":[{"gross_charge":326.28,"discounted_cash":326.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0133","type":"HCPCS"},{"code":"63323032514","type":"NDC"}],"standard_charges":[{"gross_charge":386.56,"discounted_cash":386.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCIUM GLUCONATE-NACL 1-0.675 GM/50ML-% IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"44567062024","type":"NDC"}],"standard_charges":[{"gross_charge":96.9,"discounted_cash":96.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCIUM GLUCONATE-NACL 1-0.675 GM/50ML-% IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"65219016210","type":"NDC"}],"standard_charges":[{"gross_charge":89.75,"discounted_cash":89.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"63323028004","type":"NDC"}],"standard_charges":[{"gross_charge":327.95,"discounted_cash":327.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROPIVACAINE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"25021067187","type":"NDC"}],"standard_charges":[{"gross_charge":420.91,"discounted_cash":420.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE HCL (PF) 0.25 % IJ SOLN","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"55150016710","type":"NDC"}],"standard_charges":[{"gross_charge":346.48,"discounted_cash":346.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN (PORCINE) IN NACL 1000-0.9 UT/500ML-% IV SOLN","drug_information":{"unit":0.008,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00264987210","type":"NDC"}],"standard_charges":[{"gross_charge":325.01,"discounted_cash":325.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE IN D5W 1-5 GM/100ML-% IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"00409672723","type":"NDC"}],"standard_charges":[{"gross_charge":431.15,"discounted_cash":431.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LINEZOLID 600 MG/300ML IV SOLN","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"63323071313","type":"NDC"}],"standard_charges":[{"gross_charge":89.2,"discounted_cash":89.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE IN D5W 1-5 GM/100ML-% IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"00338170940","type":"NDC"}],"standard_charges":[{"gross_charge":440.8,"discounted_cash":440.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/100ML IV SOLN","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00338070548","type":"NDC"}],"standard_charges":[{"gross_charge":403.44,"discounted_cash":403.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00990792323","type":"NDC"}],"standard_charges":[{"gross_charge":365.25,"discounted_cash":365.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CIPROFLOXACIN IN D5W 400 MG/200ML IV SOLN","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0744","type":"HCPCS"},{"code":"00409330024","type":"NDC"}],"standard_charges":[{"gross_charge":80.4,"discounted_cash":80.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOPAMINE-DEXTROSE 1.6-5 MG/ML-% IV SOLN","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"00409780922","type":"NDC"}],"standard_charges":[{"gross_charge":414.13,"discounted_cash":414.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE 4 GM/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"00264420654","type":"NDC"}],"standard_charges":[{"gross_charge":371.4,"discounted_cash":371.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE IN D5W 1-5 GM/100ML-% IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"44567041024","type":"NDC"}],"standard_charges":[{"gross_charge":371.4,"discounted_cash":371.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00338001741","type":"NDC"}],"standard_charges":[{"gross_charge":364.6,"discounted_cash":364.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"14789022010","type":"NDC"}],"standard_charges":[{"gross_charge":111.2,"discounted_cash":111.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 3 % IN NEBU","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00378699789","type":"NDC"}],"standard_charges":[{"gross_charge":25.82,"discounted_cash":25.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409427801","type":"NDC"}],"standard_charges":[{"gross_charge":326.64,"discounted_cash":326.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCOPYRROLATE 1 MG/5ML IJ SOSY","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"69374090305","type":"NDC"}],"standard_charges":[{"gross_charge":356.5,"discounted_cash":356.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OCTREOTIDE ACETATE 50 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"00641617410","type":"NDC"}],"standard_charges":[{"gross_charge":379.03,"discounted_cash":379.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARDENE IV 40-0.83 MG/200ML-% IV SOLN","drug_information":{"unit":19.792,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"J2404","type":"HCPCS"},{"code":"43066002810","type":"NDC"}],"standard_charges":[{"gross_charge":72.48,"discounted_cash":72.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARDENE IV 40-0.83 MG/200ML-% IV SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"J2404","type":"HCPCS"},{"code":"43066001610","type":"NDC"}],"standard_charges":[{"gross_charge":338.67,"discounted_cash":338.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 3 % IN NEBU","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"76204002260","type":"NDC"}],"standard_charges":[{"gross_charge":41.99,"discounted_cash":41.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VASOSTRICT 40-5 UT/100ML-% IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2598","type":"HCPCS"},{"code":"42023021910","type":"NDC"}],"standard_charges":[{"gross_charge":437.7,"discounted_cash":437.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IPRATROPIUM BROMIDE 0.02 % IN SOLN","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"76204010001","type":"NDC"}],"standard_charges":[{"gross_charge":31.07,"discounted_cash":31.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"00409128331","type":"NDC"}],"standard_charges":[{"gross_charge":333.34,"discounted_cash":333.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE SULFATE (PF) 4 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"00409189123","type":"NDC"}],"standard_charges":[{"gross_charge":401.54,"discounted_cash":401.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE SULFATE 4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2272","type":"HCPCS"},{"code":"76045000511","type":"NDC"}],"standard_charges":[{"gross_charge":383.24,"discounted_cash":383.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE SULFATE (PF) 4 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"00409189101","type":"NDC"}],"standard_charges":[{"gross_charge":376.12,"discounted_cash":376.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE SULFATE (PF) 4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2272","type":"HCPCS"},{"code":"63323045401","type":"NDC"}],"standard_charges":[{"gross_charge":383.9,"discounted_cash":383.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE SULFATE (PF) 2 MG/ML IV SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"00409189001","type":"NDC"}],"standard_charges":[{"gross_charge":353.6,"discounted_cash":353.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE SULFATE 2 MG/ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2272","type":"HCPCS"},{"code":"76045000411","type":"NDC"}],"standard_charges":[{"gross_charge":364.1,"discounted_cash":364.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE SULFATE (PF) 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2272","type":"HCPCS"},{"code":"63323045201","type":"NDC"}],"standard_charges":[{"gross_charge":382.78,"discounted_cash":382.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE SULFATE (PF) 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"00409189023","type":"NDC"}],"standard_charges":[{"gross_charge":387.89,"discounted_cash":387.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE SULFATE-NACL 100-0.9 MG/100ML-% IV SOLN","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"70092138036","type":"NDC"}],"standard_charges":[{"gross_charge":173.8,"discounted_cash":173.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENHYDRAMINE HCL 25 MG/10ML PO LIQD","drug_information":{"unit":1.667,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"60687083008","type":"NDC"}],"standard_charges":[{"gross_charge":8.89,"discounted_cash":8.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENHYDRAMINE HCL 12.5 MG/5ML PO LIQD","drug_information":{"unit":3.333,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"69339015219","type":"NDC"}],"standard_charges":[{"gross_charge":11.49,"discounted_cash":11.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM-SODIUM CHLORIDE (PF) 100-0.9 MG/100ML-% IV SOLN","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2251","type":"HCPCS"},{"code":"25021068887","type":"NDC"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":82.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM-SODIUM CHLORIDE 100-0.9 MG/100ML-% IV SOLN","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2251","type":"HCPCS"},{"code":"44567061110","type":"NDC"}],"standard_charges":[{"gross_charge":151.6,"discounted_cash":151.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM-SODIUM CHLORIDE 100-0.9 MG/100ML-% IV SOLN","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2251","type":"HCPCS"},{"code":"00143938010","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM-SODIUM CHLORIDE 100-0.9 MG/100ML-% IV SOLN","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2251","type":"HCPCS"},{"code":"70092141836","type":"NDC"}],"standard_charges":[{"gross_charge":300.4,"discounted_cash":300.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METRONIDAZOLE 500 MG/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1836","type":"HCPCS"},{"code":"00338954124","type":"NDC"}],"standard_charges":[{"gross_charge":440.8,"discounted_cash":440.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METRONIDAZOLE 500 MG/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1836","type":"HCPCS"},{"code":"47335099301","type":"NDC"}],"standard_charges":[{"gross_charge":363.4,"discounted_cash":363.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METRONIDAZOLE 500 MG/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1836","type":"HCPCS"},{"code":"25021013182","type":"NDC"}],"standard_charges":[{"gross_charge":498.7,"discounted_cash":498.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METRONIDAZOLE 500 MG/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1836","type":"HCPCS"},{"code":"00338105548","type":"NDC"}],"standard_charges":[{"gross_charge":440.8,"discounted_cash":440.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METRONIDAZOLE 500 MG/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1836","type":"HCPCS"},{"code":"00409015224","type":"NDC"}],"standard_charges":[{"gross_charge":508.35,"discounted_cash":508.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL-NACL 1-0.9 MG/10ML-% IV SOSY","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"73702012510","type":"NDC"}],"standard_charges":[{"gross_charge":333.28,"discounted_cash":333.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL-NACL 1-0.9 MG/10ML-% IV SOSY","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"70092104646","type":"NDC"}],"standard_charges":[{"gross_charge":336.42,"discounted_cash":336.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 1 MG/10ML IV SOSY","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"71449000115","type":"NDC"}],"standard_charges":[{"gross_charge":334.84,"discounted_cash":334.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 1 MG/10ML IV SOSY","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"73177010803","type":"NDC"}],"standard_charges":[{"gross_charge":370.14,"discounted_cash":370.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 1 MG/10ML IV SOSY","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"71266901101","type":"NDC"}],"standard_charges":[{"gross_charge":347.39,"discounted_cash":347.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOLN","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"70069002125","type":"NDC"}],"standard_charges":[{"gross_charge":329.03,"discounted_cash":329.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOLN","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323050601","type":"NDC"}],"standard_charges":[{"gross_charge":336.02,"discounted_cash":336.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOLN","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"55150030425","type":"NDC"}],"standard_charges":[{"gross_charge":351.38,"discounted_cash":351.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOLN","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323050616","type":"NDC"}],"standard_charges":[{"gross_charge":336.02,"discounted_cash":336.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"00641620610","type":"NDC"}],"standard_charges":[{"gross_charge":389.06,"discounted_cash":389.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"XOLAIR 150 MG/ML SC SOSY","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2357","type":"HCPCS"},{"code":"50242021501","type":"NDC"}],"standard_charges":[{"gross_charge":21687.29,"discounted_cash":21687.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % EX CREA","drug_information":{"unit":30.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"51672128202","type":"NDC"}],"standard_charges":[{"gross_charge":38.79,"discounted_cash":38.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCORTISONE 1 % EX CREA","drug_information":{"unit":30.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"68001047646","type":"NDC"}],"standard_charges":[{"gross_charge":29.89,"discounted_cash":29.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GNP LIDOCAINE PAIN RELIEVING 4 % EX CREA","drug_information":{"unit":76.5,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"46122061410","type":"NDC"}],"standard_charges":[{"gross_charge":38.34,"discounted_cash":38.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SYMBICORT 80-4.5 MCG/ACT IN AERO","drug_information":{"unit":6.9,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00186037228","type":"NDC"}],"standard_charges":[{"gross_charge":393.24,"discounted_cash":393.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SYMBICORT 160-4.5 MCG/ACT IN AERO","drug_information":{"unit":6.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00186037028","type":"NDC"}],"standard_charges":[{"gross_charge":397.72,"discounted_cash":397.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROCTOZONE-HC 2.5 % EX CREA","drug_information":{"unit":30.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"64980032430","type":"NDC"}],"standard_charges":[{"gross_charge":64.15,"discounted_cash":64.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROCTOFOAM HC 1-1 % EX FOAM","drug_information":{"unit":10.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00037682210","type":"NDC"}],"standard_charges":[{"gross_charge":1297.75,"discounted_cash":1297.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GNP TRIPLE ANTIBIOTIC EX OINT","drug_information":{"unit":28.4,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"46122041403","type":"NDC"}],"standard_charges":[{"gross_charge":32.69,"discounted_cash":32.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMERICAINE 20 % EX AERO","drug_information":{"unit":57.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"63736037882","type":"NDC"}],"standard_charges":[{"gross_charge":41.95,"discounted_cash":41.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ANECREAM 4 % EX CREA","drug_information":{"unit":5.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"24357070106","type":"NDC"}],"standard_charges":[{"gross_charge":37.17,"discounted_cash":37.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIPLE ANTIBIOTIC 5-400-5000 EX OINT","drug_information":{"unit":14.2,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"68001048346","type":"NDC"}],"standard_charges":[{"gross_charge":36.8,"discounted_cash":36.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GNP TRIPLE ANTIBIOTIC EX OINT","drug_information":{"unit":14.2,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"46122041405","type":"NDC"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":31.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SSD 1 % EX CREA","drug_information":{"unit":25.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"43598021025","type":"NDC"}],"standard_charges":[{"gross_charge":59.64,"discounted_cash":59.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SILVADENE 1 % EX CREA","drug_information":{"unit":50.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"61570013155","type":"NDC"}],"standard_charges":[{"gross_charge":75.08,"discounted_cash":75.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CETACAINE 2-2-14 % EX AERO","drug_information":{"unit":20.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"10223020103","type":"NDC"}],"standard_charges":[{"gross_charge":913.06,"discounted_cash":913.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SANTYL 250 UNIT/GM EX OINT","drug_information":{"unit":30.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"50484001030","type":"NDC"}],"standard_charges":[{"gross_charge":869.68,"discounted_cash":869.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREMARIN 0.625 MG/GM VA CREA","drug_information":{"unit":30.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00046087221","type":"NDC"}],"standard_charges":[{"gross_charge":1273.42,"discounted_cash":1273.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE-PRILOCAINE 2.5-2.5 % EX CREA","drug_information":{"unit":5.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"62332058204","type":"NDC"}],"standard_charges":[{"gross_charge":62.11,"discounted_cash":62.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE-PRILOCAINE 2.5-2.5 % EX CREA","drug_information":{"unit":5.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00168035755","type":"NDC"}],"standard_charges":[{"gross_charge":78.4,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOBRADEX 0.3-0.1 % OP OINT","drug_information":{"unit":3.5,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00078087601","type":"NDC"}],"standard_charges":[{"gross_charge":827.2,"discounted_cash":827.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FIRST AID ANTISEPTIC 10 % EX OINT","drug_information":{"unit":28.4,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00536127180","type":"NDC"}],"standard_charges":[{"gross_charge":33.17,"discounted_cash":33.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SILVADENE 1 % EX CREA","drug_information":{"unit":400.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"61570013140","type":"NDC"}],"standard_charges":[{"gross_charge":261.6,"discounted_cash":261.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SILVADENE 1 % EX CREA","drug_information":{"unit":25.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"61570013125","type":"NDC"}],"standard_charges":[{"gross_charge":32.56,"discounted_cash":32.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SILVADENE 1 % EX CREA","drug_information":{"unit":50.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"61570013150","type":"NDC"}],"standard_charges":[{"gross_charge":121.35,"discounted_cash":121.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BOUDREAUXS BUTT PASTE 16 % EX OINT","drug_information":{"unit":57.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"62103033302","type":"NDC"}],"standard_charges":[{"gross_charge":37.08,"discounted_cash":37.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERYTHROMYCIN 5 MG/GM OP OINT","drug_information":{"unit":1.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"24208091019","type":"NDC"}],"standard_charges":[{"gross_charge":75.65,"discounted_cash":75.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERYTHROMYCIN 5 MG/GM OP OINT","drug_information":{"unit":3.5,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"24208091055","type":"NDC"}],"standard_charges":[{"gross_charge":89.43,"discounted_cash":89.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ESTRADIOL 0.01 % VA CREA","drug_information":{"unit":42.5,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"66993000210","type":"NDC"}],"standard_charges":[{"gross_charge":671.54,"discounted_cash":671.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETH 3.5-10000-0.1 OP OINT","drug_information":{"unit":3.5,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"24208079535","type":"NDC"}],"standard_charges":[{"gross_charge":99.07,"discounted_cash":99.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS","drug_information":{"unit":8.5,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"17270074000","type":"NDC"}],"standard_charges":[{"gross_charge":141.5,"discounted_cash":141.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":1.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"50268056815","type":"NDC"}],"standard_charges":[{"gross_charge":31.19,"discounted_cash":31.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEMORRHOIDAL 0.25-14-74.9 % RE OINT","drug_information":{"unit":57.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"45802018816","type":"NDC"}],"standard_charges":[{"gross_charge":41.01,"discounted_cash":41.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS","drug_information":{"unit":6.7,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"69097014260","type":"NDC"}],"standard_charges":[{"gross_charge":135.12,"discounted_cash":135.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LATANOPROST 0.005 % OP SOLN","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"70069042103","type":"NDC"}],"standard_charges":[{"gross_charge":41.64,"discounted_cash":41.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MOXIFLOXACIN HCL 0.5 % OP SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"70756063825","type":"NDC"}],"standard_charges":[{"gross_charge":37.84,"discounted_cash":37.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VISINE RED EYE COMFORT 0.05 % OP SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"69968035501","type":"NDC"}],"standard_charges":[{"gross_charge":46.77,"discounted_cash":46.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BETADINE 10 % EX SOLN","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"67618015017","type":"NDC"}],"standard_charges":[{"gross_charge":45.95,"discounted_cash":45.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BETADINE 5 % EX SOLN","drug_information":{"unit":88.7,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"67618016003","type":"NDC"}],"standard_charges":[{"gross_charge":65.61,"discounted_cash":65.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SALINE NASAL SPRAY 0.65 % NA SOLN","drug_information":{"unit":45.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"45802035758","type":"NDC"}],"standard_charges":[{"gross_charge":23.77,"discounted_cash":23.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INFANTS GAS RELIEF 20 MG/0.3ML PO SUSP","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"69618005951","type":"NDC"}],"standard_charges":[{"gross_charge":2.56,"discounted_cash":2.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SORE THROAT SPRAY 1.4 % MT LIQD","drug_information":{"unit":177.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00904630521","type":"NDC"}],"standard_charges":[{"gross_charge":25.36,"discounted_cash":25.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENASEPTIC 1.4 % MT LIQD","drug_information":{"unit":177.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00536122858","type":"NDC"}],"standard_charges":[{"gross_charge":29.61,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OP SUSP","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"24208029525","type":"NDC"}],"standard_charges":[{"gross_charge":204.31,"discounted_cash":204.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 0.1 % OP SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"24208072002","type":"NDC"}],"standard_charges":[{"gross_charge":387.32,"discounted_cash":387.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BRIMONIDINE TARTRATE 0.1 % OP SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"82182032105","type":"NDC"}],"standard_charges":[{"gross_charge":832.3,"discounted_cash":832.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BRIMONIDINE TARTRATE 0.15 % OP SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"61314014405","type":"NDC"}],"standard_charges":[{"gross_charge":470.16,"discounted_cash":470.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCITONIN (SALMON) 200 UNIT/ACT NA SOLN","drug_information":{"unit":3.7,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"60505082306","type":"NDC"}],"standard_charges":[{"gross_charge":377.52,"discounted_cash":377.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BRIMONIDINE TARTRATE 0.15 % OP SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"60505056401","type":"NDC"}],"standard_charges":[{"gross_charge":419.41,"discounted_cash":419.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MOXIFLOXACIN HCL 0.5 % OP SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"16714064301","type":"NDC"}],"standard_charges":[{"gross_charge":402.96,"discounted_cash":402.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TIMOLOL HEMIHYDRATE 0.5 % OP SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"70069069601","type":"NDC"}],"standard_charges":[{"gross_charge":738.77,"discounted_cash":738.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MOXIFLOXACIN HCL 0.5 % OP SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"60505058204","type":"NDC"}],"standard_charges":[{"gross_charge":453.05,"discounted_cash":453.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OT SUSP","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"72485062513","type":"NDC"}],"standard_charges":[{"gross_charge":542.28,"discounted_cash":542.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LOTEPREDNOL ETABONATE 0.5 % OP SUSP","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"72603032401","type":"NDC"}],"standard_charges":[{"gross_charge":1412.01,"discounted_cash":1412.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 0.5 % OP SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"61314012605","type":"NDC"}],"standard_charges":[{"gross_charge":98.49,"discounted_cash":98.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OFLOXACIN 0.3 % OP SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"72603019201","type":"NDC"}],"standard_charges":[{"gross_charge":134.61,"discounted_cash":134.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TROPICAMIDE 1 % OP SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"61314035501","type":"NDC"}],"standard_charges":[{"gross_charge":84.67,"discounted_cash":84.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CIPROFLOXACIN HCL 0.3 % OP SOLN","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"69315030802","type":"NDC"}],"standard_charges":[{"gross_charge":101.2,"discounted_cash":101.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OFLOXACIN 0.3 % OP SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"24208043405","type":"NDC"}],"standard_charges":[{"gross_charge":168.02,"discounted_cash":168.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUDESONIDE 1 MG/2ML IN SUSP","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"69097032187","type":"NDC"}],"standard_charges":[{"gross_charge":73.52,"discounted_cash":73.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OT SUSP","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"62756042790","type":"NDC"}],"standard_charges":[{"gross_charge":452.23,"discounted_cash":452.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUOROMETHOLONE 0.1 % OP SUSP","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"60219158503","type":"NDC"}],"standard_charges":[{"gross_charge":466.32,"discounted_cash":466.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TROPICAMIDE-CYCLOPENTOLATE-PE 1-1-2.5 % OP SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"71449009245","type":"NDC"}],"standard_charges":[{"gross_charge":307.5,"discounted_cash":307.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIFLURIDINE 1 % OP SOLN","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"61314004475","type":"NDC"}],"standard_charges":[{"gross_charge":1291.24,"discounted_cash":1291.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LATANOPROST 0.005 % OP SOLN","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"24208046325","type":"NDC"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":31.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HALOPERIDOL LACTATE 2 MG/ML PO CONC UNIT DOSE","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00121058115","type":"NDC"}],"standard_charges":[{"gross_charge":14.52,"discounted_cash":14.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCORTISONE 1 % EX OINT","drug_information":{"unit":28.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"45802027603","type":"NDC"}],"standard_charges":[{"gross_charge":35.23,"discounted_cash":35.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROGLYCERIN 0.4 MG/SPRAY TL SOLN","drug_information":{"unit":9.8,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"45802021001","type":"NDC"}],"standard_charges":[{"gross_charge":1647.93,"discounted_cash":1647.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUDESONIDE-FORMOTEROL FUMARATE 160-4.5 MCG/ACT IN AERO","drug_information":{"unit":10.2,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00310737020","type":"NDC"}],"standard_charges":[{"gross_charge":630.9,"discounted_cash":630.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS","drug_information":{"unit":8.5,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"68180096301","type":"NDC"}],"standard_charges":[{"gross_charge":143.23,"discounted_cash":143.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS","drug_information":{"unit":6.7,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"60687066291","type":"NDC"}],"standard_charges":[{"gross_charge":122.65,"discounted_cash":122.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP","drug_information":{"unit":16.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00054327099","type":"NDC"}],"standard_charges":[{"gross_charge":77.49,"discounted_cash":77.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % EX CREA","drug_information":{"unit":15.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00168025815","type":"NDC"}],"standard_charges":[{"gross_charge":121.18,"discounted_cash":121.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOCONAZOLE 2 % EX CREA","drug_information":{"unit":15.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"16714095501","type":"NDC"}],"standard_charges":[{"gross_charge":151.53,"discounted_cash":151.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % EX CREA","drug_information":{"unit":15.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"51672404801","type":"NDC"}],"standard_charges":[{"gross_charge":140.94,"discounted_cash":140.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS","drug_information":{"unit":6.7,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00054074287","type":"NDC"}],"standard_charges":[{"gross_charge":104.59,"discounted_cash":104.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BACITRA-NEOMYCIN-POLYMYXIN-HC 1 % OP OINT","drug_information":{"unit":3.5,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"24208078555","type":"NDC"}],"standard_charges":[{"gross_charge":120.34,"discounted_cash":120.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS","drug_information":{"unit":6.7,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00781729685","type":"NDC"}],"standard_charges":[{"gross_charge":129.77,"discounted_cash":129.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":1.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"81033002099","type":"NDC"}],"standard_charges":[{"gross_charge":37.97,"discounted_cash":37.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":1.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"81033002050","type":"NDC"}],"standard_charges":[{"gross_charge":37.97,"discounted_cash":37.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETH 3.5-10000-0.1 OP OINT","drug_information":{"unit":3.5,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"61314063136","type":"NDC"}],"standard_charges":[{"gross_charge":102.14,"discounted_cash":102.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVALBUTEROL TARTRATE 45 MCG/ACT IN AERO","drug_information":{"unit":15.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00591292754","type":"NDC"}],"standard_charges":[{"gross_charge":393.13,"discounted_cash":393.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NYSTOP 100000 UNIT/GM EX POWD","drug_information":{"unit":60.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00574200802","type":"NDC"}],"standard_charges":[{"gross_charge":114.04,"discounted_cash":114.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NYSTOP 100000 UNIT/GM EX POWD","drug_information":{"unit":30.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00574200830","type":"NDC"}],"standard_charges":[{"gross_charge":72.99,"discounted_cash":72.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NYSTOP 100000 UNIT/GM EX POWD","drug_information":{"unit":15.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00574200815","type":"NDC"}],"standard_charges":[{"gross_charge":46.05,"discounted_cash":46.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HURRICAINE 20 % MT AERO","drug_information":{"unit":57.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00283067902","type":"NDC"}],"standard_charges":[{"gross_charge":295.86,"discounted_cash":295.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BACITRACIN ZINC 500 UNIT/GM EX OINT","drug_information":{"unit":14.2,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"51672207501","type":"NDC"}],"standard_charges":[{"gross_charge":42.11,"discounted_cash":42.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BACITRACIN ZINC 500 UNIT/GM EX OINT","drug_information":{"unit":28.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00536126328","type":"NDC"}],"standard_charges":[{"gross_charge":29.04,"discounted_cash":29.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BACITRACIN 500 UNIT/GM EX OINT","drug_information":{"unit":14.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"45802006001","type":"NDC"}],"standard_charges":[{"gross_charge":24.76,"discounted_cash":24.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GNP ATHLETES FOOT 1 % EX CREA","drug_information":{"unit":14.2,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"24385020501","type":"NDC"}],"standard_charges":[{"gross_charge":36.07,"discounted_cash":36.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ANTIFUNGAL (CLOTRIMAZOLE) 1 % EX CREA","drug_information":{"unit":28.4,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"68001047547","type":"NDC"}],"standard_charges":[{"gross_charge":29.16,"discounted_cash":29.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOTRIMAZOLE ANTI-FUNGAL 1 % EX CREA","drug_information":{"unit":45.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00536126526","type":"NDC"}],"standard_charges":[{"gross_charge":36.78,"discounted_cash":36.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BAZA ANTIFUNGAL 2 % EX CREA","drug_information":{"unit":142.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"11701004514","type":"NDC"}],"standard_charges":[{"gross_charge":99.03,"discounted_cash":99.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITRO-BID 2 % TD OINT","drug_information":{"unit":1.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00281032608","type":"NDC"}],"standard_charges":[{"gross_charge":31.02,"discounted_cash":31.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BACITRACIN 500 UNIT/GM EX OINT","drug_information":{"unit":28.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"45802006003","type":"NDC"}],"standard_charges":[{"gross_charge":32.85,"discounted_cash":32.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BACITRACIN 500 UNIT/GM EX OINT","drug_information":{"unit":28.4,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00713028031","type":"NDC"}],"standard_charges":[{"gross_charge":33.17,"discounted_cash":33.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BACITRACIN 500 UNIT/GM EX OINT","drug_information":{"unit":60.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00536125628","type":"NDC"}],"standard_charges":[{"gross_charge":34.51,"discounted_cash":34.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BACITRACIN ZINC 500 UNIT/GM EX OINT","drug_information":{"unit":28.4,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"51672207502","type":"NDC"}],"standard_charges":[{"gross_charge":33.74,"discounted_cash":33.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BACITRACIN-POLYMYXIN B 500-10000 UNIT/GM OP OINT","drug_information":{"unit":3.5,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"24208055555","type":"NDC"}],"standard_charges":[{"gross_charge":71.94,"discounted_cash":71.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROGLYCERIN 0.4 MG/SPRAY TL SOLN","drug_information":{"unit":24.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"45802021002","type":"NDC"}],"standard_charges":[{"gross_charge":2907.73,"discounted_cash":2907.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METRONIDAZOLE 0.75 % EX CREA","drug_information":{"unit":45.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00168032346","type":"NDC"}],"standard_charges":[{"gross_charge":449.46,"discounted_cash":449.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOBETASOL PROPIONATE 0.05 % EX CREA","drug_information":{"unit":15.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"51672125801","type":"NDC"}],"standard_charges":[{"gross_charge":93.65,"discounted_cash":93.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NYSTATIN 100000 UNIT/GM EX OINT","drug_information":{"unit":15.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"45802004835","type":"NDC"}],"standard_charges":[{"gross_charge":38.36,"discounted_cash":38.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.5 % EX CREA","drug_information":{"unit":15.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"16714098701","type":"NDC"}],"standard_charges":[{"gross_charge":51.61,"discounted_cash":51.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ESTRADIOL 0.01 % VA CREA","drug_information":{"unit":42.5,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"45802009735","type":"NDC"}],"standard_charges":[{"gross_charge":133.55,"discounted_cash":133.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NYSTATIN 100000 UNIT/GM EX POWD","drug_information":{"unit":60.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"69315030660","type":"NDC"}],"standard_charges":[{"gross_charge":468.49,"discounted_cash":468.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % EX CREA","drug_information":{"unit":30.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"67877025130","type":"NDC"}],"standard_charges":[{"gross_charge":63.01,"discounted_cash":63.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCORTISONE (PERIANAL) 2.5 % EX CREA","drug_information":{"unit":30.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"62559043130","type":"NDC"}],"standard_charges":[{"gross_charge":79.26,"discounted_cash":79.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METRONIDAZOLE 0.75 % EX GEL","drug_information":{"unit":45.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"51672411606","type":"NDC"}],"standard_charges":[{"gross_charge":139.29,"discounted_cash":139.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOCONAZOLE 2 % EX CREA","drug_information":{"unit":30.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"51672129802","type":"NDC"}],"standard_charges":[{"gross_charge":97.21,"discounted_cash":97.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PERMETHRIN 5 % EX CREA","drug_information":{"unit":60.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"45802026937","type":"NDC"}],"standard_charges":[{"gross_charge":164.02,"discounted_cash":164.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE 4 % EX CREA","drug_information":{"unit":5.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"39328002455","type":"NDC"}],"standard_charges":[{"gross_charge":34.37,"discounted_cash":34.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE 5 % EX OINT","drug_information":{"unit":35.44,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"16714087801","type":"NDC"}],"standard_charges":[{"gross_charge":162.73,"discounted_cash":162.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE 5 % EX OINT","drug_information":{"unit":30.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"51672302002","type":"NDC"}],"standard_charges":[{"gross_charge":243.07,"discounted_cash":243.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZINC OXIDE 20 % EX OINT","drug_information":{"unit":28.4,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"75834017001","type":"NDC"}],"standard_charges":[{"gross_charge":55.6,"discounted_cash":55.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOTRIMAZOLE 1 % EX CREA","drug_information":{"unit":15.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"51672127501","type":"NDC"}],"standard_charges":[{"gross_charge":43.2,"discounted_cash":43.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NYSTATIN 100000 UNIT/GM EX CREA","drug_information":{"unit":30.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"gross_charge":67.29,"discounted_cash":67.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SILVER SULFADIAZINE 1 % EX CREA","drug_information":{"unit":25.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"67877012425","type":"NDC"}],"standard_charges":[{"gross_charge":85.76,"discounted_cash":85.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SILVER SULFADIAZINE 1 % EX CREA","drug_information":{"unit":50.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"67877012450","type":"NDC"}],"standard_charges":[{"gross_charge":141.75,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NYSTATIN 100000 UNIT/GM EX POWD","drug_information":{"unit":15.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"68382037001","type":"NDC"}],"standard_charges":[{"gross_charge":70.85,"discounted_cash":70.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOBETASOL PROPIONATE 0.05 % EX CREA","drug_information":{"unit":15.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00168016315","type":"NDC"}],"standard_charges":[{"gross_charge":135.33,"discounted_cash":135.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NYSTATIN 100000 UNIT/GM EX CREA","drug_information":{"unit":30.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00713067831","type":"NDC"}],"standard_charges":[{"gross_charge":66.72,"discounted_cash":66.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % EX OINT","drug_information":{"unit":15.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"45802005535","type":"NDC"}],"standard_charges":[{"gross_charge":30.95,"discounted_cash":30.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ESTRADIOL 0.01 % VA CREA","drug_information":{"unit":42.5,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00093354143","type":"NDC"}],"standard_charges":[{"gross_charge":119.46,"discounted_cash":119.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NYSTATIN 100000 UNIT/GM EX POWD","drug_information":{"unit":15.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"75907006044","type":"NDC"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METRONIDAZOLE 0.75 % EX CREA","drug_information":{"unit":45.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"66993096045","type":"NDC"}],"standard_charges":[{"gross_charge":319.83,"discounted_cash":319.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NYSTATIN-TRIAMCINOLONE 100000-0.1 UNIT/GM-% EX OINT","drug_information":{"unit":15.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"45802024414","type":"NDC"}],"standard_charges":[{"gross_charge":42.63,"discounted_cash":42.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SILVER SULFADIAZINE 1 % EX CREA","drug_information":{"unit":20.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"67877012420","type":"NDC"}],"standard_charges":[{"gross_charge":88.66,"discounted_cash":88.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % EX CREA","drug_information":{"unit":15.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"16714049601","type":"NDC"}],"standard_charges":[{"gross_charge":63.72,"discounted_cash":63.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOCONAZOLE 2 % EX CREA","drug_information":{"unit":15.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00168009915","type":"NDC"}],"standard_charges":[{"gross_charge":61.59,"discounted_cash":61.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP","drug_information":{"unit":16.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"72888014135","type":"NDC"}],"standard_charges":[{"gross_charge":75.06,"discounted_cash":75.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUOCINONIDE 0.05 % EX CREA","drug_information":{"unit":15.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"51672138601","type":"NDC"}],"standard_charges":[{"gross_charge":84.53,"discounted_cash":84.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEBUSAL 3 % IN NEBU","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"50190014263","type":"NDC"}],"standard_charges":[{"gross_charge":47.41,"discounted_cash":47.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"XOLAIR 150 MG/ML SC SOSY","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2357","type":"HCPCS"},{"code":"50242021503","type":"NDC"}],"standard_charges":[{"gross_charge":23329.65,"discounted_cash":23329.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"XOLAIR 75 MG/0.5ML SC SOSY","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2357","type":"HCPCS"},{"code":"50242021401","type":"NDC"}],"standard_charges":[{"gross_charge":12629.99,"discounted_cash":12629.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOFLOXACIN IN D5W 500 MG/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"55150024447","type":"NDC"}],"standard_charges":[{"gross_charge":357.0,"discounted_cash":357.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE IN D5W 1-5 GM/100ML-% IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323010826","type":"NDC"}],"standard_charges":[{"gross_charge":357.0,"discounted_cash":357.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 MG/3ML IN SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"60687040583","type":"NDC"}],"standard_charges":[{"gross_charge":33.22,"discounted_cash":33.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALUM & MAG HYDROXIDE-SIMETH 1200-1200-120 MG/30ML PO SUSP","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"57237031631","type":"NDC"}],"standard_charges":[{"gross_charge":16.08,"discounted_cash":16.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN 500 MG/50 ML IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0136","type":"HCPCS"},{"code":"00264405080","type":"NDC"}],"standard_charges":[{"gross_charge":55.1,"discounted_cash":55.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE HCL (PF) 0.5 % IJ SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"55150017030","type":"NDC"}],"standard_charges":[{"gross_charge":357.39,"discounted_cash":357.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"63323028026","type":"NDC"}],"standard_charges":[{"gross_charge":336.81,"discounted_cash":336.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROPIVACAINE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"70069006425","type":"NDC"}],"standard_charges":[{"gross_charge":340.74,"discounted_cash":340.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE 50 % IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323006411","type":"NDC"}],"standard_charges":[{"gross_charge":335.25,"discounted_cash":335.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"36000028325","type":"NDC"}],"standard_charges":[{"gross_charge":335.33,"discounted_cash":335.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEGESTROL ACETATE 40 MG/ML PO SUSP UNIT DOSE","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"68094006362","type":"NDC"}],"standard_charges":[{"gross_charge":8.55,"discounted_cash":8.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"71288020303","type":"NDC"}],"standard_charges":[{"gross_charge":342.63,"discounted_cash":342.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZOLEDRONIC ACID 5 MG/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"72266015201","type":"NDC"}],"standard_charges":[{"gross_charge":134.15,"discounted_cash":134.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE VISCOUS HCL 2 % MT SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"60687087064","type":"NDC"}],"standard_charges":[{"gross_charge":54.46,"discounted_cash":54.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOCLOPRAMIDE HCL 10 MG/10ML PO SOLN UNIT DOSE","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00121157610","type":"NDC"}],"standard_charges":[{"gross_charge":37.64,"discounted_cash":37.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SENNA 8.8 MG/5ML PO SYRP UNIT DOSE","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"39328012050","type":"NDC"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRANEXAMIC ACID 1000 MG/10ML IV SOLN","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3290","type":"HCPCS"},{"code":"43066000810","type":"NDC"}],"standard_charges":[{"gross_charge":139.6,"discounted_cash":139.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FAMOTIDINE (PF) 20 MG/2ML IV SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1308","type":"HCPCS"},{"code":"00641602225","type":"NDC"}],"standard_charges":[{"gross_charge":345.91,"discounted_cash":345.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"72205010107","type":"NDC"}],"standard_charges":[{"gross_charge":379.58,"discounted_cash":379.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"25021031102","type":"NDC"}],"standard_charges":[{"gross_charge":354.6,"discounted_cash":354.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"68462046954","type":"NDC"}],"standard_charges":[{"gross_charge":376.12,"discounted_cash":376.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILTIAZEM HCL 25 MG/5ML IV SOLN","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1163","type":"HCPCS"},{"code":"25021031905","type":"NDC"}],"standard_charges":[{"gross_charge":326.85,"discounted_cash":326.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ESMOLOL HCL 100 MG/10ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1805","type":"HCPCS"},{"code":"67457018210","type":"NDC"}],"standard_charges":[{"gross_charge":384.22,"discounted_cash":384.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"72266011925","type":"NDC"}],"standard_charges":[{"gross_charge":331.74,"discounted_cash":331.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":850.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00990792209","type":"NDC"}],"standard_charges":[{"gross_charge":383.65,"discounted_cash":383.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 3 % IV SOLN","drug_information":{"unit":90.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7131","type":"HCPCS"},{"code":"00264780510","type":"NDC"}],"standard_charges":[{"gross_charge":350.74,"discounted_cash":350.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN (PORCINE) IN NACL 1000-0.9 UT/500ML-% IV SOLN","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00409762003","type":"NDC"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN 1000 MG/100 ML IV SOLN","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"36000030660","type":"NDC"}],"standard_charges":[{"gross_charge":426.33,"discounted_cash":426.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN 1000 MG/100 ML IV SOLN","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"00781315695","type":"NDC"}],"standard_charges":[{"gross_charge":428.35,"discounted_cash":428.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CIPROFLOXACIN IN D5W 200 MG/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0744","type":"HCPCS"},{"code":"25021011482","type":"NDC"}],"standard_charges":[{"gross_charge":360.2,"discounted_cash":360.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CIPROFLOXACIN IN D5W 400 MG/200ML IV SOLN","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0744","type":"HCPCS"},{"code":"25021019287","type":"NDC"}],"standard_charges":[{"gross_charge":379.4,"discounted_cash":379.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOFLOXACIN IN D5W 750 MG/150ML IV SOLN","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"44567043724","type":"NDC"}],"standard_charges":[{"gross_charge":380.2,"discounted_cash":380.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE IN D5W 1-5 GM/100ML-% IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323010801","type":"NDC"}],"standard_charges":[{"gross_charge":357.0,"discounted_cash":357.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00990792337","type":"NDC"}],"standard_charges":[{"gross_charge":356.35,"discounted_cash":356.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KCL-LACTATED RINGERS-D5W 20 MEQ/L IV SOLN","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00990711109","type":"NDC"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":88.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRANEXAMIC ACID-NACL 1000-0.7 MG/100ML-% IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3290","type":"HCPCS"},{"code":"80830232902","type":"NDC"}],"standard_charges":[{"gross_charge":62.8,"discounted_cash":62.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00990707526","type":"NDC"}],"standard_charges":[{"gross_charge":62.8,"discounted_cash":62.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRANEXAMIC ACID-NACL 1000-0.7 MG/100ML-% IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3290","type":"HCPCS"},{"code":"51754010803","type":"NDC"}],"standard_charges":[{"gross_charge":60.6,"discounted_cash":60.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE 4 GM/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"47335099202","type":"NDC"}],"standard_charges":[{"gross_charge":60.6,"discounted_cash":60.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM IN NACL 500 MG/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"36000035240","type":"NDC"}],"standard_charges":[{"gross_charge":59.5,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"55150016330","type":"NDC"}],"standard_charges":[{"gross_charge":341.81,"discounted_cash":341.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE IN D5W 1-5 GM/100ML-% IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"00264440054","type":"NDC"}],"standard_charges":[{"gross_charge":368.2,"discounted_cash":368.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN HCL 1250 MG/250ML IV SOLN","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3375","type":"HCPCS"},{"code":"70594005702","type":"NDC"}],"standard_charges":[{"gross_charge":112.38,"discounted_cash":112.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN HCL 750 MG/150ML IV SOLN","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3375","type":"HCPCS"},{"code":"70594005603","type":"NDC"}],"standard_charges":[{"gross_charge":112.3,"discounted_cash":112.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LINEZOLID 600 MG/300ML IV SOLN","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"57664068357","type":"NDC"}],"standard_charges":[{"gross_charge":128.95,"discounted_cash":128.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILTIAZEM HCL-DEXTROSE 125-5 MG/125ML-% IV SOLN","drug_information":{"unit":125.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1163","type":"HCPCS"},{"code":"70092157536","type":"NDC"}],"standard_charges":[{"gross_charge":92.5,"discounted_cash":92.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MANNITOL 25 % IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2151","type":"HCPCS"},{"code":"00409403101","type":"NDC"}],"standard_charges":[{"gross_charge":396.5,"discounted_cash":396.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOPAMINE-DEXTROSE 1.6-5 MG/ML-% IV SOLN","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"00338100702","type":"NDC"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":88.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W 900 MG/50ML IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0737","type":"HCPCS"},{"code":"00338411424","type":"NDC"}],"standard_charges":[{"gross_charge":65.55,"discounted_cash":65.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROPIVACAINE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"43066002310","type":"NDC"}],"standard_charges":[{"gross_charge":341.56,"discounted_cash":341.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCOPYRROLATE 0.4 MG/2ML IJ SOLN","drug_information":{"unit":0.001,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"00517460225","type":"NDC"}],"standard_charges":[{"gross_charge":325.02,"discounted_cash":325.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROPIVACAINE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":24.6,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"55150019720","type":"NDC"}],"standard_charges":[{"gross_charge":410.71,"discounted_cash":410.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/15ML (10%) PO SOLN UNIT DOSE","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"60687088416","type":"NDC"}],"standard_charges":[{"gross_charge":49.88,"discounted_cash":49.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"67457026510","type":"NDC"}],"standard_charges":[{"gross_charge":92.55,"discounted_cash":92.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROPIVACAINE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"70069006225","type":"NDC"}],"standard_charges":[{"gross_charge":364.33,"discounted_cash":364.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 2 % IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00143959425","type":"NDC"}],"standard_charges":[{"gross_charge":339.02,"discounted_cash":339.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200000 IJ SOLN","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"00409318301","type":"NDC"}],"standard_charges":[{"gross_charge":334.78,"discounted_cash":334.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"73293000102","type":"NDC"}],"standard_charges":[{"gross_charge":356.78,"discounted_cash":356.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM HCL (PF) 5 MG/5ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"00409230505","type":"NDC"}],"standard_charges":[{"gross_charge":328.18,"discounted_cash":328.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE 20 GM/500ML IV SOLN","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"00409205020","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"00990792203","type":"NDC"}],"standard_charges":[{"gross_charge":394.0,"discounted_cash":394.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE IN LACTATED RINGERS 5 % IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7121","type":"HCPCS"},{"code":"00990792903","type":"NDC"}],"standard_charges":[{"gross_charge":340.6,"discounted_cash":340.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"00338001738","type":"NDC"}],"standard_charges":[{"gross_charge":325.52,"discounted_cash":325.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN SOD (PORCINE) IN D5W 100 UNIT/ML IV SOLN","drug_information":{"unit":8.133,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00264958720","type":"NDC"}],"standard_charges":[{"gross_charge":342.24,"discounted_cash":342.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN 1000 MG/100 ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"24201010024","type":"NDC"}],"standard_charges":[{"gross_charge":68.3,"discounted_cash":68.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOFLOXACIN IN D5W 500 MG/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"25021013282","type":"NDC"}],"standard_charges":[{"gross_charge":66.1,"discounted_cash":66.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 400 MCG/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"C9399","type":"HCPCS"},{"code":"00781349595","type":"NDC"}],"standard_charges":[{"gross_charge":95.8,"discounted_cash":95.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 MG/3ML IN SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00378967193","type":"NDC"}],"standard_charges":[{"gross_charge":39.93,"discounted_cash":39.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IPRATROPIUM BROMIDE 0.02 % IN SOLN","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00487980101","type":"NDC"}],"standard_charges":[{"gross_charge":32.79,"discounted_cash":32.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE-SODIUM CHLORIDE 5-0.45 % IV SOLN","drug_information":{"unit":990.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7121","type":"HCPCS"},{"code":"00264761200","type":"NDC"}],"standard_charges":[{"gross_charge":357.67,"discounted_cash":357.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACTATED RINGERS IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"00264775010","type":"NDC"}],"standard_charges":[{"gross_charge":328.9,"discounted_cash":328.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"00264751010","type":"NDC"}],"standard_charges":[{"gross_charge":331.5,"discounted_cash":331.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACTATED RINGERS IV SOLN","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"00264775020","type":"NDC"}],"standard_charges":[{"gross_charge":328.12,"discounted_cash":328.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 10 % IV SOLN","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00264752010","type":"NDC"}],"standard_charges":[{"gross_charge":349.75,"discounted_cash":349.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 10 % IV SOLN","drug_information":{"unit":750.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"00990793002","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"00264151032","type":"NDC"}],"standard_charges":[{"gross_charge":336.7,"discounted_cash":336.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE IN D5W 4-5 MG/ML-% IV SOLN","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2002","type":"HCPCS"},{"code":"00264959410","type":"NDC"}],"standard_charges":[{"gross_charge":376.75,"discounted_cash":376.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN 1000 MG/100 ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"00781927495","type":"NDC"}],"standard_charges":[{"gross_charge":387.4,"discounted_cash":387.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOFLOXACIN IN D5W 500 MG/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"44567043624","type":"NDC"}],"standard_charges":[{"gross_charge":369.8,"discounted_cash":369.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE 4 GM/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"00338171540","type":"NDC"}],"standard_charges":[{"gross_charge":361.8,"discounted_cash":361.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACOSAMIDE 200 MG/20ML IV SOLN","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"C9254","type":"HCPCS"},{"code":"25021079120","type":"NDC"}],"standard_charges":[{"gross_charge":341.28,"discounted_cash":341.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXALIPLATIN 50 MG/10ML IV SOLN","drug_information":{"unit":4.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"71288017111","type":"NDC"}],"standard_charges":[{"gross_charge":58.16,"discounted_cash":58.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM BICARBONATE 4.2 % IV SOLN","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"63323008305","type":"NDC"}],"standard_charges":[{"gross_charge":370.61,"discounted_cash":370.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORAZEPAM 2 MG/ML IJ SOLN","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"65219036802","type":"NDC"}],"standard_charges":[{"gross_charge":341.39,"discounted_cash":341.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN","drug_information":{"unit":0.04,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"C9399","type":"HCPCS"},{"code":"42023014625","type":"NDC"}],"standard_charges":[{"gross_charge":327.54,"discounted_cash":327.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXALIPLATIN 50 MG/10ML IV SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"67457046910","type":"NDC"}],"standard_charges":[{"gross_charge":63.84,"discounted_cash":63.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"71288041403","type":"NDC"}],"standard_charges":[{"gross_charge":390.81,"discounted_cash":390.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM HCL 2 MG/ML PO SYRP UNIT DOSE","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"68094076262","type":"NDC"}],"standard_charges":[{"gross_charge":23.59,"discounted_cash":23.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LABETALOL HCL 20 MG/4ML IV SOSY","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"69374094604","type":"NDC"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":166.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCIUM GLUCONATE-NACL 1-0.675 GM/50ML-% IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"80830236209","type":"NDC"}],"standard_charges":[{"gross_charge":102.4,"discounted_cash":102.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GUAIFENESIN-DM 100-10 MG/5ML PO SYRP UNIT DOSE","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00121127600","type":"NDC"}],"standard_charges":[{"gross_charge":14.72,"discounted_cash":14.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00409665305","type":"NDC"}],"standard_charges":[{"gross_charge":472.65,"discounted_cash":472.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM HCL (PF) 5 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"70069081710","type":"NDC"}],"standard_charges":[{"gross_charge":330.99,"discounted_cash":330.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15ML PO SOLN UNIT DOSE","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00121231650","type":"NDC"}],"standard_charges":[{"gross_charge":35.48,"discounted_cash":35.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE 2 GM/50ML IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"67457055300","type":"NDC"}],"standard_charges":[{"gross_charge":84.75,"discounted_cash":84.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 MG/3ML IN SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"76204060001","type":"NDC"}],"standard_charges":[{"gross_charge":30.64,"discounted_cash":30.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN 1000 MG/100 ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0137","type":"HCPCS"},{"code":"00143938610","type":"NDC"}],"standard_charges":[{"gross_charge":68.3,"discounted_cash":68.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN HCL IN NACL 2-0.9 GM/500ML-% IV SOLN","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"70004092844","type":"NDC"}],"standard_charges":[{"gross_charge":289.5,"discounted_cash":289.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"00264150990","type":"NDC"}],"standard_charges":[{"gross_charge":107.9,"discounted_cash":107.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN 1000 MG/100 ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0136","type":"HCPCS"},{"code":"00264410090","type":"NDC"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":378.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"00338001731","type":"NDC"}],"standard_charges":[{"gross_charge":363.78,"discounted_cash":363.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROGLYCERIN IN D5W 200-5 MCG/ML-% IV SOLN","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2305","type":"HCPCS"},{"code":"00338104902","type":"NDC"}],"standard_charges":[{"gross_charge":327.28,"discounted_cash":327.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE HCL (PF) 0.25 % IJ SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409115902","type":"NDC"}],"standard_charges":[{"gross_charge":333.49,"discounted_cash":333.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOBUTAMINE-DEXTROSE 2-5 MG/ML-% IV SOLN","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1250","type":"HCPCS"},{"code":"00409234732","type":"NDC"}],"standard_charges":[{"gross_charge":101.5,"discounted_cash":101.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE 2 GM/50ML IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"70121171909","type":"NDC"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":373.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRANEXAMIC ACID-NACL 1000-0.7 MG/100ML-% IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3290","type":"HCPCS"},{"code":"25021041882","type":"NDC"}],"standard_charges":[{"gross_charge":73.8,"discounted_cash":73.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"36000035640","type":"NDC"}],"standard_charges":[{"gross_charge":72.7,"discounted_cash":72.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL CITRATE (PF) 2500 MCG/50ML IJ SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"63323080650","type":"NDC"}],"standard_charges":[{"gross_charge":169.6,"discounted_cash":169.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 7 % IN NEBU","drug_information":{"unit":8.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00487900730","type":"NDC"}],"standard_charges":[{"gross_charge":27.27,"discounted_cash":27.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 400 MCG/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"C9399","type":"HCPCS"},{"code":"55150029710","type":"NDC"}],"standard_charges":[{"gross_charge":85.4,"discounted_cash":85.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"00143915610","type":"NDC"}],"standard_charges":[{"gross_charge":343.7,"discounted_cash":343.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IPRATROPIUM BROMIDE 0.02 % IN SOLN","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"60687039483","type":"NDC"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MILRINONE LACTATE IN DEXTROSE 20-5 MG/100ML-% IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"00409204510","type":"NDC"}],"standard_charges":[{"gross_charge":96.4,"discounted_cash":96.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRANEXAMIC ACID 1000 MG/10ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3290","type":"HCPCS"},{"code":"25021041510","type":"NDC"}],"standard_charges":[{"gross_charge":376.84,"discounted_cash":376.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRANEXAMIC ACID 1000 MG/10ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3290","type":"HCPCS"},{"code":"25021041566","type":"NDC"}],"standard_charges":[{"gross_charge":376.84,"discounted_cash":376.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"71288020305","type":"NDC"}],"standard_charges":[{"gross_charge":336.56,"discounted_cash":336.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 2 % IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"55150016505","type":"NDC"}],"standard_charges":[{"gross_charge":340.01,"discounted_cash":340.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCIUM GLUCONATE-NACL 2-0.675 GM/100ML-% IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"44567062124","type":"NDC"}],"standard_charges":[{"gross_charge":117.25,"discounted_cash":117.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W 600 MG/50ML IV SOLN","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"00781328909","type":"NDC"}],"standard_charges":[{"gross_charge":387.0,"discounted_cash":387.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"00409379625","type":"NDC"}],"standard_charges":[{"gross_charge":329.59,"discounted_cash":329.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NYSTATIN 100000 UNIT/ML MT SUSP BULK","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"60687080017","type":"NDC"}],"standard_charges":[{"gross_charge":15.02,"discounted_cash":15.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN HCL 1750 MG/350ML IV SOLN","drug_information":{"unit":350.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3375","type":"HCPCS"},{"code":"70594005802","type":"NDC"}],"standard_charges":[{"gross_charge":155.6,"discounted_cash":155.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN HCL 1500 MG/300ML IV SOLN","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3375","type":"HCPCS"},{"code":"70594004302","type":"NDC"}],"standard_charges":[{"gross_charge":130.9,"discounted_cash":130.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"25021079482","type":"NDC"}],"standard_charges":[{"gross_charge":77.1,"discounted_cash":77.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN 1000 MG/100 ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"67457094010","type":"NDC"}],"standard_charges":[{"gross_charge":77.1,"discounted_cash":77.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM IN NACL 500 MG/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"44567050110","type":"NDC"}],"standard_charges":[{"gross_charge":70.5,"discounted_cash":70.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN NA (PORK) LOCK FLSH PF 100 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"64253033335","type":"NDC"}],"standard_charges":[{"gross_charge":329.18,"discounted_cash":329.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/50ML IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00990707714","type":"NDC"}],"standard_charges":[{"gross_charge":62.8,"discounted_cash":62.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"63323096510","type":"NDC"}],"standard_charges":[{"gross_charge":371.64,"discounted_cash":371.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"XOLAIR 75 MG/0.5ML SC SOSY","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2357","type":"HCPCS"},{"code":"50242021403","type":"NDC"}],"standard_charges":[{"gross_charge":12915.75,"discounted_cash":12915.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE 4 GM/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323010601","type":"NDC"}],"standard_charges":[{"gross_charge":358.6,"discounted_cash":358.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KCL IN DEXTROSE-NACL 20-5-0.9 MEQ/L-%-% IV SOLN","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00990710709","type":"NDC"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":417.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN (PORCINE) IN NACL 25000-0.45 UT/250ML-% IV SOLN","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323051774","type":"NDC"}],"standard_charges":[{"gross_charge":70.5,"discounted_cash":70.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE 4 GM/50ML IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323010705","type":"NDC"}],"standard_charges":[{"gross_charge":370.6,"discounted_cash":370.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN (PORCINE) IN NACL 25000-0.45 UT/250ML-% IV SOLN","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00409765030","type":"NDC"}],"standard_charges":[{"gross_charge":96.13,"discounted_cash":96.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE 2 GM/50ML IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"83634050081","type":"NDC"}],"standard_charges":[{"gross_charge":367.4,"discounted_cash":367.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE 10 MEQ/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00990707426","type":"NDC"}],"standard_charges":[{"gross_charge":61.7,"discounted_cash":61.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACTULOSE 10 GM/15ML PO SOLN","drug_information":{"unit":7.6,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00121115400","type":"NDC"}],"standard_charges":[{"gross_charge":10.89,"discounted_cash":10.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE (PF) 0.9 % IJ SOLN","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"J7030","type":"HCPCS"},{"code":"63323018610","type":"NDC"}],"standard_charges":[{"gross_charge":336.64,"discounted_cash":336.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE 2 GM/50ML IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"00338170840","type":"NDC"}],"standard_charges":[{"gross_charge":378.6,"discounted_cash":378.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN HCL 2000 MG/400ML IV SOLN","drug_information":{"unit":400.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3375","type":"HCPCS"},{"code":"70594004402","type":"NDC"}],"standard_charges":[{"gross_charge":171.2,"discounted_cash":171.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"63323028010","type":"NDC"}],"standard_charges":[{"gross_charge":339.76,"discounted_cash":339.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPOFOL 1000 MG/100ML IV EMUL","drug_information":{"unit":1.04,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"00069024810","type":"NDC"}],"standard_charges":[{"gross_charge":327.35,"discounted_cash":327.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPOFOL 1000 MG/100ML IV EMUL","drug_information":{"unit":1.317,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"00409469924","type":"NDC"}],"standard_charges":[{"gross_charge":327.81,"discounted_cash":327.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPOFOL 500 MG/50ML IV EMUL","drug_information":{"unit":0.964,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"00409469933","type":"NDC"}],"standard_charges":[{"gross_charge":327.06,"discounted_cash":327.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPOFOL 1000 MG/100ML IV EMUL","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"23155034543","type":"NDC"}],"standard_charges":[{"gross_charge":413.55,"discounted_cash":413.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/15ML (10%) PO SOLN UNIT DOSE","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"60687088471","type":"NDC"}],"standard_charges":[{"gross_charge":25.04,"discounted_cash":25.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROPIVACAINE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"70069006325","type":"NDC"}],"standard_charges":[{"gross_charge":349.6,"discounted_cash":349.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 400 MCG/100ML IV SOLN","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"C9399","type":"HCPCS"},{"code":"43066056512","type":"NDC"}],"standard_charges":[{"gross_charge":343.92,"discounted_cash":343.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOPROLOL TARTRATE 5 MG/5ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0616","type":"HCPCS"},{"code":"00143966010","type":"NDC"}],"standard_charges":[{"gross_charge":347.55,"discounted_cash":347.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOPROLOL TARTRATE 5 MG/5ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0616","type":"HCPCS"},{"code":"25021030305","type":"NDC"}],"standard_charges":[{"gross_charge":347.35,"discounted_cash":347.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN PHOSPHATE IN NACL 900-0.9 MG/50ML-% IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0737","type":"HCPCS"},{"code":"00338955324","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOFLOXACIN IN D5W 750 MG/150ML IV SOLN","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"00409444424","type":"NDC"}],"standard_charges":[{"gross_charge":377.8,"discounted_cash":377.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 MG/3ML IN SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"J7620","type":"HCPCS"},{"code":"00487020160","type":"NDC"}],"standard_charges":[{"gross_charge":28.83,"discounted_cash":28.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409427902","type":"NDC"}],"standard_charges":[{"gross_charge":325.9,"discounted_cash":325.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE HCL (PF) 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409116202","type":"NDC"}],"standard_charges":[{"gross_charge":327.58,"discounted_cash":327.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 10 % IN NEBU","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00378699889","type":"NDC"}],"standard_charges":[{"gross_charge":21.87,"discounted_cash":21.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM IN NACL 500 MG/100ML IV SOLN","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"67457025510","type":"NDC"}],"standard_charges":[{"gross_charge":123.1,"discounted_cash":123.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W 600 MG/50ML IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0737","type":"HCPCS"},{"code":"00338361624","type":"NDC"}],"standard_charges":[{"gross_charge":54.55,"discounted_cash":54.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN PHOSPHATE IN NACL 600-0.9 MG/50ML-% IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0737","type":"HCPCS"},{"code":"00338954924","type":"NDC"}],"standard_charges":[{"gross_charge":54.55,"discounted_cash":54.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPOFOL 200 MG/20ML IV EMUL","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"83634060320","type":"NDC"}],"standard_charges":[{"gross_charge":329.11,"discounted_cash":329.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOFLOXACIN IN D5W 500 MG/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"00409333024","type":"NDC"}],"standard_charges":[{"gross_charge":363.4,"discounted_cash":363.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPOFOL 1000 MG/100ML IV EMUL","drug_information":{"unit":46.464,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"43598054910","type":"NDC"}],"standard_charges":[{"gross_charge":366.68,"discounted_cash":366.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN SOD (PORCINE) IN D5W 100 UNIT/ML IV SOLN","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323052374","type":"NDC"}],"standard_charges":[{"gross_charge":92.5,"discounted_cash":92.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GENTAMICIN IN SALINE 0.8-0.9 MG/ML-% IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"00338050348","type":"NDC"}],"standard_charges":[{"gross_charge":379.4,"discounted_cash":379.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIBTAYO 350 MG/7ML IV SOLN","drug_information":{"unit":7.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9119","type":"HCPCS"},{"code":"61755000801","type":"NDC"}],"standard_charges":[{"gross_charge":22672.95,"discounted_cash":22672.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TWINRIX 720-20 ELU-MCG/ML IM SUSY","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90636","type":"HCPCS"},{"code":"58160081552","type":"NDC"}],"standard_charges":[{"gross_charge":1996.89,"discounted_cash":1996.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROLIA 60 MG/ML SC SOSY","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0897","type":"HCPCS"},{"code":"55513071021","type":"NDC"}],"standard_charges":[{"gross_charge":34321.34,"discounted_cash":34321.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TECENTRIQ 840 MG/14ML IV SOLN","drug_information":{"unit":28.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9022","type":"HCPCS"},{"code":"50242091801","type":"NDC"}],"standard_charges":[{"gross_charge":33308.27,"discounted_cash":33308.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"L.E.T. 4-0.05-0.5 % EX GEL","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"70092161243","type":"NDC"}],"standard_charges":[{"gross_charge":230.65,"discounted_cash":230.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"63323080601","type":"NDC"}],"standard_charges":[{"gross_charge":341.56,"discounted_cash":341.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"00641624725","type":"NDC"}],"standard_charges":[{"gross_charge":337.08,"discounted_cash":337.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL CITRATE (PF) 50 MCG/ML IJ SOSY","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"63323080811","type":"NDC"}],"standard_charges":[{"gross_charge":343.27,"discounted_cash":343.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EVENITY 105 MG/1.17ML SC SOSY","drug_information":{"unit":2.34,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3111","type":"HCPCS"},{"code":"55513088002","type":"NDC"}],"standard_charges":[{"gross_charge":43619.92,"discounted_cash":43619.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EVENITY 105 MG/1.17ML SC SOSY","drug_information":{"unit":2.34,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3111","type":"HCPCS"},{"code":"55513099802","type":"NDC"}],"standard_charges":[{"gross_charge":49460.15,"discounted_cash":49460.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KENALOG-80 80 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"00003031505","type":"NDC"}],"standard_charges":[{"gross_charge":369.31,"discounted_cash":369.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NUCALA 100 MG/ML SC SOSY","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2182","type":"HCPCS"},{"code":"00173089242","type":"NDC"}],"standard_charges":[{"gross_charge":69397.05,"discounted_cash":69397.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NUCALA 100 MG/ML SC SOAJ","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2182","type":"HCPCS"},{"code":"00173089201","type":"NDC"}],"standard_charges":[{"gross_charge":67376.02,"discounted_cash":67376.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILAUDID 0.2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"76045012111","type":"NDC"}],"standard_charges":[{"gross_charge":360.01,"discounted_cash":360.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MVASI 100 MG/4ML IV SOLN","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5107","type":"HCPCS"},{"code":"55513020601","type":"NDC"}],"standard_charges":[{"gross_charge":1666.33,"discounted_cash":1666.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MVASI 400 MG/16ML IV SOLN","drug_information":{"unit":16.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5107","type":"HCPCS"},{"code":"55513020701","type":"NDC"}],"standard_charges":[{"gross_charge":5814.94,"discounted_cash":5814.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE IN LACTATED RINGERS 5 % IV SOLN","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7121","type":"HCPCS"},{"code":"00264775100","type":"NDC"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":358.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00264751000","type":"NDC"}],"standard_charges":[{"gross_charge":332.8,"discounted_cash":332.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE-SODIUM CHLORIDE 5-0.9 % IV SOLN","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"00264761000","type":"NDC"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":358.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KCL IN DEXTROSE-NACL 20-5-0.45 MEQ/L-%-% IV SOLN","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00264763500","type":"NDC"}],"standard_charges":[{"gross_charge":359.5,"discounted_cash":359.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KCL IN DEXTROSE-NACL 20-5-0.9 MEQ/L-%-% IV SOLN","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00264765200","type":"NDC"}],"standard_charges":[{"gross_charge":359.5,"discounted_cash":359.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 10 % IV SOLN","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00264752000","type":"NDC"}],"standard_charges":[{"gross_charge":359.5,"discounted_cash":359.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"00338001748","type":"NDC"}],"standard_charges":[{"gross_charge":336.05,"discounted_cash":336.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOFLOXACIN IN D5W 750 MG/150ML IV SOLN","drug_information":{"unit":150.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"00143972024","type":"NDC"}],"standard_charges":[{"gross_charge":513.18,"discounted_cash":513.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN (PORCINE) IN NACL 1000-0.9 UT/500ML-% IV SOLN","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323051977","type":"NDC"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":373.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACTATED RINGERS IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"00990795309","type":"NDC"}],"standard_charges":[{"gross_charge":332.8,"discounted_cash":332.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACTATED RINGERS IV SOLN","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"65219047905","type":"NDC"}],"standard_charges":[{"gross_charge":359.5,"discounted_cash":359.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE 10 MEQ/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00338070948","type":"NDC"}],"standard_charges":[{"gross_charge":382.6,"discounted_cash":382.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE 4 GM/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"44567042124","type":"NDC"}],"standard_charges":[{"gross_charge":379.4,"discounted_cash":379.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN 1000 MG/100 ML IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"55150030724","type":"NDC"}],"standard_charges":[{"gross_charge":479.4,"discounted_cash":479.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE 4 GM/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"70121172009","type":"NDC"}],"standard_charges":[{"gross_charge":358.6,"discounted_cash":358.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROGLYCERIN IN D5W 100-5 MCG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2305","type":"HCPCS"},{"code":"00338104702","type":"NDC"}],"standard_charges":[{"gross_charge":332.95,"discounted_cash":332.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE HCL (PF) 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00143933010","type":"NDC"}],"standard_charges":[{"gross_charge":329.47,"discounted_cash":329.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE 2 GM/50ML IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"00264420452","type":"NDC"}],"standard_charges":[{"gross_charge":358.6,"discounted_cash":358.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN 1000 MG/100 ML IV SOLN","drug_information":{"unit":14.95,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0134","type":"HCPCS"},{"code":"63323043400","type":"NDC"}],"standard_charges":[{"gross_charge":386.8,"discounted_cash":386.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MINERAL OIL PO OIL","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"48433020230","type":"NDC"}],"standard_charges":[{"gross_charge":11.62,"discounted_cash":11.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"36000028425","type":"NDC"}],"standard_charges":[{"gross_charge":358.62,"discounted_cash":358.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 MG/3ML IN SOLN","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"259","type":"RC"},{"code":"J7620","type":"HCPCS"},{"code":"00487020103","type":"NDC"}],"standard_charges":[{"gross_charge":17.05,"discounted_cash":17.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPOFOL 200 MG/20ML IV EMUL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"00409601025","type":"NDC"}],"standard_charges":[{"gross_charge":327.13,"discounted_cash":327.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPOFOL 200 MG/20ML IV EMUL","drug_information":{"unit":1.645,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"23155034541","type":"NDC"}],"standard_charges":[{"gross_charge":328.42,"discounted_cash":328.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"44567050210","type":"NDC"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/50ML IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00338070341","type":"NDC"}],"standard_charges":[{"gross_charge":380.2,"discounted_cash":380.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN HCL 1000 MG/200ML IV SOLN","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3372","type":"HCPCS"},{"code":"70594004203","type":"NDC"}],"standard_charges":[{"gross_charge":90.6,"discounted_cash":90.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE 4 GM/50ML IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"44567042424","type":"NDC"}],"standard_charges":[{"gross_charge":374.6,"discounted_cash":374.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOPROLOL TARTRATE 5 MG/5ML IV SOLN","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0616","type":"HCPCS"},{"code":"36000003310","type":"NDC"}],"standard_charges":[{"gross_charge":338.74,"discounted_cash":338.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROPIVACAINE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"43066001910","type":"NDC"}],"standard_charges":[{"gross_charge":386.88,"discounted_cash":386.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 400 MCG/100ML IV SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"C9399","type":"HCPCS"},{"code":"00338955712","type":"NDC"}],"standard_charges":[{"gross_charge":350.23,"discounted_cash":350.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOPROLOL TARTRATE 5 MG/5ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0616","type":"HCPCS"},{"code":"00143987325","type":"NDC"}],"standard_charges":[{"gross_charge":345.3,"discounted_cash":345.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE 50 % IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323064220","type":"NDC"}],"standard_charges":[{"gross_charge":342.38,"discounted_cash":342.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ESMOLOL HCL 100 MG/10ML IV SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1805","type":"HCPCS"},{"code":"55150019410","type":"NDC"}],"standard_charges":[{"gross_charge":329.04,"discounted_cash":329.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W 900 MG/50ML IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"00781329009","type":"NDC"}],"standard_charges":[{"gross_charge":100.2,"discounted_cash":100.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CITRATE-CITRIC ACID 500-334 MG/5ML PO SOLN UNIT DOSE","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00121119000","type":"NDC"}],"standard_charges":[{"gross_charge":51.68,"discounted_cash":51.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM 500 MG/5ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"00409188602","type":"NDC"}],"standard_charges":[{"gross_charge":369.64,"discounted_cash":369.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE HCL (PF) 0.5 % IJ SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"55150016910","type":"NDC"}],"standard_charges":[{"gross_charge":387.4,"discounted_cash":387.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"00143915525","type":"NDC"}],"standard_charges":[{"gross_charge":344.52,"discounted_cash":344.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROPIVACAINE HCL 10 MG/ML IJ SOLN","drug_information":{"unit":40.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"43066002710","type":"NDC"}],"standard_charges":[{"gross_charge":235.6,"discounted_cash":235.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROPIVACAINE HCL 10 MG/ML IJ SOLN","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"70069006710","type":"NDC"}],"standard_charges":[{"gross_charge":118.96,"discounted_cash":118.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACTATED RINGERS IV SOLN","drug_information":{"unit":18.67,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"00264775000","type":"NDC"}],"standard_charges":[{"gross_charge":326.46,"discounted_cash":326.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"00264751020","type":"NDC"}],"standard_charges":[{"gross_charge":327.08,"discounted_cash":327.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN (PORCINE) IN NACL 2000-0.9 UNIT/L-% IV SOLN","drug_information":{"unit":2000.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00264987200","type":"NDC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00990792255","type":"NDC"}],"standard_charges":[{"gross_charge":388.25,"discounted_cash":388.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KCL IN DEXTROSE-NACL 20-5-0.45 MEQ/L-%-% IV SOLN","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00990790209","type":"NDC"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":417.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE (PF) 0.9 % IJ SOLN","drug_information":{"unit":9.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"J7030","type":"HCPCS"},{"code":"00409488810","type":"NDC"}],"standard_charges":[{"gross_charge":341.24,"discounted_cash":341.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 4 MEQ/ML IV SOLN","drug_information":{"unit":38.46,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7131","type":"HCPCS"},{"code":"63323009330","type":"NDC"}],"standard_charges":[{"gross_charge":373.21,"discounted_cash":373.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRANEXAMIC ACID-NACL 1000-0.7 MG/100ML-% IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3290","type":"HCPCS"},{"code":"65219053410","type":"NDC"}],"standard_charges":[{"gross_charge":67.2,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE HCL (PF) 0.25 % IJ SOLN","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"55150016830","type":"NDC"}],"standard_charges":[{"gross_charge":389.8,"discounted_cash":389.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"00409610210","type":"NDC"}],"standard_charges":[{"gross_charge":341.89,"discounted_cash":341.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN HCL IN NACL 1.5-0.9 GM/250ML-% IV SOLN","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"70092905605","type":"NDC"}],"standard_charges":[{"gross_charge":170.88,"discounted_cash":170.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","drug_information":{"unit":1.1,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"J7613","type":"HCPCS"},{"code":"00487950101","type":"NDC"}],"standard_charges":[{"gross_charge":18.42,"discounted_cash":18.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE IN LACTATED RINGERS 5 % IV SOLN","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7121","type":"HCPCS"},{"code":"00264775110","type":"NDC"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":351.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACTATED RINGERS IV SOLN","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"00338011704","type":"NDC"}],"standard_charges":[{"gross_charge":382.5,"discounted_cash":382.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00990792202","type":"NDC"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":338.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOFLOXACIN IN D5W 500 MG/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"00143972124","type":"NDC"}],"standard_charges":[{"gross_charge":498.7,"discounted_cash":498.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE 2 GM/50ML IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"00409672924","type":"NDC"}],"standard_charges":[{"gross_charge":513.18,"discounted_cash":513.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00264151031","type":"NDC"}],"standard_charges":[{"gross_charge":347.75,"discounted_cash":347.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CIPROFLOXACIN IN D5W 400 MG/200ML IV SOLN","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0744","type":"HCPCS"},{"code":"25021011487","type":"NDC"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":76.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOFLOXACIN IN D5W 250 MG/50ML IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"00143972224","type":"NDC"}],"standard_charges":[{"gross_charge":460.1,"discounted_cash":460.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE 2 GM/50ML IV SOLN","drug_information":{"unit":45.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323010605","type":"NDC"}],"standard_charges":[{"gross_charge":370.36,"discounted_cash":370.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"63323096520","type":"NDC"}],"standard_charges":[{"gross_charge":390.72,"discounted_cash":390.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"25021018482","type":"NDC"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":361.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN SOD (PORCINE) IN D5W 100 UNIT/ML IV SOLN","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00409452030","type":"NDC"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IPRATROPIUM BROMIDE 0.02 % IN SOLN","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"J7644","type":"HCPCS"},{"code":"00487980125","type":"NDC"}],"standard_charges":[{"gross_charge":18.6,"discounted_cash":18.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPOFOL 200 MG/20ML IV EMUL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"23155034544","type":"NDC"}],"standard_charges":[{"gross_charge":327.08,"discounted_cash":327.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN HCL IN NACL 1.75-0.9 GM/500ML-% IV SOLN","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"70004092644","type":"NDC"}],"standard_charges":[{"gross_charge":247.25,"discounted_cash":247.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"J7620","type":"HCPCS"},{"code":"00487950125","type":"NDC"}],"standard_charges":[{"gross_charge":28.58,"discounted_cash":28.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"J7613","type":"HCPCS"},{"code":"00487950103","type":"NDC"}],"standard_charges":[{"gross_charge":28.58,"discounted_cash":28.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE 4 GM/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"00409672923","type":"NDC"}],"standard_charges":[{"gross_charge":83.7,"discounted_cash":83.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE 2 GM/50ML IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323010626","type":"NDC"}],"standard_charges":[{"gross_charge":375.4,"discounted_cash":375.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN HCL IN NACL 1.25-0.9 GM/250ML-% IV SOLN","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"70092905405","type":"NDC"}],"standard_charges":[{"gross_charge":157.88,"discounted_cash":157.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"63323028036","type":"NDC"}],"standard_charges":[{"gross_charge":332.38,"discounted_cash":332.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 MG/3ML IN SOLN","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00487020101","type":"NDC"}],"standard_charges":[{"gross_charge":29.14,"discounted_cash":29.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPOFOL 200 MG/20ML IV EMUL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"00069020910","type":"NDC"}],"standard_charges":[{"gross_charge":327.26,"discounted_cash":327.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"44567050310","type":"NDC"}],"standard_charges":[{"gross_charge":102.4,"discounted_cash":102.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 400 MCG/100ML IV SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"C9399","type":"HCPCS"},{"code":"43598097558","type":"NDC"}],"standard_charges":[{"gross_charge":350.86,"discounted_cash":350.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GUAIFENESIN 100 MG/5ML PO LIQUID UNIT DOSE","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00121148800","type":"NDC"}],"standard_charges":[{"gross_charge":13.04,"discounted_cash":13.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MILRINONE LACTATE IN DEXTROSE 20-5 MG/100ML-% IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"00143971910","type":"NDC"}],"standard_charges":[{"gross_charge":384.8,"discounted_cash":384.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MYLICON INFANTS GAS RELIEF 20 MG/0.3ML PO SUSP","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"62372063015","type":"NDC"}],"standard_charges":[{"gross_charge":49.7,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SIMETHICONE DROPS INFANTS 20 MG/0.3ML PO SUSP","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00536130375","type":"NDC"}],"standard_charges":[{"gross_charge":3.77,"discounted_cash":3.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GNP INFANT GAS RELIEF 20 MG/0.3ML PO SUSP","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"46122054703","type":"NDC"}],"standard_charges":[{"gross_charge":4.32,"discounted_cash":4.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM HCL 50 MG/10ML IJ SOLN","drug_information":{"unit":40.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"00641606010","type":"NDC"}],"standard_charges":[{"gross_charge":158.8,"discounted_cash":158.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"70069080610","type":"NDC"}],"standard_charges":[{"gross_charge":364.48,"discounted_cash":364.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KENALOG-40 40 MG/ML IJ SUSP","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"00003029328","type":"NDC"}],"standard_charges":[{"gross_charge":383.37,"discounted_cash":383.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TUBERSOL 5 UNIT/0.1ML ID SOLN","drug_information":{"unit":5.0,"type":"UN"},"code_information":[{"code":"250","type":"RC"},{"code":"86580","type":"HCPCS"},{"code":"49281075222","type":"NDC"}],"standard_charges":[{"gross_charge":7829.45,"discounted_cash":7829.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"APLISOL 5 UNIT/0.1ML ID SOLN","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"86580","type":"HCPCS"},{"code":"42023010405","type":"NDC"}],"standard_charges":[{"gross_charge":207.54,"discounted_cash":207.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"APLISOL 5 UNIT/0.1ML ID SOLN","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"86580","type":"HCPCS"},{"code":"42023010401","type":"NDC"}],"standard_charges":[{"gross_charge":230.71,"discounted_cash":230.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TUBERSOL 5 UNIT/0.1ML ID SOLN","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"86580","type":"HCPCS"},{"code":"49281075221","type":"NDC"}],"standard_charges":[{"gross_charge":232.29,"discounted_cash":232.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUMINEX 25 % IV SOLN","drug_information":{"unit":40.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9046","type":"HCPCS"},{"code":"64208251203","type":"NDC"}],"standard_charges":[{"gross_charge":170.56,"discounted_cash":170.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CELESTONE SOLUSPAN 6 (3-3) MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0702","type":"HCPCS"},{"code":"78206011801","type":"NDC"}],"standard_charges":[{"gross_charge":201.28,"discounted_cash":201.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUELICIN 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"00409662902","type":"NDC"}],"standard_charges":[{"gross_charge":346.44,"discounted_cash":346.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ANECTINE 20 MG/ML IJ SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"00781341195","type":"NDC"}],"standard_charges":[{"gross_charge":374.36,"discounted_cash":374.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THIAMINE HCL 200 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"43598005025","type":"NDC"}],"standard_charges":[{"gross_charge":371.73,"discounted_cash":371.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THIAMINE HCL 200 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"72485050725","type":"NDC"}],"standard_charges":[{"gross_charge":383.92,"discounted_cash":383.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPINEPHRINE 30 MG/30ML IJ SOLN","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0165","type":"HCPCS"},{"code":"00517303001","type":"NDC"}],"standard_charges":[{"gross_charge":358.49,"discounted_cash":358.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPINEPHRINE 30 MG/30ML IJ SOLN","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0173","type":"HCPCS"},{"code":"76329906000","type":"NDC"}],"standard_charges":[{"gross_charge":380.05,"discounted_cash":380.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBURX 5 % IV SOLN","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"44206031025","type":"NDC"}],"standard_charges":[{"gross_charge":209.5,"discounted_cash":209.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBURX 5 % IV SOLN","drug_information":{"unit":350.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"44206031050","type":"NDC"}],"standard_charges":[{"gross_charge":287.2,"discounted_cash":287.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TROPICAMIDE-CYCLOPENTOLATE-PE 1-1-2.5 % OP SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"71266821105","type":"NDC"}],"standard_charges":[{"gross_charge":453.77,"discounted_cash":453.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1071","type":"HCPCS"},{"code":"69097080232","type":"NDC"}],"standard_charges":[{"gross_charge":260.11,"discounted_cash":260.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"69918090112","type":"NDC"}],"standard_charges":[{"gross_charge":1034.8,"discounted_cash":1034.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN","drug_information":{"unit":5.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"69918090110","type":"NDC"}],"standard_charges":[{"gross_charge":1390.76,"discounted_cash":1390.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"50227103005","type":"NDC"}],"standard_charges":[{"gross_charge":838.32,"discounted_cash":838.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUPHENAZINE DECANOATE 25 MG/ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2680","type":"HCPCS"},{"code":"63323027205","type":"NDC"}],"standard_charges":[{"gross_charge":307.4,"discounted_cash":307.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIMENHYDRINATE 50 MG/ML IJ SOLN","drug_information":{"unit":0.12,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1240","type":"HCPCS"},{"code":"63323036601","type":"NDC"}],"standard_charges":[{"gross_charge":347.56,"discounted_cash":347.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"63323004444","type":"NDC"}],"standard_charges":[{"gross_charge":361.33,"discounted_cash":361.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"63323004401","type":"NDC"}],"standard_charges":[{"gross_charge":361.33,"discounted_cash":361.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GENTAMICIN SULFATE 40 MG/ML IJ SOLN","drug_information":{"unit":8.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"55150040325","type":"NDC"}],"standard_charges":[{"gross_charge":220.82,"discounted_cash":220.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORAZEPAM 2 MG/ML IJ SOLN","drug_information":{"unit":0.13,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"00641620725","type":"NDC"}],"standard_charges":[{"gross_charge":330.68,"discounted_cash":330.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":0.005,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"42023021410","type":"NDC"}],"standard_charges":[{"gross_charge":325.21,"discounted_cash":325.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"68462047054","type":"NDC"}],"standard_charges":[{"gross_charge":335.5,"discounted_cash":335.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":3.6,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"72603017925","type":"NDC"}],"standard_charges":[{"gross_charge":121.46,"discounted_cash":121.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288040211","type":"NDC"}],"standard_charges":[{"gross_charge":328.51,"discounted_cash":328.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W 900 MG/50ML IV SOLN","drug_information":{"unit":33.333,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0737","type":"HCPCS"},{"code":"00338381424","type":"NDC"}],"standard_charges":[{"gross_charge":54.37,"discounted_cash":54.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THIAMINE HCL 100 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"25021050002","type":"NDC"}],"standard_charges":[{"gross_charge":390.02,"discounted_cash":390.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THIAMINE HCL 100 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"63323001302","type":"NDC"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":384.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN","drug_information":{"unit":8.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"65219057210","type":"NDC"}],"standard_charges":[{"gross_charge":372.81,"discounted_cash":372.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUOROURACIL 5 GM/100ML IV SOLN","drug_information":{"unit":7.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"71288015476","type":"NDC"}],"standard_charges":[{"gross_charge":36.22,"discounted_cash":36.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 120 MG/30ML IJ SOLN","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"67457042130","type":"NDC"}],"standard_charges":[{"gross_charge":355.34,"discounted_cash":355.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"72266010201","type":"NDC"}],"standard_charges":[{"gross_charge":337.01,"discounted_cash":337.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"63323041510","type":"NDC"}],"standard_charges":[{"gross_charge":333.41,"discounted_cash":333.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 120 MG/30ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323016530","type":"NDC"}],"standard_charges":[{"gross_charge":334.18,"discounted_cash":334.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"00641627710","type":"NDC"}],"standard_charges":[{"gross_charge":347.51,"discounted_cash":347.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00781354525","type":"NDC"}],"standard_charges":[{"gross_charge":347.47,"discounted_cash":347.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCOD POLST-CPM POLST ER 10-8 MG/5ML PO SUER UNIT DOSE","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"27808008601","type":"NDC"}],"standard_charges":[{"gross_charge":28.94,"discounted_cash":28.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"67457047322","type":"NDC"}],"standard_charges":[{"gross_charge":360.26,"discounted_cash":360.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MESNA 100 MG/ML IV SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9209","type":"HCPCS"},{"code":"10019095301","type":"NDC"}],"standard_charges":[{"gross_charge":44.67,"discounted_cash":44.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"70121165501","type":"NDC"}],"standard_charges":[{"gross_charge":365.18,"discounted_cash":365.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ETOPOSIDE 100 MG/5ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"63323010406","type":"NDC"}],"standard_charges":[{"gross_charge":95.2,"discounted_cash":95.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 10000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"25021040304","type":"NDC"}],"standard_charges":[{"gross_charge":365.43,"discounted_cash":365.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"00641614910","type":"NDC"}],"standard_charges":[{"gross_charge":332.5,"discounted_cash":332.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ONDANSETRON HCL 40 MG/20ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"23155054931","type":"NDC"}],"standard_charges":[{"gross_charge":339.27,"discounted_cash":339.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUOXETINE HCL 20 MG/5ML PO SOLN UNIT DOSE","drug_information":{"unit":7.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00832603212","type":"NDC"}],"standard_charges":[{"gross_charge":24.09,"discounted_cash":24.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323054015","type":"NDC"}],"standard_charges":[{"gross_charge":376.84,"discounted_cash":376.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISPLATIN 100 MG/100ML IV SOLN","drug_information":{"unit":43.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"63323010365","type":"NDC"}],"standard_charges":[{"gross_charge":233.86,"discounted_cash":233.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOBRAMYCIN SULFATE 1.2 GM/30ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"67457042830","type":"NDC"}],"standard_charges":[{"gross_charge":352.55,"discounted_cash":352.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"71288080876","type":"NDC"}],"standard_charges":[{"gross_charge":381.55,"discounted_cash":381.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOPLATIN 600 MG/60ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"55150038601","type":"NDC"}],"standard_charges":[{"gross_charge":88.64,"discounted_cash":88.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN UNIT DOSE","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7510","type":"HCPCS"},{"code":"00121075908","type":"NDC"}],"standard_charges":[{"gross_charge":32.24,"discounted_cash":32.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"00409318203","type":"NDC"}],"standard_charges":[{"gross_charge":333.36,"discounted_cash":333.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHADONE HCL 10 MG/ML PO CONC UNIT DOSE","drug_information":{"unit":0.9,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00054039168","type":"NDC"}],"standard_charges":[{"gross_charge":6.08,"discounted_cash":6.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"00409317803","type":"NDC"}],"standard_charges":[{"gross_charge":330.04,"discounted_cash":330.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"72266010301","type":"NDC"}],"standard_charges":[{"gross_charge":347.63,"discounted_cash":347.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W 600 MG/50ML IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0737","type":"HCPCS"},{"code":"00338361224","type":"NDC"}],"standard_charges":[{"gross_charge":63.9,"discounted_cash":63.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"72266020410","type":"NDC"}],"standard_charges":[{"gross_charge":391.1,"discounted_cash":391.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GENTAMICIN SULFATE 40 MG/ML IJ SOLN","drug_information":{"unit":5.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"63323001095","type":"NDC"}],"standard_charges":[{"gross_charge":160.48,"discounted_cash":160.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THIAMINE HCL 100 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"65145012925","type":"NDC"}],"standard_charges":[{"gross_charge":389.12,"discounted_cash":389.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN SODIUM 300 MG/3ML IJ SOLN","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00548560800","type":"NDC"}],"standard_charges":[{"gross_charge":401.05,"discounted_cash":401.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PYRIDOXINE HCL 100 MG/ML IJ SOLN","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3415","type":"HCPCS"},{"code":"63323018001","type":"NDC"}],"standard_charges":[{"gross_charge":356.8,"discounted_cash":356.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BETAMETHASONE SOD PHOS & ACET 6 (3-3) MG/ML IJ SUSP","drug_information":{"unit":0.167,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0702","type":"HCPCS"},{"code":"00517072001","type":"NDC"}],"standard_charges":[{"gross_charge":365.77,"discounted_cash":365.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2598","type":"HCPCS"},{"code":"55150037025","type":"NDC"}],"standard_charges":[{"gross_charge":140.59,"discounted_cash":140.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN","drug_information":{"unit":6.8,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"39822625001","type":"NDC"}],"standard_charges":[{"gross_charge":1942.66,"discounted_cash":1942.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN","drug_information":{"unit":0.7,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"70069030125","type":"NDC"}],"standard_charges":[{"gross_charge":336.88,"discounted_cash":336.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":0.01,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"70121157807","type":"NDC"}],"standard_charges":[{"gross_charge":325.21,"discounted_cash":325.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUOROURACIL 5 GM/100ML IV SOLN","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"70700018922","type":"NDC"}],"standard_charges":[{"gross_charge":155.72,"discounted_cash":155.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM HCL 2 MG/2ML IJ SOLN","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"63323041112","type":"NDC"}],"standard_charges":[{"gross_charge":331.09,"discounted_cash":331.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM HCL 5 MG/ML IJ SOLN","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"00641606125","type":"NDC"}],"standard_charges":[{"gross_charge":329.43,"discounted_cash":329.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HALOPERIDOL LACTATE 5 MG/ML IJ SOLN","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1630","type":"HCPCS"},{"code":"63323047401","type":"NDC"}],"standard_charges":[{"gross_charge":327.96,"discounted_cash":327.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"25021040266","type":"NDC"}],"standard_charges":[{"gross_charge":350.91,"discounted_cash":350.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","drug_information":{"unit":0.34,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"25021040201","type":"NDC"}],"standard_charges":[{"gross_charge":333.81,"discounted_cash":333.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXORUBICIN HCL 2 MG/ML IV SOLN","drug_information":{"unit":7.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9000","type":"HCPCS"},{"code":"45963073360","type":"NDC"}],"standard_charges":[{"gross_charge":88.1,"discounted_cash":88.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"70069030110","type":"NDC"}],"standard_charges":[{"gross_charge":343.37,"discounted_cash":343.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GENTAMICIN SULFATE 40 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"63323001094","type":"NDC"}],"standard_charges":[{"gross_charge":346.73,"discounted_cash":346.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"36000024425","type":"NDC"}],"standard_charges":[{"gross_charge":362.58,"discounted_cash":362.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"67457012410","type":"NDC"}],"standard_charges":[{"gross_charge":335.5,"discounted_cash":335.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":0.005,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"72485050510","type":"NDC"}],"standard_charges":[{"gross_charge":325.2,"discounted_cash":325.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ETOPOSIDE 1 GM/50ML IV SOLN","drug_information":{"unit":8.3,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"00143951201","type":"NDC"}],"standard_charges":[{"gross_charge":121.82,"discounted_cash":121.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BRIMONIDINE TARTRATE 0.2 % OP SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"24208041105","type":"NDC"}],"standard_charges":[{"gross_charge":42.59,"discounted_cash":42.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"83634077802","type":"NDC"}],"standard_charges":[{"gross_charge":363.7,"discounted_cash":363.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"70512084025","type":"NDC"}],"standard_charges":[{"gross_charge":363.7,"discounted_cash":363.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"71288030302","type":"NDC"}],"standard_charges":[{"gross_charge":369.35,"discounted_cash":369.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":7.93,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"00641618910","type":"NDC"}],"standard_charges":[{"gross_charge":234.58,"discounted_cash":234.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GENTAMICIN SULFATE 40 MG/ML IJ SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"63323001020","type":"NDC"}],"standard_charges":[{"gross_charge":413.92,"discounted_cash":413.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ETOPOSIDE 100 MG/5ML IV SOLN","drug_information":{"unit":4.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"16729011431","type":"NDC"}],"standard_charges":[{"gross_charge":97.59,"discounted_cash":97.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"00713035125","type":"NDC"}],"standard_charges":[{"gross_charge":385.84,"discounted_cash":385.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"00517003125","type":"NDC"}],"standard_charges":[{"gross_charge":378.69,"discounted_cash":378.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUPHENAZINE DECANOATE 25 MG/ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2680","type":"HCPCS"},{"code":"00143952901","type":"NDC"}],"standard_charges":[{"gross_charge":403.26,"discounted_cash":403.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"83634045110","type":"NDC"}],"standard_charges":[{"gross_charge":1007.92,"discounted_cash":1007.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VINBLASTINE SULFATE 1 MG/ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9360","type":"HCPCS"},{"code":"63323027810","type":"NDC"}],"standard_charges":[{"gross_charge":303.14,"discounted_cash":303.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"70121116801","type":"NDC"}],"standard_charges":[{"gross_charge":177.9,"discounted_cash":177.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"69680011225","type":"NDC"}],"standard_charges":[{"gross_charge":386.2,"discounted_cash":386.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NALOXONE HCL 0.4 MG/ML IJ SOLN","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"00641613225","type":"NDC"}],"standard_charges":[{"gross_charge":355.2,"discounted_cash":355.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"43066009025","type":"NDC"}],"standard_charges":[{"gross_charge":368.06,"discounted_cash":368.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"70069037125","type":"NDC"}],"standard_charges":[{"gross_charge":346.83,"discounted_cash":346.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 10000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"25021040301","type":"NDC"}],"standard_charges":[{"gross_charge":363.09,"discounted_cash":363.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"70069000510","type":"NDC"}],"standard_charges":[{"gross_charge":377.56,"discounted_cash":377.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THIAMINE HCL 100 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"00641622825","type":"NDC"}],"standard_charges":[{"gross_charge":372.38,"discounted_cash":372.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THIAMINE HCL 100 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"63323001326","type":"NDC"}],"standard_charges":[{"gross_charge":381.09,"discounted_cash":381.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GEMCITABINE HCL 200 MG/2ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9196","type":"HCPCS"},{"code":"16729039130","type":"NDC"}],"standard_charges":[{"gross_charge":369.45,"discounted_cash":369.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCETAXEL 160 MG/8ML IV CONC","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"67457078108","type":"NDC"}],"standard_charges":[{"gross_charge":118.53,"discounted_cash":118.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLITAXEL 300 MG/50ML IV CONC","drug_information":{"unit":12.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"63323076350","type":"NDC"}],"standard_charges":[{"gross_charge":190.42,"discounted_cash":190.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN LISPRO 100 UNIT/ML IJ SOLN","drug_information":{"unit":0.03,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"00002773701","type":"NDC"}],"standard_charges":[{"gross_charge":327.81,"discounted_cash":327.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ETOPOSIDE 500 MG/25ML IV SOLN","drug_information":{"unit":4.3,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"16729011408","type":"NDC"}],"standard_charges":[{"gross_charge":137.53,"discounted_cash":137.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"69680011210","type":"NDC"}],"standard_charges":[{"gross_charge":410.54,"discounted_cash":410.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCETAXEL 160 MG/8ML IV CONC","drug_information":{"unit":6.8,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"16729026765","type":"NDC"}],"standard_charges":[{"gross_charge":632.02,"discounted_cash":632.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCETAXEL 80 MG/4ML IV CONC","drug_information":{"unit":2.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"00409036701","type":"NDC"}],"standard_charges":[{"gross_charge":241.37,"discounted_cash":241.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"00548960200","type":"NDC"}],"standard_charges":[{"gross_charge":393.12,"discounted_cash":393.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"63323030602","type":"NDC"}],"standard_charges":[{"gross_charge":405.7,"discounted_cash":405.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THIAMINE HCL 100 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"67457019602","type":"NDC"}],"standard_charges":[{"gross_charge":377.85,"discounted_cash":377.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"81952011106","type":"NDC"}],"standard_charges":[{"gross_charge":369.21,"discounted_cash":369.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLITAXEL 300 MG/50ML IV CONC","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"62332062250","type":"NDC"}],"standard_charges":[{"gross_charge":239.72,"discounted_cash":239.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FOLIC ACID 5 MG/ML IJ SOLN","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1808","type":"HCPCS"},{"code":"39822110001","type":"NDC"}],"standard_charges":[{"gross_charge":339.35,"discounted_cash":339.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ETOPOSIDE 500 MG/25ML IV SOLN","drug_information":{"unit":4.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"63323010425","type":"NDC"}],"standard_charges":[{"gross_charge":109.4,"discounted_cash":109.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"00641613525","type":"NDC"}],"standard_charges":[{"gross_charge":381.86,"discounted_cash":381.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FOLIC ACID 5 MG/ML IJ SOLN","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1808","type":"HCPCS"},{"code":"63323018410","type":"NDC"}],"standard_charges":[{"gross_charge":342.27,"discounted_cash":342.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"67457064002","type":"NDC"}],"standard_charges":[{"gross_charge":426.14,"discounted_cash":426.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"70121116901","type":"NDC"}],"standard_charges":[{"gross_charge":401.39,"discounted_cash":401.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM HCL 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"63323041202","type":"NDC"}],"standard_charges":[{"gross_charge":401.39,"discounted_cash":401.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUPHENAZINE DECANOATE 25 MG/ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2680","type":"HCPCS"},{"code":"42023012901","type":"NDC"}],"standard_charges":[{"gross_charge":392.21,"discounted_cash":392.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"16714015001","type":"NDC"}],"standard_charges":[{"gross_charge":347.63,"discounted_cash":347.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 10000 UNIT/ML IJ SOLN","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323054214","type":"NDC"}],"standard_charges":[{"gross_charge":333.09,"discounted_cash":333.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLITAXEL 300 MG/50ML IV CONC","drug_information":{"unit":16.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"61703034250","type":"NDC"}],"standard_charges":[{"gross_charge":289.12,"discounted_cash":289.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUOROURACIL 2.5 GM/50ML IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"70700018822","type":"NDC"}],"standard_charges":[{"gross_charge":182.6,"discounted_cash":182.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GABAPENTIN 250 MG/5ML PO SOLN","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"72888010425","type":"NDC"}],"standard_charges":[{"gross_charge":9.38,"discounted_cash":9.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"00409000710","type":"NDC"}],"standard_charges":[{"gross_charge":332.87,"discounted_cash":332.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"72205026507","type":"NDC"}],"standard_charges":[{"gross_charge":379.9,"discounted_cash":379.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISPLATIN 100 MG/100ML IV SOLN","drug_information":{"unit":34.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"16729028838","type":"NDC"}],"standard_charges":[{"gross_charge":161.49,"discounted_cash":161.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 100 MG/10ML IJ SOLN","drug_information":{"unit":1.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"67457042010","type":"NDC"}],"standard_charges":[{"gross_charge":342.96,"discounted_cash":342.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00781354325","type":"NDC"}],"standard_charges":[{"gross_charge":369.82,"discounted_cash":369.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL 1 % IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"55150025110","type":"NDC"}],"standard_charges":[{"gross_charge":326.56,"discounted_cash":326.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323016526","type":"NDC"}],"standard_charges":[{"gross_charge":327.77,"discounted_cash":327.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM HCL 2 MG/2ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"00641620925","type":"NDC"}],"standard_charges":[{"gross_charge":327.77,"discounted_cash":327.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISPLATIN 100 MG/100ML IV SOLN","drug_information":{"unit":13.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"25021025351","type":"NDC"}],"standard_charges":[{"gross_charge":50.37,"discounted_cash":50.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUOROURACIL 2.5 GM/50ML IV SOLN","drug_information":{"unit":8.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"25021021598","type":"NDC"}],"standard_charges":[{"gross_charge":38.69,"discounted_cash":38.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"00641614610","type":"NDC"}],"standard_charges":[{"gross_charge":347.26,"discounted_cash":347.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"71288071911","type":"NDC"}],"standard_charges":[{"gross_charge":341.4,"discounted_cash":341.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"69918070025","type":"NDC"}],"standard_charges":[{"gross_charge":344.56,"discounted_cash":344.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"25021061110","type":"NDC"}],"standard_charges":[{"gross_charge":334.72,"discounted_cash":334.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUOROURACIL 5 GM/100ML IV SOLN","drug_information":{"unit":9.8,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"25021021599","type":"NDC"}],"standard_charges":[{"gross_charge":40.85,"discounted_cash":40.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"00409317802","type":"NDC"}],"standard_charges":[{"gross_charge":334.35,"discounted_cash":334.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 70 % IV SOLN","drug_information":{"unit":178.571,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00264738750","type":"NDC"}],"standard_charges":[{"gross_charge":362.14,"discounted_cash":362.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE HCL 0.5 % IJ SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"71288072652","type":"NDC"}],"standard_charges":[{"gross_charge":352.68,"discounted_cash":352.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL 1 % IJ SOLN","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409427602","type":"NDC"}],"standard_charges":[{"gross_charge":325.98,"discounted_cash":325.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM CITRATE 1.745 GM/30ML PO SOLN BULK","drug_information":{"unit":148.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"69452038998","type":"NDC"}],"standard_charges":[{"gross_charge":63.57,"discounted_cash":63.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISPLATIN 100 MG/100ML IV SOLN","drug_information":{"unit":43.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"00143950501","type":"NDC"}],"standard_charges":[{"gross_charge":97.31,"discounted_cash":97.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROMETHAZINE HCL 6.25 MG/5ML PO SYRP UNIT DOSE","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"27808005102","type":"NDC"}],"standard_charges":[{"gross_charge":7.04,"discounted_cash":7.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE HCL 0.5 % IJ SOLN","drug_information":{"unit":0.28,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409116301","type":"NDC"}],"standard_charges":[{"gross_charge":325.44,"discounted_cash":325.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE HCL 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"55150024950","type":"NDC"}],"standard_charges":[{"gross_charge":326.35,"discounted_cash":326.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00264194420","type":"NDC"}],"standard_charges":[{"gross_charge":407.68,"discounted_cash":407.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5ML PO SUSP UNIT DOSE","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"65862049647","type":"NDC"}],"standard_charges":[{"gross_charge":15.28,"discounted_cash":15.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN","drug_information":{"unit":8.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"00409014710","type":"NDC"}],"standard_charges":[{"gross_charge":351.9,"discounted_cash":351.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM HCL 5 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"00641605910","type":"NDC"}],"standard_charges":[{"gross_charge":328.9,"discounted_cash":328.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GABAPENTIN 250 MG/5ML PO SOLN","drug_information":{"unit":6.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"42192060816","type":"NDC"}],"standard_charges":[{"gross_charge":13.39,"discounted_cash":13.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM HCL 5 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"00641621010","type":"NDC"}],"standard_charges":[{"gross_charge":328.9,"discounted_cash":328.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL 2 % IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"55150025410","type":"NDC"}],"standard_charges":[{"gross_charge":326.52,"discounted_cash":326.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1921","type":"HCPCS"},{"code":"00143962201","type":"NDC"}],"standard_charges":[{"gross_charge":328.16,"discounted_cash":328.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ADMELOG 100 UNIT/ML IJ SOLN","drug_information":{"unit":0.01,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"00024592605","type":"NDC"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":327.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ADMELOG 100 UNIT/ML IJ SOLN","drug_information":{"unit":0.01,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"00024592410","type":"NDC"}],"standard_charges":[{"gross_charge":328.13,"discounted_cash":328.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROCRIT 20000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"59676032004","type":"NDC"}],"standard_charges":[{"gross_charge":5291.11,"discounted_cash":5291.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPOGEN 20000 UNIT/ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"55513047810","type":"NDC"}],"standard_charges":[{"gross_charge":12144.58,"discounted_cash":12144.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL 1 % IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"31722011633","type":"NDC"}],"standard_charges":[{"gross_charge":332.22,"discounted_cash":332.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETIC ACID 3 % SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"51552005106","type":"NDC"}],"standard_charges":[{"gross_charge":13.18,"discounted_cash":13.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE HCL 0.5 % IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"55150025050","type":"NDC"}],"standard_charges":[{"gross_charge":327.71,"discounted_cash":327.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL 1 % IJ SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00143957710","type":"NDC"}],"standard_charges":[{"gross_charge":405.6,"discounted_cash":405.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACTULOSE 10 GM/15ML PO SOLN","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00121087332","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":20.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"00641234141","type":"NDC"}],"standard_charges":[{"gross_charge":416.14,"discounted_cash":416.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCOPYRROLATE 1 MG/5ML IJ SOLN","drug_information":{"unit":0.002,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1598","type":"HCPCS"},{"code":"63323057805","type":"NDC"}],"standard_charges":[{"gross_charge":325.12,"discounted_cash":325.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NAROPIN 2 MG/ML IJ SOLN","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028563","type":"NDC"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":226.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NAROPIN 2 MG/ML IJ SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028561","type":"NDC"}],"standard_charges":[{"gross_charge":116.8,"discounted_cash":116.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHADOSE 10 MG/ML PO CONC","drug_information":{"unit":0.9,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00406052710","type":"NDC"}],"standard_charges":[{"gross_charge":5.56,"discounted_cash":5.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE HCL 0.5 % IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00143932910","type":"NDC"}],"standard_charges":[{"gross_charge":327.21,"discounted_cash":327.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM 100 MG/ML PO SOLN UNIT DOSE","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00121079916","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":4.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL 1 % IJ SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00143917210","type":"NDC"}],"standard_charges":[{"gross_charge":332.79,"discounted_cash":332.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL 2 % IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409427701","type":"NDC"}],"standard_charges":[{"gross_charge":326.03,"discounted_cash":326.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE 0.5 %-1:200000 IJ SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"00409317701","type":"NDC"}],"standard_charges":[{"gross_charge":334.02,"discounted_cash":334.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL 1 % IJ SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"55150025220","type":"NDC"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":333.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCOPYRROLATE 1 MG/5ML IJ SOLN","drug_information":{"unit":0.002,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"70860078105","type":"NDC"}],"standard_charges":[{"gross_charge":325.04,"discounted_cash":325.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCOPYRROLATE 1 MG/5ML IJ SOLN","drug_information":{"unit":0.004,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"66794020442","type":"NDC"}],"standard_charges":[{"gross_charge":325.1,"discounted_cash":325.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCOPYRROLATE 1 MG/5ML IJ SOLN","drug_information":{"unit":0.001,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"00143968025","type":"NDC"}],"standard_charges":[{"gross_charge":325.01,"discounted_cash":325.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCOPYRROLATE 1 MG/5ML IJ SOLN","drug_information":{"unit":0.001,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"70069061925","type":"NDC"}],"standard_charges":[{"gross_charge":325.01,"discounted_cash":325.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCOPYRROLATE 1 MG/5ML IJ SOLN","drug_information":{"unit":0.001,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"70700016725","type":"NDC"}],"standard_charges":[{"gross_charge":325.08,"discounted_cash":325.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM 100 MG/ML PO SOLN UNIT DOSE","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"31722057447","type":"NDC"}],"standard_charges":[{"gross_charge":4.7,"discounted_cash":4.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL 1 % IJ SOLN","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409427601","type":"NDC"}],"standard_charges":[{"gross_charge":325.8,"discounted_cash":325.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"00338604648","type":"NDC"}],"standard_charges":[{"gross_charge":56.2,"discounted_cash":56.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409427702","type":"NDC"}],"standard_charges":[{"gross_charge":326.72,"discounted_cash":326.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1921","type":"HCPCS"},{"code":"00143932001","type":"NDC"}],"standard_charges":[{"gross_charge":328.16,"discounted_cash":328.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML IJ SOLN","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"00641036725","type":"NDC"}],"standard_charges":[{"gross_charge":329.82,"discounted_cash":329.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL 1 % IJ SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"70756064525","type":"NDC"}],"standard_charges":[{"gross_charge":335.82,"discounted_cash":335.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"25021005205","type":"NDC"}],"standard_charges":[{"gross_charge":338.53,"discounted_cash":338.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACOSAMIDE 10 MG/ML PO SOLN UNIT DOSE","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"31722062726","type":"NDC"}],"standard_charges":[{"gross_charge":32.42,"discounted_cash":32.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOBRAMYCIN SULFATE 1.2 GM/30ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"63323030630","type":"NDC"}],"standard_charges":[{"gross_charge":361.74,"discounted_cash":361.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORAZEPAM 2 MG/ML PO CONC UNIT DOSE","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00121077001","type":"NDC"}],"standard_charges":[{"gross_charge":9.16,"discounted_cash":9.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISPLATIN 100 MG/100ML IV SOLN","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"72266025301","type":"NDC"}],"standard_charges":[{"gross_charge":125.85,"discounted_cash":125.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IPRATROPIUM BROMIDE 0.06 % NA SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00054004641","type":"NDC"}],"standard_charges":[{"gross_charge":92.08,"discounted_cash":92.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLITAXEL 300 MG/50ML IV CONC","drug_information":{"unit":12.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"16714013701","type":"NDC"}],"standard_charges":[{"gross_charge":117.27,"discounted_cash":117.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXORUBICIN HCL 2 MG/ML IV SOLN","drug_information":{"unit":5.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9000","type":"HCPCS"},{"code":"00069154220","type":"NDC"}],"standard_charges":[{"gross_charge":66.55,"discounted_cash":66.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM HCL 5 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"63323041125","type":"NDC"}],"standard_charges":[{"gross_charge":346.2,"discounted_cash":346.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOPLATIN 600 MG/60ML IV SOLN","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"61703033956","type":"NDC"}],"standard_charges":[{"gross_charge":65.5,"discounted_cash":65.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"23155052341","type":"NDC"}],"standard_charges":[{"gross_charge":348.84,"discounted_cash":348.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"23155029441","type":"NDC"}],"standard_charges":[{"gross_charge":347.16,"discounted_cash":347.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHOTREXATE SODIUM 50 MG/2ML IJ SOLN","drug_information":{"unit":0.48,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9260","type":"HCPCS"},{"code":"61703035038","type":"NDC"}],"standard_charges":[{"gross_charge":34.22,"discounted_cash":34.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THIAMINE HCL 100 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"72603013925","type":"NDC"}],"standard_charges":[{"gross_charge":384.18,"discounted_cash":384.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 100 MG/10ML IJ SOLN","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323051610","type":"NDC"}],"standard_charges":[{"gross_charge":328.39,"discounted_cash":328.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLITAXEL 300 MG/50ML IV CONC","drug_information":{"unit":13.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"25021025550","type":"NDC"}],"standard_charges":[{"gross_charge":149.12,"discounted_cash":149.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"70756063525","type":"NDC"}],"standard_charges":[{"gross_charge":363.95,"discounted_cash":363.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"00641618810","type":"NDC"}],"standard_charges":[{"gross_charge":108.88,"discounted_cash":108.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUOROURACIL 5 GM/100ML IV SOLN","drug_information":{"unit":11.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"62332077931","type":"NDC"}],"standard_charges":[{"gross_charge":201.76,"discounted_cash":201.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 10000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"25021040366","type":"NDC"}],"standard_charges":[{"gross_charge":363.16,"discounted_cash":363.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"23155029442","type":"NDC"}],"standard_charges":[{"gross_charge":362.4,"discounted_cash":362.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"25021050201","type":"NDC"}],"standard_charges":[{"gross_charge":361.5,"discounted_cash":361.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00409272002","type":"NDC"}],"standard_charges":[{"gross_charge":330.84,"discounted_cash":330.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"43598066625","type":"NDC"}],"standard_charges":[{"gross_charge":332.48,"discounted_cash":332.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISPLATIN 50 MG/50ML IV SOLN","drug_information":{"unit":58.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"16729028811","type":"NDC"}],"standard_charges":[{"gross_charge":300.05,"discounted_cash":300.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"70069078325","type":"NDC"}],"standard_charges":[{"gross_charge":377.56,"discounted_cash":377.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOPLATIN 450 MG/45ML IV SOLN","drug_information":{"unit":45.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"00703424801","type":"NDC"}],"standard_charges":[{"gross_charge":271.87,"discounted_cash":271.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOPLATIN 600 MG/60ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"00703423901","type":"NDC"}],"standard_charges":[{"gross_charge":50.72,"discounted_cash":50.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"67457038599","type":"NDC"}],"standard_charges":[{"gross_charge":365.93,"discounted_cash":365.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GENTAMICIN SULFATE 40 MG/ML IJ SOLN","drug_information":{"unit":0.025,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"gross_charge":325.54,"discounted_cash":325.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN","drug_information":{"unit":40.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"00641600710","type":"NDC"}],"standard_charges":[{"gross_charge":259.48,"discounted_cash":259.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SALINE BACTERIOSTATIC 0.9 % IJ SOLN","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"J7030","type":"HCPCS"},{"code":"63323092410","type":"NDC"}],"standard_charges":[{"gross_charge":338.94,"discounted_cash":338.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"67457042254","type":"NDC"}],"standard_charges":[{"gross_charge":335.95,"discounted_cash":335.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323020110","type":"NDC"}],"standard_charges":[{"gross_charge":334.96,"discounted_cash":334.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"25021040010","type":"NDC"}],"standard_charges":[{"gross_charge":331.54,"discounted_cash":331.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM HCL 2 MG/2ML IJ SOLN","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"00641605725","type":"NDC"}],"standard_charges":[{"gross_charge":326.38,"discounted_cash":326.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM CITRATE 1.745 GM/30ML PO SOLN BULK","drug_information":{"unit":296.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"69452039098","type":"NDC"}],"standard_charges":[{"gross_charge":125.14,"discounted_cash":125.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.9,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00781354025","type":"NDC"}],"standard_charges":[{"gross_charge":335.36,"discounted_cash":335.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUOROURACIL 5 GM/100ML IV SOLN","drug_information":{"unit":9.6,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"63323011761","type":"NDC"}],"standard_charges":[{"gross_charge":44.58,"discounted_cash":44.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.8,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"25021040067","type":"NDC"}],"standard_charges":[{"gross_charge":335.7,"discounted_cash":335.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288042096","type":"NDC"}],"standard_charges":[{"gross_charge":326.48,"discounted_cash":326.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE HCL 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409116001","type":"NDC"}],"standard_charges":[{"gross_charge":326.97,"discounted_cash":326.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL 2 % IJ SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"55150025520","type":"NDC"}],"standard_charges":[{"gross_charge":334.35,"discounted_cash":334.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":11.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"25021040030","type":"NDC"}],"standard_charges":[{"gross_charge":363.79,"discounted_cash":363.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACOSAMIDE 10 MG/ML PO SOLN UNIT DOSE","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"72603030501","type":"NDC"}],"standard_charges":[{"gross_charge":12.16,"discounted_cash":12.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323016505","type":"NDC"}],"standard_charges":[{"gross_charge":330.54,"discounted_cash":330.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VUEWAY 0.5 MMOL/ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"A9573","type":"HCPCS"},{"code":"00270701546","type":"NDC"}],"standard_charges":[{"gross_charge":59.31,"discounted_cash":59.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEPO-MEDROL 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"00009028002","type":"NDC"}],"standard_charges":[{"gross_charge":115.41,"discounted_cash":115.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"XYLOCAINE 0.5 % IJ SOLN","drug_information":{"unit":6.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323048457","type":"NDC"}],"standard_charges":[{"gross_charge":337.05,"discounted_cash":337.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"XYLOCAINE 1 % IJ SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323048526","type":"NDC"}],"standard_charges":[{"gross_charge":334.84,"discounted_cash":334.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"XYLOCAINE 1 % IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323048557","type":"NDC"}],"standard_charges":[{"gross_charge":333.53,"discounted_cash":333.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"XYLOCAINE 1 % IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323048527","type":"NDC"}],"standard_charges":[{"gross_charge":328.44,"discounted_cash":328.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"XYLOCAINE 2 % IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323048657","type":"NDC"}],"standard_charges":[{"gross_charge":335.66,"discounted_cash":335.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"XYLOCAINE 2 % IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323048617","type":"NDC"}],"standard_charges":[{"gross_charge":350.75,"discounted_cash":350.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"XYLOCAINE 2 % IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323048627","type":"NDC"}],"standard_charges":[{"gross_charge":339.35,"discounted_cash":339.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SENSORCAINE 0.25 % IJ SOLN","drug_information":{"unit":8.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046557","type":"NDC"}],"standard_charges":[{"gross_charge":385.77,"discounted_cash":385.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SENSORCAINE 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046757","type":"NDC"}],"standard_charges":[{"gross_charge":334.64,"discounted_cash":334.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NESACAINE 2 % IJ SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2401","type":"HCPCS"},{"code":"63323047637","type":"NDC"}],"standard_charges":[{"gross_charge":392.08,"discounted_cash":392.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"00641614525","type":"NDC"}],"standard_charges":[{"gross_charge":339.49,"discounted_cash":339.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLITAXEL 300 MG/50ML IV CONC","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"00703321801","type":"NDC"}],"standard_charges":[{"gross_charge":113.53,"discounted_cash":113.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORAZEPAM 2 MG/ML IJ SOLN","drug_information":{"unit":0.13,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"76329826101","type":"NDC"}],"standard_charges":[{"gross_charge":329.6,"discounted_cash":329.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMIODARONE HCL 450 MG/9ML IV SOLN","drug_information":{"unit":9.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"67457015309","type":"NDC"}],"standard_charges":[{"gross_charge":176.32,"discounted_cash":176.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXORUBICIN HCL 2 MG/ML IV SOLN","drug_information":{"unit":8.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9000","type":"HCPCS"},{"code":"25021020751","type":"NDC"}],"standard_charges":[{"gross_charge":54.27,"discounted_cash":54.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CITALOPRAM HYDROBROMIDE 10 MG/5ML PO SOLN","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00054006258","type":"NDC"}],"standard_charges":[{"gross_charge":10.12,"discounted_cash":10.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ETOPOSIDE 1 GM/50ML IV SOLN","drug_information":{"unit":4.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"16729011411","type":"NDC"}],"standard_charges":[{"gross_charge":134.43,"discounted_cash":134.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOPLATIN 600 MG/60ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"16729029512","type":"NDC"}],"standard_charges":[{"gross_charge":70.88,"discounted_cash":70.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIQUID C 500 MG/5ML PO LIQD","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"69618001854","type":"NDC"}],"standard_charges":[{"gross_charge":6.05,"discounted_cash":6.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRUEPLUS GLUCOSE 15 GM/32ML PO GEL","drug_information":{"unit":32.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"56151162501","type":"NDC"}],"standard_charges":[{"gross_charge":20.05,"discounted_cash":20.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARTIFICIAL TEARS 0.2-0.2-1 % OP SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"57896018105","type":"NDC"}],"standard_charges":[{"gross_charge":33.46,"discounted_cash":33.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GAVILYTE-C 240 G PO SOLR","drug_information":{"unit":4000.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"43386006019","type":"NDC"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":130.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GEBAUERS PAIN EASE EX AERO","drug_information":{"unit":116.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00386000803","type":"NDC"}],"standard_charges":[{"gross_charge":252.56,"discounted_cash":252.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRESIBA FLEXTOUCH 200 UNIT/ML SC SOPN","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"00169255013","type":"NDC"}],"standard_charges":[{"gross_charge":128.38,"discounted_cash":128.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GNP MAGNESIUM CITRATE 1.745 GM/30ML PO SOLN","drug_information":{"unit":296.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"46122074038","type":"NDC"}],"standard_charges":[{"gross_charge":127.5,"discounted_cash":127.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLEET OIL RE ENEM","drug_information":{"unit":133.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00132030140","type":"NDC"}],"standard_charges":[{"gross_charge":39.39,"discounted_cash":39.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VISINE 0.025-0.3 % OP SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"12547049378","type":"NDC"}],"standard_charges":[{"gross_charge":59.45,"discounted_cash":59.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GNP NASAL SPRAY 0.05 % NA SOLN","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"46122016510","type":"NDC"}],"standard_charges":[{"gross_charge":26.32,"discounted_cash":26.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NASAL DECONGESTANT SPRAY 0.05 % NA SOLN","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00904742730","type":"NDC"}],"standard_charges":[{"gross_charge":41.62,"discounted_cash":41.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NASAL DECONGESTANT SPRAY 0.05 % NA SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00904743535","type":"NDC"}],"standard_charges":[{"gross_charge":35.76,"discounted_cash":35.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FT NASAL SPRAY 0.05 % NA SOLN","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"70677103701","type":"NDC"}],"standard_charges":[{"gross_charge":39.07,"discounted_cash":39.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"12 HOUR DECONGESTANT 0.05 % NA SOLN","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"69618005051","type":"NDC"}],"standard_charges":[{"gross_charge":42.64,"discounted_cash":42.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VICKS SINEX 12 HOUR DECONGEST 0.05 % NA SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"37000080301","type":"NDC"}],"standard_charges":[{"gross_charge":47.62,"discounted_cash":47.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GNP NO DRIP NASAL SPRAY 0.05 % NA SOLN","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"24385035210","type":"NDC"}],"standard_charges":[{"gross_charge":42.13,"discounted_cash":42.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEO-SYNEPHRINE COLD/ALLRG MILD 0.25 % NA SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00225080047","type":"NDC"}],"standard_charges":[{"gross_charge":40.21,"discounted_cash":40.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEO-SYNEPHRINE COLD/ALLRGY REG 0.5 % NA SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00225080547","type":"NDC"}],"standard_charges":[{"gross_charge":40.5,"discounted_cash":40.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEO-SYNEPHRINE COLD/ALLRGY EXT 1 % NA SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00225081047","type":"NDC"}],"standard_charges":[{"gross_charge":43.77,"discounted_cash":43.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PURE & GENTLE ENEMA RE ENEM","drug_information":{"unit":133.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"53329001411","type":"NDC"}],"standard_charges":[{"gross_charge":23.57,"discounted_cash":23.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYOSYNE 0.125 MG/ML PO SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"54838050615","type":"NDC"}],"standard_charges":[{"gross_charge":32.89,"discounted_cash":32.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FT MAGNESIUM CITRATE 1.745 GM/30ML PO SOLN","drug_information":{"unit":296.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"70677111101","type":"NDC"}],"standard_charges":[{"gross_charge":23.31,"discounted_cash":23.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GNP MAGNESIUM CITRATE 1.745 GM/30ML PO SOLN","drug_information":{"unit":296.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"46122074138","type":"NDC"}],"standard_charges":[{"gross_charge":125.14,"discounted_cash":125.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ONELAX MAGNESIUM CITRATE 1.745 GM/30ML PO SOLN","drug_information":{"unit":75.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"71399788901","type":"NDC"}],"standard_charges":[{"gross_charge":11.6,"discounted_cash":11.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ONELAX MAGNESIUM CITRATE 1.745 GM/30ML PO SOLN","drug_information":{"unit":296.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"71399005101","type":"NDC"}],"standard_charges":[{"gross_charge":33.97,"discounted_cash":33.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FT EARWAX REMOVAL 6.5 % OT SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"70677115401","type":"NDC"}],"standard_charges":[{"gross_charge":29.52,"discounted_cash":29.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GNP EARWAX REMOVAL DROPS 6.5 % OT SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"46122055705","type":"NDC"}],"standard_charges":[{"gross_charge":25.05,"discounted_cash":25.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVALBUTEROL HCL 1.25 MG/3ML IN NEBU","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"J7620","type":"HCPCS"},{"code":"00093414856","type":"NDC"}],"standard_charges":[{"gross_charge":33.66,"discounted_cash":33.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETYLCYSTEINE 20 % IN SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"63323069404","type":"NDC"}],"standard_charges":[{"gross_charge":42.16,"discounted_cash":42.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LATANOPROST 0.005 % OP SOLN","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"59762033302","type":"NDC"}],"standard_charges":[{"gross_charge":31.66,"discounted_cash":31.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLEAR EYES REDNESS RELIEF 0.012-0.25 % OP SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"78112025415","type":"NDC"}],"standard_charges":[{"gross_charge":34.94,"discounted_cash":34.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN HCL 50 MG/ML PO SOLR UNIT DOSE","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"67877075181","type":"NDC"}],"standard_charges":[{"gross_charge":28.97,"discounted_cash":28.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"D-VITE PEDIATRIC 10 MCG/ML PO LIQD","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"71399740105","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":4.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POLYMYXIN B-TRIMETHOPRIM 10000-0.1 UNIT/ML-% OP SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"61314062810","type":"NDC"}],"standard_charges":[{"gross_charge":53.23,"discounted_cash":53.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CIPROFLOXACIN HCL 0.3 % OP SOLN","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"61314065625","type":"NDC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":48.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LATANOPROST 0.005 % OP SOLN","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"61314054701","type":"NDC"}],"standard_charges":[{"gross_charge":43.25,"discounted_cash":43.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PILOCARPINE HCL 1 % OP SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"70069018101","type":"NDC"}],"standard_charges":[{"gross_charge":283.23,"discounted_cash":283.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUDESONIDE 1 MG/2ML IN SUSP","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"69097032153","type":"NDC"}],"standard_charges":[{"gross_charge":45.32,"discounted_cash":45.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MYCOPHENOLATE MOFETIL 200 MG/ML PO SUSR UNIT DOSE","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"23155084851","type":"NDC"}],"standard_charges":[{"gross_charge":95.72,"discounted_cash":95.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OFLOXACIN 0.3 % OP SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"64980051505","type":"NDC"}],"standard_charges":[{"gross_charge":103.39,"discounted_cash":103.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MOXIFLOXACIN HCL 0.5 % OP SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"68180042201","type":"NDC"}],"standard_charges":[{"gross_charge":87.89,"discounted_cash":87.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREDNISOLONE ACETATE 1 % OP SUSP","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"61314063705","type":"NDC"}],"standard_charges":[{"gross_charge":208.31,"discounted_cash":208.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL 2.5 % OP SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"75907012907","type":"NDC"}],"standard_charges":[{"gross_charge":150.85,"discounted_cash":150.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYCLOPENTOLATE HCL 1 % OP SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"24208073501","type":"NDC"}],"standard_charges":[{"gross_charge":103.84,"discounted_cash":103.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETH 3.5-10000-0.1 OP SUSP","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"61314063006","type":"NDC"}],"standard_charges":[{"gross_charge":98.91,"discounted_cash":98.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OP SUSP","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00574403125","type":"NDC"}],"standard_charges":[{"gross_charge":98.26,"discounted_cash":98.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETYLCYSTEINE 20 % IN SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00517760425","type":"NDC"}],"standard_charges":[{"gross_charge":72.53,"discounted_cash":72.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MYCOPHENOLATE MOFETIL 200 MG/ML PO SUSR UNIT DOSE","drug_information":{"unit":2.3,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"67877023022","type":"NDC"}],"standard_charges":[{"gross_charge":124.03,"discounted_cash":124.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL 10 % OP SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"70756061430","type":"NDC"}],"standard_charges":[{"gross_charge":274.18,"discounted_cash":274.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL 2.5 % OP SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"70756062925","type":"NDC"}],"standard_charges":[{"gross_charge":232.87,"discounted_cash":232.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BRIMONIDINE TARTRATE 0.2 % OP SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"61314014310","type":"NDC"}],"standard_charges":[{"gross_charge":45.25,"discounted_cash":45.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FAMOTIDINE 40 MG/5ML PO SUSR UNIT DOSE","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"68180015001","type":"NDC"}],"standard_charges":[{"gross_charge":17.33,"discounted_cash":17.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IPRATROPIUM BROMIDE 0.06 % NA SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"60505082701","type":"NDC"}],"standard_charges":[{"gross_charge":88.23,"discounted_cash":88.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHADONE HCL 10 MG/ML PO CONC UNIT DOSE","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00527192736","type":"NDC"}],"standard_charges":[{"gross_charge":20.11,"discounted_cash":20.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POLYVINYL ALCOHOL 1.4 % OP SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"50268067815","type":"NDC"}],"standard_charges":[{"gross_charge":79.4,"discounted_cash":79.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOBRAMYCIN 0.3 % OP SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"70069013101","type":"NDC"}],"standard_charges":[{"gross_charge":53.04,"discounted_cash":53.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 0.5 % OP SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"60505100301","type":"NDC"}],"standard_charges":[{"gross_charge":60.64,"discounted_cash":60.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL URETHRAL/MUCOSAL 2 % EX PRSY","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"76329301105","type":"NDC"}],"standard_charges":[{"gross_charge":59.97,"discounted_cash":59.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IPRATROPIUM BROMIDE 0.03 % NA SOLN","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"24208039830","type":"NDC"}],"standard_charges":[{"gross_charge":293.05,"discounted_cash":293.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUDESONIDE 0.25 MG/2ML IN SUSP","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00487960101","type":"NDC"}],"standard_charges":[{"gross_charge":38.2,"discounted_cash":38.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPARACAINE HCL 0.5 % OP SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"61314001601","type":"NDC"}],"standard_charges":[{"gross_charge":196.66,"discounted_cash":196.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENHYDRAMINE HCL 12.5 MG/5ML PO ELIX","drug_information":{"unit":1.667,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00121097800","type":"NDC"}],"standard_charges":[{"gross_charge":11.71,"discounted_cash":11.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IPRATROPIUM BROMIDE 0.03 % NA SOLN","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00054004544","type":"NDC"}],"standard_charges":[{"gross_charge":97.5,"discounted_cash":97.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GENTEAL TEARS 0.1-0.2-0.3 % OP SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00065042636","type":"NDC"}],"standard_charges":[{"gross_charge":67.43,"discounted_cash":67.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREDNISOLONE ACETATE 1 % OP SUSP","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"60758011905","type":"NDC"}],"standard_charges":[{"gross_charge":208.22,"discounted_cash":208.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZELASTINE HCL 0.1 % NA SOLN","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"60505083305","type":"NDC"}],"standard_charges":[{"gross_charge":66.72,"discounted_cash":66.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMMONIUM LACTATE 12 % EX LOTN","drug_information":{"unit":226.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00904598426","type":"NDC"}],"standard_charges":[{"gross_charge":44.35,"discounted_cash":44.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GNP NIGHTTIME RELIEF LUB EYE 57.3-42.5 % OP OINT","drug_information":{"unit":3.5,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"46122075737","type":"NDC"}],"standard_charges":[{"gross_charge":42.39,"discounted_cash":42.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GENTEAL TEARS NIGHT-TIME OP OINT","drug_information":{"unit":3.5,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00065051801","type":"NDC"}],"standard_charges":[{"gross_charge":72.14,"discounted_cash":72.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SSKI 1 GM/ML PO SOLN","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"71740011230","type":"NDC"}],"standard_charges":[{"gross_charge":19.27,"discounted_cash":19.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN GLARGINE-YFGN 100 UNIT/ML SC SOLN","drug_information":{"unit":0.03,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"83257001411","type":"NDC"}],"standard_charges":[{"gross_charge":332.18,"discounted_cash":332.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"REFRESH TEARS 0.5 % OP SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00023079815","type":"NDC"}],"standard_charges":[{"gross_charge":82.82,"discounted_cash":82.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FE-VITE IRON 75 (15 FE) MG/ML PO SOLN","drug_information":{"unit":1.867,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"71399748005","type":"NDC"}],"standard_charges":[{"gross_charge":6.7,"discounted_cash":6.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AKTEN 3.5 % OP GEL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"82584079225","type":"NDC"}],"standard_charges":[{"gross_charge":191.46,"discounted_cash":191.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEEP SEA NASAL SPRAY 0.65 % NA SOLN","drug_information":{"unit":44.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00904386575","type":"NDC"}],"standard_charges":[{"gross_charge":22.72,"discounted_cash":22.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EYE ITCH RELIEF 0.035 % OP SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00536125240","type":"NDC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":69.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BETADINE OPHTHALMIC PREP 5 % OP SOLN","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00065041130","type":"NDC"}],"standard_charges":[{"gross_charge":104.1,"discounted_cash":104.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAXITROL 0.1 % OP SUSP","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"82667010005","type":"NDC"}],"standard_charges":[{"gross_charge":760.09,"discounted_cash":760.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GOLYTELY 236 G PO SOLR","drug_information":{"unit":4000.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"52268010001","type":"NDC"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEG-3350/ELECTROLYTES 236 G PO SOLR","drug_information":{"unit":4000.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"10572010001","type":"NDC"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GAVILYTE-G 236 G PO SOLR","drug_information":{"unit":4000.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"43386009019","type":"NDC"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MURO 128 2 % OP SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"24208027615","type":"NDC"}],"standard_charges":[{"gross_charge":133.42,"discounted_cash":133.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYCLOMYDRIL 0.2-1 % OP SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00065035902","type":"NDC"}],"standard_charges":[{"gross_charge":282.94,"discounted_cash":282.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GASTROGRAFIN 66-10 % PO SOLN","drug_information":{"unit":7.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9963","type":"HCPCS"},{"code":"00270044535","type":"NDC"}],"standard_charges":[{"gross_charge":24.11,"discounted_cash":24.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GASTROGRAFIN 66-10 % PO SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9963","type":"HCPCS"},{"code":"00270044540","type":"NDC"}],"standard_charges":[{"gross_charge":15.33,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NOVOLIN N 100 UNIT/ML SC SUSP","drug_information":{"unit":0.02,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"00169183411","type":"NDC"}],"standard_charges":[{"gross_charge":327.62,"discounted_cash":327.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HUMULIN N 100 UNIT/ML SC SUSP","drug_information":{"unit":0.04,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"00002831501","type":"NDC"}],"standard_charges":[{"gross_charge":328.18,"discounted_cash":328.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HUMULIN 70/30 (70-30) 100 UNIT/ML SC SUSP","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"00002871501","type":"NDC"}],"standard_charges":[{"gross_charge":363.95,"discounted_cash":363.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NOVOLIN 70/30 (70-30) 100 UNIT/ML SC SUSP","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"00169183711","type":"NDC"}],"standard_charges":[{"gross_charge":351.23,"discounted_cash":351.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HUMULIN R 100 UNIT/ML IJ SOLN","drug_information":{"unit":0.03,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"00002821501","type":"NDC"}],"standard_charges":[{"gross_charge":327.28,"discounted_cash":327.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NOVOLIN R 100 UNIT/ML IJ SOLN","drug_information":{"unit":0.03,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"00169183311","type":"NDC"}],"standard_charges":[{"gross_charge":328.93,"discounted_cash":328.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GERI-LANTA 200-200-20 MG/5ML PO SUSP","drug_information":{"unit":3.333,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"57896062912","type":"NDC"}],"standard_charges":[{"gross_charge":3.93,"discounted_cash":3.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ANTACID/ANTIGAS 400-400-40 MG/10ML PO SUSP","drug_information":{"unit":1.667,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00536131783","type":"NDC"}],"standard_charges":[{"gross_charge":3.29,"discounted_cash":3.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GERI-MOX 200-200-20 MG/5ML PO SUSP","drug_information":{"unit":3.333,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"57896063912","type":"NDC"}],"standard_charges":[{"gross_charge":3.93,"discounted_cash":3.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ANTACID REGULAR STRENGTH 200-200-20 MG/5ML PO SUSP","drug_information":{"unit":1.667,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00536129383","type":"NDC"}],"standard_charges":[{"gross_charge":3.29,"discounted_cash":3.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MINTOX MAXIMUM STRENGTH 400-400-40 MG/5ML PO SUSP","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00904572514","type":"NDC"}],"standard_charges":[{"gross_charge":5.6,"discounted_cash":5.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DICLOFENAC SODIUM 1 % EX GEL","drug_information":{"unit":100.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00536129497","type":"NDC"}],"standard_charges":[{"gross_charge":83.15,"discounted_cash":83.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCORTISONE 1 % EX CREA","drug_information":{"unit":14.2,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"51672201301","type":"NDC"}],"standard_charges":[{"gross_charge":39.45,"discounted_cash":39.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VENTOLIN HFA 108 (90 BASE) MCG/ACT IN AERS","drug_information":{"unit":8.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00173068224","type":"NDC"}],"standard_charges":[{"gross_charge":184.76,"discounted_cash":184.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ANTI-ITCH 2-0.1 % EX CREA","drug_information":{"unit":28.4,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"51672208902","type":"NDC"}],"standard_charges":[{"gross_charge":31.58,"discounted_cash":31.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MENTHOL-ZINC OXIDE 0.44-20.625 % EX OINT","drug_information":{"unit":113.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"10135070104","type":"NDC"}],"standard_charges":[{"gross_charge":38.61,"discounted_cash":38.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIPLE ANTIBIOTIC 3.5-400-5000 EX OINT","drug_information":{"unit":28.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"45802014303","type":"NDC"}],"standard_charges":[{"gross_charge":41.42,"discounted_cash":41.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENHYDRAMINE-ZINC ACETATE 2-0.1 % EX CREA","drug_information":{"unit":28.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"45802035803","type":"NDC"}],"standard_charges":[{"gross_charge":28.09,"discounted_cash":28.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZINC OXIDE 20 % EX OINT","drug_information":{"unit":30.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00536131628","type":"NDC"}],"standard_charges":[{"gross_charge":37.03,"discounted_cash":37.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % EX CREA","drug_information":{"unit":80.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"67877025180","type":"NDC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":48.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % EX OINT","drug_information":{"unit":15.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"51672128401","type":"NDC"}],"standard_charges":[{"gross_charge":39.33,"discounted_cash":39.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":22.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"45802011222","type":"NDC"}],"standard_charges":[{"gross_charge":29.86,"discounted_cash":29.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIBUCAINE 1 % EX OINT","drug_information":{"unit":28.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00536121195","type":"NDC"}],"standard_charges":[{"gross_charge":44.31,"discounted_cash":44.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % EX CREA","drug_information":{"unit":15.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"45802006435","type":"NDC"}],"standard_charges":[{"gross_charge":27.6,"discounted_cash":27.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DICLOFENAC SODIUM 1 % EX GEL","drug_information":{"unit":100.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"43598097710","type":"NDC"}],"standard_charges":[{"gross_charge":99.3,"discounted_cash":99.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOBETASOL PROPIONATE 0.05 % EX OINT","drug_information":{"unit":15.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00713065615","type":"NDC"}],"standard_charges":[{"gross_charge":41.64,"discounted_cash":41.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP","drug_information":{"unit":16.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"60505082901","type":"NDC"}],"standard_charges":[{"gross_charge":68.98,"discounted_cash":68.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIPLE ANTIBIOTIC 3.5-400-5000 EX OINT","drug_information":{"unit":28.4,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00713026831","type":"NDC"}],"standard_charges":[{"gross_charge":37.52,"discounted_cash":37.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % EX CREA","drug_information":{"unit":15.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"16714098601","type":"NDC"}],"standard_charges":[{"gross_charge":37.54,"discounted_cash":37.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCORTISONE 1 % EX CREA","drug_information":{"unit":28.4,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"51672201302","type":"NDC"}],"standard_charges":[{"gross_charge":38.6,"discounted_cash":38.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CAPSAICIN 0.1 % EX CREA","drug_information":{"unit":42.5,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00536126456","type":"NDC"}],"standard_charges":[{"gross_charge":85.5,"discounted_cash":85.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCORTISONE 1 % EX OINT","drug_information":{"unit":28.35,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00168002031","type":"NDC"}],"standard_charges":[{"gross_charge":54.17,"discounted_cash":54.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN PHOS (TWICE-DAILY) 1 % EX GEL","drug_information":{"unit":30.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"21922002705","type":"NDC"}],"standard_charges":[{"gross_charge":70.71,"discounted_cash":70.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DICLOFENAC SODIUM 1 % EX GEL","drug_information":{"unit":100.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"45802095301","type":"NDC"}],"standard_charges":[{"gross_charge":59.4,"discounted_cash":59.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE 5 % EX OINT","drug_information":{"unit":35.44,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"51672302009","type":"NDC"}],"standard_charges":[{"gross_charge":56.13,"discounted_cash":56.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIBUCAINE (PERIANAL) 1 % EX OINT","drug_information":{"unit":28.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"71399282901","type":"NDC"}],"standard_charges":[{"gross_charge":37.93,"discounted_cash":37.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DICLOFENAC SODIUM 1 % EX GEL","drug_information":{"unit":50.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00536129434","type":"NDC"}],"standard_charges":[{"gross_charge":77.45,"discounted_cash":77.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NYSTATIN 100000 UNIT/GM EX CREA","drug_information":{"unit":15.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00713067815","type":"NDC"}],"standard_charges":[{"gross_charge":44.06,"discounted_cash":44.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE 5 % EX OINT","drug_information":{"unit":30.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"33342040530","type":"NDC"}],"standard_charges":[{"gross_charge":72.7,"discounted_cash":72.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":22.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"51672131200","type":"NDC"}],"standard_charges":[{"gross_charge":32.99,"discounted_cash":32.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":22.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"68462018022","type":"NDC"}],"standard_charges":[{"gross_charge":32.78,"discounted_cash":32.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIPLE ANTIBIOTIC 3.5-400-5000 EX OINT","drug_information":{"unit":14.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"45802014301","type":"NDC"}],"standard_charges":[{"gross_charge":34.28,"discounted_cash":34.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CAPSAICIN 0.025 % EX CREA","drug_information":{"unit":60.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00536252525","type":"NDC"}],"standard_charges":[{"gross_charge":36.79,"discounted_cash":36.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCORTISONE 1 % EX CREA","drug_information":{"unit":28.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"45802043803","type":"NDC"}],"standard_charges":[{"gross_charge":31.9,"discounted_cash":31.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BANOPHEN 2-0.1 % EX CREA","drug_information":{"unit":28.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00904535431","type":"NDC"}],"standard_charges":[{"gross_charge":36.18,"discounted_cash":36.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 0.5 % OP SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"69315032205","type":"NDC"}],"standard_charges":[{"gross_charge":227.52,"discounted_cash":227.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 OT SUSP","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"24208063562","type":"NDC"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":286.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MOXIFLOXACIN HCL 0.5 % OP SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00832141003","type":"NDC"}],"standard_charges":[{"gross_charge":211.37,"discounted_cash":211.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLEET ENEMA RE ENEM","drug_information":{"unit":133.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00132020140","type":"NDC"}],"standard_charges":[{"gross_charge":25.83,"discounted_cash":25.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN 400 MG/5ML PO SUSR","drug_information":{"unit":10.938,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"65862007101","type":"NDC"}],"standard_charges":[{"gross_charge":12.33,"discounted_cash":12.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 200 MG/10ML IV SOSY (WRAPPED)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"71286601102","type":"NDC"}],"standard_charges":[{"gross_charge":348.37,"discounted_cash":348.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYMETAZOLINE HCL 0.05 % NA SOLN","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"45802041059","type":"NDC"}],"standard_charges":[{"gross_charge":27.34,"discounted_cash":27.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MINERAL OIL RE ENEM","drug_information":{"unit":133.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"53329001311","type":"NDC"}],"standard_charges":[{"gross_charge":35.27,"discounted_cash":35.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZELASTINE HCL 137 MCG/SPRAY NA SOLN","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"65162067684","type":"NDC"}],"standard_charges":[{"gross_charge":103.33,"discounted_cash":103.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE (HYPERTONIC) 5 % OP SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00536125494","type":"NDC"}],"standard_charges":[{"gross_charge":43.49,"discounted_cash":43.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00378827052","type":"NDC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":26.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"76204020030","type":"NDC"}],"standard_charges":[{"gross_charge":27.29,"discounted_cash":27.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACTIDOSE WITH SORBITOL 25 GM/120ML PO SUSP","drug_information":{"unit":240.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00574052074","type":"NDC"}],"standard_charges":[{"gross_charge":197.84,"discounted_cash":197.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM CITRATE 1.745 GM/30ML PO SOLN BULK","drug_information":{"unit":296.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00904741844","type":"NDC"}],"standard_charges":[{"gross_charge":26.86,"discounted_cash":26.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BSS IO SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00065079550","type":"NDC"}],"standard_charges":[{"gross_charge":38.38,"discounted_cash":38.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENOL 1.4 % MT LIQD","drug_information":{"unit":177.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"67172011120","type":"NDC"}],"standard_charges":[{"gross_charge":44.48,"discounted_cash":44.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SENNA 8.8 MG/5ML PO SYRP UNIT DOSE","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"57896047208","type":"NDC"}],"standard_charges":[{"gross_charge":8.76,"discounted_cash":8.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"60687039583","type":"NDC"}],"standard_charges":[{"gross_charge":28.83,"discounted_cash":28.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"76204020060","type":"NDC"}],"standard_charges":[{"gross_charge":24.19,"discounted_cash":24.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"76204020001","type":"NDC"}],"standard_charges":[{"gross_charge":30.12,"discounted_cash":30.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 400-57 MG/5ML PO SUSR UNIT DOSE","drug_information":{"unit":10.938,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"65862053450","type":"NDC"}],"standard_charges":[{"gross_charge":14.95,"discounted_cash":14.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BSS PLUS IO SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00065080094","type":"NDC"}],"standard_charges":[{"gross_charge":21.22,"discounted_cash":21.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE VISCOUS HCL 2 % MT SOLN","drug_information":{"unit":3.333,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00054350049","type":"NDC"}],"standard_charges":[{"gross_charge":36.66,"discounted_cash":36.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALAMINE 8-8 % EX LOTN","drug_information":{"unit":177.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00904253321","type":"NDC"}],"standard_charges":[{"gross_charge":31.06,"discounted_cash":31.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEPHALEXIN 250 MG/5ML PO SUSR","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00093417773","type":"NDC"}],"standard_charges":[{"gross_charge":15.56,"discounted_cash":15.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEPHALEXIN 250 MG/5ML PO SUSR","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"68180044101","type":"NDC"}],"standard_charges":[{"gross_charge":15.44,"discounted_cash":15.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVALBUTEROL HCL 1.25 MG/3ML IN NEBU","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"J7620","type":"HCPCS"},{"code":"76204090025","type":"NDC"}],"standard_charges":[{"gross_charge":49.73,"discounted_cash":49.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 400-57 MG/5ML PO SUSR UNIT DOSE","drug_information":{"unit":10.938,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"16714029303","type":"NDC"}],"standard_charges":[{"gross_charge":21.16,"discounted_cash":21.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POVIDONE-IODINE 10 % EX SOLN","drug_information":{"unit":9.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00904110309","type":"NDC"}],"standard_charges":[{"gross_charge":19.29,"discounted_cash":19.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"J7613","type":"HCPCS"},{"code":"00378827093","type":"NDC"}],"standard_charges":[{"gross_charge":29.61,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IPRATROPIUM BROMIDE 0.03 % NA SOLN","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"60505082601","type":"NDC"}],"standard_charges":[{"gross_charge":88.09,"discounted_cash":88.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MAL 2-0.5 % OP SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"70069005101","type":"NDC"}],"standard_charges":[{"gross_charge":88.19,"discounted_cash":88.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EYE WASH OP SOLN","drug_information":{"unit":118.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00536122497","type":"NDC"}],"standard_charges":[{"gross_charge":31.3,"discounted_cash":31.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BRIMONIDINE TARTRATE 0.2 % OP SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"61314014305","type":"NDC"}],"standard_charges":[{"gross_charge":37.65,"discounted_cash":37.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LANTUS 100 UNIT/ML SC SOLN","drug_information":{"unit":0.02,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"00088222033","type":"NDC"}],"standard_charges":[{"gross_charge":329.62,"discounted_cash":329.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE VISCOUS HCL 2 % MT SOLN","drug_information":{"unit":1.667,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"72888012526","type":"NDC"}],"standard_charges":[{"gross_charge":22.33,"discounted_cash":22.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEROPENEM 1 G IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"44567040110","type":"NDC"}],"standard_charges":[{"gross_charge":195.69,"discounted_cash":195.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFAZOLIN SODIUM 10 G IJ SOLR","drug_information":{"unit":0.3,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"60505614304","type":"NDC"}],"standard_charges":[{"gross_charge":369.42,"discounted_cash":369.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEROPENEM 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"44567040010","type":"NDC"}],"standard_charges":[{"gross_charge":190.48,"discounted_cash":190.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE SULFATE POWD","drug_information":{"unit":0.04,"type":"GR"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"38779067307","type":"NDC"}],"standard_charges":[{"gross_charge":169.36,"discounted_cash":169.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIPIODOL 480 MG/ML IJ OIL","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"67684190102","type":"NDC"}],"standard_charges":[{"gross_charge":952.6,"discounted_cash":952.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OPTIRAY 350 74 % IJ SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00019133316","type":"NDC"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":37.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYSTOGRAFIN 30 % UR SOLN","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9958","type":"HCPCS"},{"code":"00270014957","type":"NDC"}],"standard_charges":[{"gross_charge":16.39,"discounted_cash":16.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOVUE-300 61 % IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131595","type":"NDC"}],"standard_charges":[{"gross_charge":23.05,"discounted_cash":23.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOVUE-300 61 % IV SOLN","drug_information":{"unit":45.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131545","type":"NDC"}],"standard_charges":[{"gross_charge":21.61,"discounted_cash":21.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOTAREM 50 MMOL/100ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"A9575","type":"HCPCS"},{"code":"67684200104","type":"NDC"}],"standard_charges":[{"gross_charge":33.85,"discounted_cash":33.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RETACRIT 20000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"00069131110","type":"NDC"}],"standard_charges":[{"gross_charge":3393.16,"discounted_cash":3393.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ADRENALIN 30 MG/30ML IJ SOLN","drug_information":{"unit":0.01,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0169","type":"HCPCS"},{"code":"42023016801","type":"NDC"}],"standard_charges":[{"gross_charge":326.5,"discounted_cash":326.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ADRENALIN 30 MG/30ML IJ SOLN","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0169","type":"HCPCS"},{"code":"42023016889","type":"NDC"}],"standard_charges":[{"gross_charge":363.29,"discounted_cash":363.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BENDEKA 100 MG/4ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9034","type":"HCPCS"},{"code":"63459034804","type":"NDC"}],"standard_charges":[{"gross_charge":5261.01,"discounted_cash":5261.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE SULFATE (CONCENTRATE) 100 MG/5ML PO SOLN","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00054051744","type":"NDC"}],"standard_charges":[{"gross_charge":6.71,"discounted_cash":6.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KENALOG-10 10 MG/ML IJ SUSP","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"00003049420","type":"NDC"}],"standard_charges":[{"gross_charge":347.65,"discounted_cash":347.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIACALCIN 200 UNIT/ML IJ SOLN","drug_information":{"unit":0.88,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0630","type":"HCPCS"},{"code":"67457067502","type":"NDC"}],"standard_charges":[{"gross_charge":4672.2,"discounted_cash":4672.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DDAVP 4 MCG/ML IJ SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"55566230000","type":"NDC"}],"standard_charges":[{"gross_charge":4429.21,"discounted_cash":4429.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MD-GASTROVIEW 66-10 % PO SOLN","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9963","type":"HCPCS"},{"code":"00019481604","type":"NDC"}],"standard_charges":[{"gross_charge":41.05,"discounted_cash":41.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOVUE-370 76 % IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131695","type":"NDC"}],"standard_charges":[{"gross_charge":12.88,"discounted_cash":12.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOVUE-370 76 % IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131645","type":"NDC"}],"standard_charges":[{"gross_charge":23.8,"discounted_cash":23.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYSTO-CONRAY II 17.2 % UR SOLN","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9958","type":"HCPCS"},{"code":"00019086250","type":"NDC"}],"standard_charges":[{"gross_charge":72.25,"discounted_cash":72.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"XYLOCAINE/EPINEPHRINE 1 %-1:100000 IJ SOLN","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"63323048257","type":"NDC"}],"standard_charges":[{"gross_charge":331.72,"discounted_cash":331.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"XYLOCAINE/EPINEPHRINE 1 %-1:100000 IJ SOLN","drug_information":{"unit":0.005,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"63323048217","type":"NDC"}],"standard_charges":[{"gross_charge":325.06,"discounted_cash":325.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VOLTAREN ARTHRITIS PAIN 1 % EX GEL","drug_information":{"unit":100.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"00067815203","type":"NDC"}],"standard_charges":[{"gross_charge":113.7,"discounted_cash":113.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZELASTINE HCL 137 MCG/SPRAY NA SOLN","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"59651021430","type":"NDC"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":150.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYSEPT 25 0.25 % EX SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"39328006325","type":"NDC"}],"standard_charges":[{"gross_charge":31.85,"discounted_cash":31.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DAKINS (1/2 STRENGTH) 0.25 % EX SOLN","drug_information":{"unit":473.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00436093616","type":"NDC"}],"standard_charges":[{"gross_charge":122.57,"discounted_cash":122.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HUMALOG 100 UNIT/ML IJ SOLN","drug_information":{"unit":0.01,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"00002751001","type":"NDC"}],"standard_charges":[{"gross_charge":326.94,"discounted_cash":326.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEPHALEXIN 250 MG/5ML PO SUSR","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"67877054588","type":"NDC"}],"standard_charges":[{"gross_charge":16.16,"discounted_cash":16.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MOXIFLOXACIN HCL 0.5 % OP SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00781713593","type":"NDC"}],"standard_charges":[{"gross_charge":62.44,"discounted_cash":62.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DICLOFENAC SODIUM 0.1 % OP SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"24208045705","type":"NDC"}],"standard_charges":[{"gross_charge":21.88,"discounted_cash":21.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN PALMITATE HCL 75 MG/5ML PO SOLR","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"16714048301","type":"NDC"}],"standard_charges":[{"gross_charge":43.92,"discounted_cash":43.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BSS IO SOLN","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00065179504","type":"NDC"}],"standard_charges":[{"gross_charge":141.75,"discounted_cash":141.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","drug_information":{"unit":9.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00378827055","type":"NDC"}],"standard_charges":[{"gross_charge":21.93,"discounted_cash":21.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OSELTAMIVIR PHOSPHATE 6 MG/ML PO SUSR BULK","drug_information":{"unit":12.5,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"27241013909","type":"NDC"}],"standard_charges":[{"gross_charge":17.45,"discounted_cash":17.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"76204020025","type":"NDC"}],"standard_charges":[{"gross_charge":22.64,"discounted_cash":22.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BSS PLUS IO SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00065080050","type":"NDC"}],"standard_charges":[{"gross_charge":21.99,"discounted_cash":21.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IPRATROPIUM BROMIDE 0.06 % NA SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"16714052701","type":"NDC"}],"standard_charges":[{"gross_charge":305.8,"discounted_cash":305.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYCLOPENTOLATE HCL 1 % OP SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"61314039601","type":"NDC"}],"standard_charges":[{"gross_charge":49.9,"discounted_cash":49.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 0.5 % OP SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"61314012610","type":"NDC"}],"standard_charges":[{"gross_charge":187.65,"discounted_cash":187.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL 10 % OP SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"75907013023","type":"NDC"}],"standard_charges":[{"gross_charge":187.4,"discounted_cash":187.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TETRACAINE HCL 0.5 % OP SOLN","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00065074114","type":"NDC"}],"standard_charges":[{"gross_charge":113.19,"discounted_cash":113.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREDNISOLONE ACETATE 1 % OP SUSP","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"70748033202","type":"NDC"}],"standard_charges":[{"gross_charge":217.32,"discounted_cash":217.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATROPINE SULFATE 1 % OP SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"60505622600","type":"NDC"}],"standard_charges":[{"gross_charge":165.81,"discounted_cash":165.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETH 3.5-10000-0.1 OP SUSP","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"24208083060","type":"NDC"}],"standard_charges":[{"gross_charge":118.89,"discounted_cash":118.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUDESONIDE 0.25 MG/2ML IN SUSP","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00093681573","type":"NDC"}],"standard_charges":[{"gross_charge":75.4,"discounted_cash":75.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 0.5 % OP SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"42571013725","type":"NDC"}],"standard_charges":[{"gross_charge":68.9,"discounted_cash":68.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MAL 2-0.5 % OP SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"61314003002","type":"NDC"}],"standard_charges":[{"gross_charge":165.64,"discounted_cash":165.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUDESONIDE 0.5 MG/2ML IN SUSP","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"60687052483","type":"NDC"}],"standard_charges":[{"gross_charge":41.03,"discounted_cash":41.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PILOCARPINE HCL 2 % OP SOLN","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"70069019101","type":"NDC"}],"standard_charges":[{"gross_charge":493.94,"discounted_cash":493.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUDESONIDE 0.5 MG/2ML IN SUSP","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00093681673","type":"NDC"}],"standard_charges":[{"gross_charge":86.95,"discounted_cash":86.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATROPINE SULFATE 1 % OP SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"60219174802","type":"NDC"}],"standard_charges":[{"gross_charge":237.04,"discounted_cash":237.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OFLOXACIN 0.3 % OT SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"70756060915","type":"NDC"}],"standard_charges":[{"gross_charge":105.37,"discounted_cash":105.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOBRAMYCIN 0.3 % OP SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"61314064305","type":"NDC"}],"standard_charges":[{"gross_charge":100.73,"discounted_cash":100.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MOXIFLOXACIN HCL 0.5 % OP SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"62332050503","type":"NDC"}],"standard_charges":[{"gross_charge":96.73,"discounted_cash":96.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OFLOXACIN 0.3 % OT SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"69238161503","type":"NDC"}],"standard_charges":[{"gross_charge":126.03,"discounted_cash":126.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROVOCHOLINE IN KIT","drug_information":{"unit":18.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"64281011006","type":"NDC"}],"standard_charges":[{"gross_charge":904.45,"discounted_cash":904.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL 4 % MT SOLN","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"76329630005","type":"NDC"}],"standard_charges":[{"gross_charge":235.73,"discounted_cash":235.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 0.5 % OP SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"42571013726","type":"NDC"}],"standard_charges":[{"gross_charge":380.33,"discounted_cash":380.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PILOCARPINE HCL 1 % OP SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"61314020315","type":"NDC"}],"standard_charges":[{"gross_charge":445.11,"discounted_cash":445.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DESMOPRESSIN ACETATE SPRAY 0.01 % NA SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"60505081500","type":"NDC"}],"standard_charges":[{"gross_charge":419.87,"discounted_cash":419.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLEET PEDIATRIC RECTAL ENEMA","drug_information":{"unit":66.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00132020220","type":"NDC"}],"standard_charges":[{"gross_charge":30.2,"discounted_cash":30.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFDINIR 125 MG/5ML PO SUSR","drug_information":{"unit":12.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"67877054798","type":"NDC"}],"standard_charges":[{"gross_charge":23.89,"discounted_cash":23.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL 4 % EX SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00527600480","type":"NDC"}],"standard_charges":[{"gross_charge":95.98,"discounted_cash":95.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BSS IO SOLN","drug_information":{"unit":2.25,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00065079515","type":"NDC"}],"standard_charges":[{"gross_charge":26.22,"discounted_cash":26.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXYCYCLINE MONOHYDRATE 25 MG/5ML PO SUSR BULK","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"68180065701","type":"NDC"}],"standard_charges":[{"gross_charge":56.96,"discounted_cash":56.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TIMOLOL MALEATE 0.5 % OP SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"60758080105","type":"NDC"}],"standard_charges":[{"gross_charge":57.5,"discounted_cash":57.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DORZOLAMIDE HCL 2 % OP SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"24208048510","type":"NDC"}],"standard_charges":[{"gross_charge":92.27,"discounted_cash":92.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBAMIDE PEROXIDE 6.5 % OT SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00074736201","type":"NDC"}],"standard_charges":[{"gross_charge":47.76,"discounted_cash":47.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RISPERIDONE 1 MG/ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"27808000201","type":"NDC"}],"standard_charges":[{"gross_charge":13.08,"discounted_cash":13.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MAL 2-0.5 % OP SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"24208048610","type":"NDC"}],"standard_charges":[{"gross_charge":84.77,"discounted_cash":84.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOTIFEN FUMARATE 0.035 % OP SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"72485061710","type":"NDC"}],"standard_charges":[{"gross_charge":66.43,"discounted_cash":66.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"25021079002","type":"NDC"}],"standard_charges":[{"gross_charge":347.78,"discounted_cash":347.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFPODOXIME PROXETIL 100 MG/5ML PO SUSR BULK","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"64980040350","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TIMOLOL MALEATE 0.5 % OP SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"64980051405","type":"NDC"}],"standard_charges":[{"gross_charge":56.36,"discounted_cash":56.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TIMOLOL MALEATE 0.5 % OP SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"61314022705","type":"NDC"}],"standard_charges":[{"gross_charge":54.46,"discounted_cash":54.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPARACAINE HCL 0.5 % OP SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"24208073006","type":"NDC"}],"standard_charges":[{"gross_charge":186.21,"discounted_cash":186.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MAL 2-0.5 % OP SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"65862094601","type":"NDC"}],"standard_charges":[{"gross_charge":165.13,"discounted_cash":165.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BRIMONIDINE TARTRATE 0.2 % OP SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"70069023201","type":"NDC"}],"standard_charges":[{"gross_charge":39.07,"discounted_cash":39.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROPIVACAINE HCL-NACL 0.2-0.9 % (ON-Q) IJ SOLN SINGLE LUMEN","drug_information":{"unit":745.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"71449007957","type":"NDC"}],"standard_charges":[{"gross_charge":683.48,"discounted_cash":683.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TROPICAMIDE 1 % OP SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"61314035502","type":"NDC"}],"standard_charges":[{"gross_charge":53.04,"discounted_cash":53.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TROPICAMIDE 1 % OP SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"70069012101","type":"NDC"}],"standard_charges":[{"gross_charge":67.71,"discounted_cash":67.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BRIMONIDINE TARTRATE 0.2 % OP SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"70069023101","type":"NDC"}],"standard_charges":[{"gross_charge":36.98,"discounted_cash":36.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVALBUTEROL HCL 0.63 MG/3ML IN NEBU","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"J7612","type":"HCPCS"},{"code":"76204080001","type":"NDC"}],"standard_charges":[{"gross_charge":30.3,"discounted_cash":30.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLOPATADINE HCL 0.1 % OP SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"70069001701","type":"NDC"}],"standard_charges":[{"gross_charge":41.64,"discounted_cash":41.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL URETHRAL/MUCOSAL 2 % EX PRSY","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"76329301305","type":"NDC"}],"standard_charges":[{"gross_charge":67.95,"discounted_cash":67.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE VISCOUS HCL 2 % MT SOLN","drug_information":{"unit":3.333,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"62135071242","type":"NDC"}],"standard_charges":[{"gross_charge":38.31,"discounted_cash":38.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPARACAINE HCL 0.5 % OP SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"70069060101","type":"NDC"}],"standard_charges":[{"gross_charge":123.48,"discounted_cash":123.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GENTAMICIN SULFATE 0.3 % OP SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"61314063305","type":"NDC"}],"standard_charges":[{"gross_charge":45.53,"discounted_cash":45.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CIPROFLOXACIN HCL 0.3 % OP SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"61314065605","type":"NDC"}],"standard_charges":[{"gross_charge":44.3,"discounted_cash":44.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OFLOXACIN 0.3 % OP SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"60505056000","type":"NDC"}],"standard_charges":[{"gross_charge":79.45,"discounted_cash":79.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUDESONIDE 0.5 MG/2ML IN SUSP","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00487970101","type":"NDC"}],"standard_charges":[{"gross_charge":35.61,"discounted_cash":35.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TROPICAMIDE 1 % OP SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"24208058564","type":"NDC"}],"standard_charges":[{"gross_charge":242.43,"discounted_cash":242.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 400-57 MG/5ML PO SUSR UNIT DOSE","drug_information":{"unit":10.938,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00143998201","type":"NDC"}],"standard_charges":[{"gross_charge":19.59,"discounted_cash":19.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYMETAZOLINE HCL 0.05 % NA SOLN","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"11523116705","type":"NDC"}],"standard_charges":[{"gross_charge":90.37,"discounted_cash":90.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXCARBAZEPINE 300 MG/5ML PO SUSP UNIT DOSE","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"65162064978","type":"NDC"}],"standard_charges":[{"gross_charge":13.84,"discounted_cash":13.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"XYLOCAINE/EPINEPHRINE 2 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"63323048327","type":"NDC"}],"standard_charges":[{"gross_charge":333.9,"discounted_cash":333.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROPIVACAINE HCL-NACL 0.2-0.9 % (ON-Q) IJ SOLN DUAL LUMEN","drug_information":{"unit":745.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"71449007959","type":"NDC"}],"standard_charges":[{"gross_charge":650.7,"discounted_cash":650.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEROL SULFATE 1.25 MG/3ML IN NEBU","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00487990401","type":"NDC"}],"standard_charges":[{"gross_charge":19.08,"discounted_cash":19.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IBUPROFEN CHILDRENS 100 MG/5ML PO SUSP","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00121091400","type":"NDC"}],"standard_charges":[{"gross_charge":26.24,"discounted_cash":26.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IBUPROFEN CHILDRENS 100 MG/5ML PO SUSP","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"68094049461","type":"NDC"}],"standard_charges":[{"gross_charge":34.16,"discounted_cash":34.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BLUDIGO 8 MG/ML IV SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9220","type":"HCPCS"},{"code":"81284031505","type":"NDC"}],"standard_charges":[{"gross_charge":2498.39,"discounted_cash":2498.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OMNIPAQUE 180 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9965","type":"HCPCS"},{"code":"00407141110","type":"NDC"}],"standard_charges":[{"gross_charge":20.95,"discounted_cash":20.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OMNIPAQUE 350 MG/ML IV SOLN","drug_information":{"unit":110.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141493","type":"NDC"}],"standard_charges":[{"gross_charge":289.84,"discounted_cash":289.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OMNIPAQUE 350 MG/ML IV SOLN","drug_information":{"unit":75.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141494","type":"NDC"}],"standard_charges":[{"gross_charge":186.4,"discounted_cash":186.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OMNIPAQUE 350 MG/ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141489","type":"NDC"}],"standard_charges":[{"gross_charge":37.63,"discounted_cash":37.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OMNIPAQUE 350 MG/ML IV SOLN","drug_information":{"unit":0.009,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141491","type":"NDC"}],"standard_charges":[{"gross_charge":10.02,"discounted_cash":10.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OMNIPAQUE 350 MG/ML IV SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141490","type":"NDC"}],"standard_charges":[{"gross_charge":15.03,"discounted_cash":15.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOVUE-M 200 41 % IJ SOLN","drug_information":{"unit":0.002,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9966","type":"HCPCS"},{"code":"00270141111","type":"NDC"}],"standard_charges":[{"gross_charge":10.01,"discounted_cash":10.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOVUE-250 51 % IV SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131702","type":"NDC"}],"standard_charges":[{"gross_charge":10.29,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOVUE-M 300 61 % IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270141215","type":"NDC"}],"standard_charges":[{"gross_charge":13.74,"discounted_cash":13.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOVUE-370 76 % IV SOLN","drug_information":{"unit":130.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131637","type":"NDC"}],"standard_charges":[{"gross_charge":41.2,"discounted_cash":41.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOVUE-370 76 % IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131630","type":"NDC"}],"standard_charges":[{"gross_charge":23.05,"discounted_cash":23.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOVUE-370 76 % IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131604","type":"NDC"}],"standard_charges":[{"gross_charge":34.9,"discounted_cash":34.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOVUE-370 76 % IV SOLN","drug_information":{"unit":0.086,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131635","type":"NDC"}],"standard_charges":[{"gross_charge":10.02,"discounted_cash":10.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"XYLOCAINE-MPF/EPINEPHRINE 1 %-1:200000 IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"63323048737","type":"NDC"}],"standard_charges":[{"gross_charge":338.78,"discounted_cash":338.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"XYLOCAINE-MPF/EPINEPHRINE 1 %-1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"63323048717","type":"NDC"}],"standard_charges":[{"gross_charge":343.94,"discounted_cash":343.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"XYLOCAINE-MPF/EPINEPHRINE 1 %-1:200000 IJ SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"63323048731","type":"NDC"}],"standard_charges":[{"gross_charge":390.91,"discounted_cash":390.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"XYLOCAINE-MPF/EPINEPHRINE 1.5 %-1:200000 IJ SOLN","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"63323048837","type":"NDC"}],"standard_charges":[{"gross_charge":150.16,"discounted_cash":150.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"XYLOCAINE-MPF/EPINEPHRINE 2 %-1:200000 IJ SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"63323048927","type":"NDC"}],"standard_charges":[{"gross_charge":378.17,"discounted_cash":378.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"XYLOCAINE-MPF/EPINEPHRINE 2 %-1:200000 IJ SOLN","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"63323048917","type":"NDC"}],"standard_charges":[{"gross_charge":393.98,"discounted_cash":393.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TIGAN 100 MG/ML IM SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3250","type":"HCPCS"},{"code":"42023011925","type":"NDC"}],"standard_charges":[{"gross_charge":1080.29,"discounted_cash":1080.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"16714099701","type":"NDC"}],"standard_charges":[{"gross_charge":452.26,"discounted_cash":452.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"23155025832","type":"NDC"}],"standard_charges":[{"gross_charge":382.1,"discounted_cash":382.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"55150019301","type":"NDC"}],"standard_charges":[{"gross_charge":1996.45,"discounted_cash":1996.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUMIN HUMAN 25 % IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9046","type":"HCPCS"},{"code":"68982064302","type":"NDC"}],"standard_charges":[{"gross_charge":320.8,"discounted_cash":320.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUMIN HUMAN 5 % IV SOLN","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"68982062303","type":"NDC"}],"standard_charges":[{"gross_charge":316.0,"discounted_cash":316.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUMIN HUMAN 5 % IV SOLN","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"68982062302","type":"NDC"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":241.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROHANCE 279.3 MG/ML IV SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"A9579","type":"HCPCS"},{"code":"00270111102","type":"NDC"}],"standard_charges":[{"gross_charge":66.03,"discounted_cash":66.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAG-AL PLUS 200-200-20 MG/5ML PO LIQD","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00121176130","type":"NDC"}],"standard_charges":[{"gross_charge":3.66,"discounted_cash":3.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROCRIT 3000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"59676030301","type":"NDC"}],"standard_charges":[{"gross_charge":1615.28,"discounted_cash":1615.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPOGEN 10000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"55513014410","type":"NDC"}],"standard_charges":[{"gross_charge":3015.84,"discounted_cash":3015.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPRIVAN 200 MG/20ML IV EMUL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323026994","type":"NDC"}],"standard_charges":[{"gross_charge":327.39,"discounted_cash":327.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPRIVAN 500 MG/50ML IV EMUL","drug_information":{"unit":49.323,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323026959","type":"NDC"}],"standard_charges":[{"gross_charge":377.18,"discounted_cash":377.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPRIVAN 500 MG/50ML IV EMUL","drug_information":{"unit":49.543,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323026950","type":"NDC"}],"standard_charges":[{"gross_charge":377.42,"discounted_cash":377.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HAVRIX 1440 EL U/ML IM SUSY","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90632","type":"HCPCS"},{"code":"58160082652","type":"NDC"}],"standard_charges":[{"gross_charge":687.34,"discounted_cash":687.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPHADASE 150 UNIT/ML IJ SOLN","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3470","type":"HCPCS"},{"code":"00548909010","type":"NDC"}],"standard_charges":[{"gross_charge":397.21,"discounted_cash":397.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VAQTA 50 UNIT/ML IM SUSY","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90632","type":"HCPCS"},{"code":"00006409602","type":"NDC"}],"standard_charges":[{"gross_charge":656.57,"discounted_cash":656.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"63323037701","type":"NDC"}],"standard_charges":[{"gross_charge":233.49,"discounted_cash":233.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"63323037704","type":"NDC"}],"standard_charges":[{"gross_charge":233.46,"discounted_cash":233.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"00641617610","type":"NDC"}],"standard_charges":[{"gross_charge":174.81,"discounted_cash":174.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEXISCAN 0.4 MG/5ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"00469650189","type":"NDC"}],"standard_charges":[{"gross_charge":3513.41,"discounted_cash":3513.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RELISTOR 12 MG/0.6ML SC SOSY","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2212","type":"HCPCS"},{"code":"65649055107","type":"NDC"}],"standard_charges":[{"gross_charge":2960.13,"discounted_cash":2960.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RELISTOR 12 MG/0.6ML SC SOSY","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2212","type":"HCPCS"},{"code":"65649055103","type":"NDC"}],"standard_charges":[{"gross_charge":2950.36,"discounted_cash":2950.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DURACLON 100 MCG/ML EP SOLN","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0735","type":"HCPCS"},{"code":"67457021810","type":"NDC"}],"standard_charges":[{"gross_charge":347.86,"discounted_cash":347.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROCRIT 40000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"59676034001","type":"NDC"}],"standard_charges":[{"gross_charge":10572.16,"discounted_cash":10572.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERRLECIT 12.5 MG/ML IV SOLN","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"00024279210","type":"NDC"}],"standard_charges":[{"gross_charge":207.21,"discounted_cash":207.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATIVAN 2 MG/ML IJ SOLN","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"00641600125","type":"NDC"}],"standard_charges":[{"gross_charge":342.73,"discounted_cash":342.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATIVAN 4 MG/ML IJ SOLN","drug_information":{"unit":0.13,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"00641600325","type":"NDC"}],"standard_charges":[{"gross_charge":337.85,"discounted_cash":337.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE SULFATE (CONCENTRATE) 10 MG/0.5ML PO SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"68094004558","type":"NDC"}],"standard_charges":[{"gross_charge":58.7,"discounted_cash":58.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROHANCE 279.3 MG/ML IV SOLN","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"A9579","type":"HCPCS"},{"code":"00270111103","type":"NDC"}],"standard_charges":[{"gross_charge":84.7,"discounted_cash":84.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VITAMIN K1 10 MG/ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"00409915801","type":"NDC"}],"standard_charges":[{"gross_charge":238.08,"discounted_cash":238.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PNEUMOVAX 23 25 MCG/0.5ML IJ SOSY","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90732","type":"HCPCS"},{"code":"00006483703","type":"NDC"}],"standard_charges":[{"gross_charge":2008.84,"discounted_cash":2008.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE IN NACL 20-0.9 MEQ/L-% IV SOLN","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00264786500","type":"NDC"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":371.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KCL (0.149%) IN NACL 20-0.9 MEQ/L-% IV SOLN","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00990711509","type":"NDC"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":417.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE IN NACL 40-0.9 MEQ/L-% IV SOLN","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"63323068810","type":"NDC"}],"standard_charges":[{"gross_charge":382.5,"discounted_cash":382.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE IN NACL 40-0.9 MEQ/L-% IV SOLN","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00338069504","type":"NDC"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":82.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TENIVAC 5-2 LF/0.5ML IM SUSP","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90714","type":"HCPCS"},{"code":"49281021510","type":"NDC"}],"standard_charges":[{"gross_charge":823.04,"discounted_cash":823.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TENIVAC 5-2 LF/0.5ML IM SUSP","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90714","type":"HCPCS"},{"code":"49281021515","type":"NDC"}],"standard_charges":[{"gross_charge":822.91,"discounted_cash":822.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PULMOZYME 2.5 MG/2.5ML IN SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"50242010040","type":"NDC"}],"standard_charges":[{"gross_charge":782.95,"discounted_cash":782.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYSTOGRAFIN-DILUTE 18 % UR SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9958","type":"HCPCS"},{"code":"00270141030","type":"NDC"}],"standard_charges":[{"gross_charge":18.55,"discounted_cash":18.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROCRIT 10000 UNIT/ML IJ SOLN","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"59676031001","type":"NDC"}],"standard_charges":[{"gross_charge":1761.11,"discounted_cash":1761.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPRIVAN 200 MG/20ML IV EMUL","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323026929","type":"NDC"}],"standard_charges":[{"gross_charge":326.47,"discounted_cash":326.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAG-AL PLUS XS 400-400-40 MG/5ML PO LIQD","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00121176230","type":"NDC"}],"standard_charges":[{"gross_charge":13.31,"discounted_cash":13.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE SPINAL 0.75-8.25 % IT SOLN","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409361301","type":"NDC"}],"standard_charges":[{"gross_charge":350.95,"discounted_cash":350.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VENOFER 20 MG/ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"00517234099","type":"NDC"}],"standard_charges":[{"gross_charge":660.9,"discounted_cash":660.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VENOFER 20 MG/ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"00517234010","type":"NDC"}],"standard_charges":[{"gross_charge":660.9,"discounted_cash":660.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VENOFER 20 MG/ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"00517231005","type":"NDC"}],"standard_charges":[{"gross_charge":660.69,"discounted_cash":660.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EXPAREL 1.3 % IJ SUSP","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0666","type":"HCPCS"},{"code":"65250026604","type":"NDC"}],"standard_charges":[{"gross_charge":6208.94,"discounted_cash":6208.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EXPAREL 1.3 % IJ SUSP","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0666","type":"HCPCS"},{"code":"65250013304","type":"NDC"}],"standard_charges":[{"gross_charge":3799.36,"discounted_cash":3799.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EXPAREL 1.3 % IJ SUSP","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0666","type":"HCPCS"},{"code":"65250026609","type":"NDC"}],"standard_charges":[{"gross_charge":1759.3,"discounted_cash":1759.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EXPAREL 1.3 % IJ SUSP","drug_information":{"unit":6.7,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0666","type":"HCPCS"},{"code":"65250013309","type":"NDC"}],"standard_charges":[{"gross_charge":2542.0,"discounted_cash":2542.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GEMCITABINE HCL 2 GM/52.6ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"67457061810","type":"NDC"}],"standard_charges":[{"gross_charge":60.16,"discounted_cash":60.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GEMCITABINE HCL 1 GM/26.3ML IV SOLN","drug_information":{"unit":8.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"25021023926","type":"NDC"}],"standard_charges":[{"gross_charge":80.75,"discounted_cash":80.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GEMCITABINE HCL 200 MG/5.26ML IV SOLN","drug_information":{"unit":1.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"00409018301","type":"NDC"}],"standard_charges":[{"gross_charge":33.86,"discounted_cash":33.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GEMCITABINE HCL 2 GM/52.6ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"25021023952","type":"NDC"}],"standard_charges":[{"gross_charge":53.36,"discounted_cash":53.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GEMCITABINE HCL 200 MG/5.26ML IV SOLN","drug_information":{"unit":1.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"25021023905","type":"NDC"}],"standard_charges":[{"gross_charge":39.44,"discounted_cash":39.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GEMCITABINE HCL 2 GM/52.6ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"00409018201","type":"NDC"}],"standard_charges":[{"gross_charge":57.52,"discounted_cash":57.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GEMCITABINE HCL 200 MG/5.26ML IV SOLN","drug_information":{"unit":1.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"71288011706","type":"NDC"}],"standard_charges":[{"gross_charge":38.93,"discounted_cash":38.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GEMCITABINE HCL 1 GM/26.3ML IV SOLN","drug_information":{"unit":1.3,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"00409018101","type":"NDC"}],"standard_charges":[{"gross_charge":32.75,"discounted_cash":32.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GEMCITABINE HCL 1 GM/26.3ML IV SOLN","drug_information":{"unit":26.3,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"67457061730","type":"NDC"}],"standard_charges":[{"gross_charge":195.8,"discounted_cash":195.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXIL 2 MG/ML IV SUSP","drug_information":{"unit":5.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2050","type":"HCPCS"},{"code":"00338006301","type":"NDC"}],"standard_charges":[{"gross_charge":726.02,"discounted_cash":726.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOVUE-300 61 % IV SOLN","drug_information":{"unit":55.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131550","type":"NDC"}],"standard_charges":[{"gross_charge":22.54,"discounted_cash":22.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOVUE-300 61 % IV SOLN","drug_information":{"unit":32.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131530","type":"NDC"}],"standard_charges":[{"gross_charge":17.68,"discounted_cash":17.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOVUE-300 61 % IV SOLN","drug_information":{"unit":0.033,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131525","type":"NDC"}],"standard_charges":[{"gross_charge":10.01,"discounted_cash":10.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOVUE-300 61 % IV SOLN","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131535","type":"NDC"}],"standard_charges":[{"gross_charge":10.03,"discounted_cash":10.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SPS (SODIUM POLYSTYRENE SULF) 15 GM/60ML CO SUSP","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"46287000660","type":"NDC"}],"standard_charges":[{"gross_charge":183.44,"discounted_cash":183.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RECOMBIVAX HB 10 MCG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90746","type":"HCPCS"},{"code":"00006499541","type":"NDC"}],"standard_charges":[{"gross_charge":810.46,"discounted_cash":810.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENGERIX-B 10 MCG/0.5ML IJ SUSY","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90744","type":"HCPCS"},{"code":"58160082052","type":"NDC"}],"standard_charges":[{"gross_charge":408.9,"discounted_cash":408.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENGERIX-B 20 MCG/ML IJ SUSY","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90746","type":"HCPCS"},{"code":"58160082152","type":"NDC"}],"standard_charges":[{"gross_charge":959.77,"discounted_cash":959.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXIL 2 MG/ML IV SUSP","drug_information":{"unit":19.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2050","type":"HCPCS"},{"code":"00338966701","type":"NDC"}],"standard_charges":[{"gross_charge":1046.81,"discounted_cash":1046.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEDVAX HIB 7.5 MCG/0.5ML IM SUSP","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90647","type":"HCPCS"},{"code":"00006489700","type":"NDC"}],"standard_charges":[{"gross_charge":569.55,"discounted_cash":569.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EUFLEXXA 20 MG/2ML IX SOSY","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J7323","type":"HCPCS"},{"code":"55566410001","type":"NDC"}],"standard_charges":[{"gross_charge":3177.24,"discounted_cash":3177.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYALGAN 20 MG/2ML IX SOSY","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7321","type":"HCPCS"},{"code":"89122072420","type":"NDC"}],"standard_charges":[{"gross_charge":3303.46,"discounted_cash":3303.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VENOFER 20 MG/ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"00517234025","type":"NDC"}],"standard_charges":[{"gross_charge":660.9,"discounted_cash":660.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MARCAINE SPINAL 0.75-8.25 % IT SOLN","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409176110","type":"NDC"}],"standard_charges":[{"gross_charge":373.74,"discounted_cash":373.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MILK OF MAGNESIA 2400 MG/30ML PO SUSP","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"63739019610","type":"NDC"}],"standard_charges":[{"gross_charge":32.66,"discounted_cash":32.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MILK OF MAGNESIA 400 MG/5ML PO SUSP","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"60687042976","type":"NDC"}],"standard_charges":[{"gross_charge":7.94,"discounted_cash":7.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KENALOG-40 40 MG/ML IJ SUSP","drug_information":{"unit":0.025,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"00003029305","type":"NDC"}],"standard_charges":[{"gross_charge":333.77,"discounted_cash":333.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEIN 5 % IV SOLN","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"68516521902","type":"NDC"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":282.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLEXBUMIN 5 % IV SOLN","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"00944049505","type":"NDC"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":268.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"XOLAIR 300 MG/2ML SC SOSY","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2357","type":"HCPCS"},{"code":"50242022701","type":"NDC"}],"standard_charges":[{"gross_charge":53131.72,"discounted_cash":53131.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PERJETA 420 MG/14ML IV SOLN","drug_information":{"unit":14.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9306","type":"HCPCS"},{"code":"50242014501","type":"NDC"}],"standard_charges":[{"gross_charge":14953.9,"discounted_cash":14953.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE HCL PF 50 MG/5ML IJ SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"00703011303","type":"NDC"}],"standard_charges":[{"gross_charge":131.08,"discounted_cash":131.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE HCL PF 500 MG/50ML IJ SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"00409263450","type":"NDC"}],"standard_charges":[{"gross_charge":500.35,"discounted_cash":500.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE HCL PF 500 MG/50ML IJ SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"00703001801","type":"NDC"}],"standard_charges":[{"gross_charge":239.95,"discounted_cash":239.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE SULFATE 10 MG/ML IV SOLN","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"00641612725","type":"NDC"}],"standard_charges":[{"gross_charge":342.09,"discounted_cash":342.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE SULFATE 8 MG/ML IV SOLN","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"00641612625","type":"NDC"}],"standard_charges":[{"gross_charge":387.75,"discounted_cash":387.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OMNIPAQUE 300 MG/ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141359","type":"NDC"}],"standard_charges":[{"gross_charge":17.59,"discounted_cash":17.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OMNIPAQUE 300 MG/ML IJ SOLN","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141363","type":"NDC"}],"standard_charges":[{"gross_charge":11.87,"discounted_cash":11.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OMNIPAQUE 300 MG/ML IJ SOLN","drug_information":{"unit":0.02,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141310","type":"NDC"}],"standard_charges":[{"gross_charge":10.22,"discounted_cash":10.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OMNIPAQUE 300 MG/ML IJ SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141361","type":"NDC"}],"standard_charges":[{"gross_charge":22.68,"discounted_cash":22.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OMNIPAQUE 240 MG/ML IJ SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9966","type":"HCPCS"},{"code":"00407141230","type":"NDC"}],"standard_charges":[{"gross_charge":117.1,"discounted_cash":117.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OMNIPAQUE 240 MG/ML IJ SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9966","type":"HCPCS"},{"code":"00407141220","type":"NDC"}],"standard_charges":[{"gross_charge":41.47,"discounted_cash":41.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OMNIPAQUE 240 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9966","type":"HCPCS"},{"code":"00407141210","type":"NDC"}],"standard_charges":[{"gross_charge":21.91,"discounted_cash":21.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ADRENALIN 1 MG/ML IJ SOLN","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0171","type":"HCPCS"},{"code":"42023015925","type":"NDC"}],"standard_charges":[{"gross_charge":380.37,"discounted_cash":380.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DUROLANE 60 MG/3ML IX PRSY","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7318","type":"HCPCS"},{"code":"89130202001","type":"NDC"}],"standard_charges":[{"gross_charge":9692.68,"discounted_cash":9692.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CINVANTI 130 MG/18ML IV EMUL","drug_information":{"unit":18.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0185","type":"HCPCS"},{"code":"47426020101","type":"NDC"}],"standard_charges":[{"gross_charge":4143.41,"discounted_cash":4143.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FASENRA 30 MG/ML SC SOSY","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0517","type":"HCPCS"},{"code":"00310173030","type":"NDC"}],"standard_charges":[{"gross_charge":97345.1,"discounted_cash":97345.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OPDIVO 240 MG/24ML IV SOLN","drug_information":{"unit":5.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9299","type":"HCPCS"},{"code":"00003373413","type":"NDC"}],"standard_charges":[{"gross_charge":4493.36,"discounted_cash":4493.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VECTIBIX 100 MG/5ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9303","type":"HCPCS"},{"code":"55513095401","type":"NDC"}],"standard_charges":[{"gross_charge":7695.58,"discounted_cash":7695.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VECTIBIX 400 MG/20ML IV SOLN","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9303","type":"HCPCS"},{"code":"55513095601","type":"NDC"}],"standard_charges":[{"gross_charge":14640.1,"discounted_cash":14640.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACTEMRA 80 MG/4ML IV SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3262","type":"HCPCS"},{"code":"50242013501","type":"NDC"}],"standard_charges":[{"gross_charge":1352.72,"discounted_cash":1352.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACTEMRA 200 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3262","type":"HCPCS"},{"code":"50242013601","type":"NDC"}],"standard_charges":[{"gross_charge":2439.68,"discounted_cash":2439.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACTEMRA 400 MG/20ML IV SOLN","drug_information":{"unit":6.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3262","type":"HCPCS"},{"code":"50242013701","type":"NDC"}],"standard_charges":[{"gross_charge":15802.93,"discounted_cash":15802.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RECK 123-0.25-0.04- 15 MG/50ML PERIARTICULA SOSY","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70092143350","type":"NDC"}],"standard_charges":[{"gross_charge":179.81,"discounted_cash":179.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MILK OF MAGNESIA 2400 MG/30ML PO SUSP","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"69339015317","type":"NDC"}],"standard_charges":[{"gross_charge":10.19,"discounted_cash":10.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MILK OF MAGNESIA 7.75 % PO SUSP","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00121043130","type":"NDC"}],"standard_charges":[{"gross_charge":7.58,"discounted_cash":7.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUPARTZ FX 25 MG/2.5ML IX SOSY","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7321","type":"HCPCS"},{"code":"89130444401","type":"NDC"}],"standard_charges":[{"gross_charge":3482.29,"discounted_cash":3482.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPRIVAN 100 MG/10ML IV EMUL","drug_information":{"unit":0.14,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323026910","type":"NDC"}],"standard_charges":[{"gross_charge":325.37,"discounted_cash":325.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GADOBUTROL 1 MMOL/ML IV SOLN","drug_information":{"unit":6.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"A9585","type":"HCPCS"},{"code":"65219028107","type":"NDC"}],"standard_charges":[{"gross_charge":42.87,"discounted_cash":42.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AVASTIN 100 MG/4ML IV SOLN","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9035","type":"HCPCS"},{"code":"50242006001","type":"NDC"}],"standard_charges":[{"gross_charge":1992.45,"discounted_cash":1992.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AVASTIN 400 MG/16ML IV SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9035","type":"HCPCS"},{"code":"50242006101","type":"NDC"}],"standard_charges":[{"gross_charge":1716.29,"discounted_cash":1716.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERBITUX 200 MG/100ML IV SOLN","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9055","type":"HCPCS"},{"code":"66733095823","type":"NDC"}],"standard_charges":[{"gross_charge":6349.4,"discounted_cash":6349.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CAMPTOSAR 300 MG/15ML IV SOLN","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"00009008202","type":"NDC"}],"standard_charges":[{"gross_charge":163.3,"discounted_cash":163.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"YERVOY 50 MG/10ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9228","type":"HCPCS"},{"code":"00003232711","type":"NDC"}],"standard_charges":[{"gross_charge":9745.47,"discounted_cash":9745.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GADAVIST 1 MMOL/ML IV SOLN","drug_information":{"unit":5.1,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"A9585","type":"HCPCS"},{"code":"50419032512","type":"NDC"}],"standard_charges":[{"gross_charge":58.15,"discounted_cash":58.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GADAVIST 1 MMOL/ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"A9585","type":"HCPCS"},{"code":"50419032513","type":"NDC"}],"standard_charges":[{"gross_charge":80.8,"discounted_cash":80.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GADAVIST 1 MMOL/ML IV SOLN","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"A9585","type":"HCPCS"},{"code":"50419032511","type":"NDC"}],"standard_charges":[{"gross_charge":10.94,"discounted_cash":10.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEXTERONE 150-4.21 MG/100ML-% IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0283","type":"HCPCS"},{"code":"43066015010","type":"NDC"}],"standard_charges":[{"gross_charge":167.3,"discounted_cash":167.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEXTERONE 360-4.14 MG/200ML-% IV SOLN","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0283","type":"HCPCS"},{"code":"43066036020","type":"NDC"}],"standard_charges":[{"gross_charge":202.4,"discounted_cash":202.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VYVGART HYTRULO 180-2000 MG-UNIT/ML SC SOLN","drug_information":{"unit":5.6,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9334","type":"HCPCS"},{"code":"73475310203","type":"NDC"}],"standard_charges":[{"gross_charge":308686.51,"discounted_cash":308686.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COSENTYX 125 MG/5ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3247","type":"HCPCS"},{"code":"00078116861","type":"NDC"}],"standard_charges":[{"gross_charge":40592.86,"discounted_cash":40592.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEIN 5 % IV SOLN","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"68516521401","type":"NDC"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":235.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEIN 5 % IV SOLN","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"68516521804","type":"NDC"}],"standard_charges":[{"gross_charge":221.5,"discounted_cash":221.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUKED 5 5 % IV SOLN","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"76125079025","type":"NDC"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":199.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYLENEX 150 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3473","type":"HCPCS"},{"code":"18657011704","type":"NDC"}],"standard_charges":[{"gross_charge":926.71,"discounted_cash":926.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OPTISON IV SUSP","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9956","type":"HCPCS"},{"code":"00407270718","type":"NDC"}],"standard_charges":[{"gross_charge":237.55,"discounted_cash":237.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OPTISON IV SUSP","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9956","type":"HCPCS"},{"code":"00407270703","type":"NDC"}],"standard_charges":[{"gross_charge":246.53,"discounted_cash":246.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLEOCIN PHOSPHATE 600 MG/4ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"00009077526","type":"NDC"}],"standard_charges":[{"gross_charge":362.08,"discounted_cash":362.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLEOCIN PHOSPHATE 900 MG/6ML IJ SOLN","drug_information":{"unit":6.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"00009090218","type":"NDC"}],"standard_charges":[{"gross_charge":399.88,"discounted_cash":399.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLEOCIN PHOSPHATE 300 MG/2ML IJ SOLN","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"00009087026","type":"NDC"}],"standard_charges":[{"gross_charge":412.05,"discounted_cash":412.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SOMATULINE DEPOT 120 MG/0.5ML SC SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1930","type":"HCPCS"},{"code":"15054112004","type":"NDC"}],"standard_charges":[{"gross_charge":102551.29,"discounted_cash":102551.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PERFOROMIST 20 MCG/2ML IN NEBU","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"49502060530","type":"NDC"}],"standard_charges":[{"gross_charge":54.97,"discounted_cash":54.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BICILLIN L-A 1200000 UNIT/2ML IM SUSY","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0561","type":"HCPCS"},{"code":"60793070110","type":"NDC"}],"standard_charges":[{"gross_charge":6416.8,"discounted_cash":6416.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BICILLIN L-A 2400000 UNIT/4ML IM SUSY","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0561","type":"HCPCS"},{"code":"60793070210","type":"NDC"}],"standard_charges":[{"gross_charge":13275.72,"discounted_cash":13275.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZOSYN 3-0.375 GM/50ML IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"00338963624","type":"NDC"}],"standard_charges":[{"gross_charge":118.35,"discounted_cash":118.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KCL (0.149%) IN NACL 20-0.45 MEQ/L-% IV SOLN","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00990925739","type":"NDC"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":417.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN SODIUM 100 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71839011310","type":"NDC"}],"standard_charges":[{"gross_charge":138.3,"discounted_cash":138.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARSENIC TRIOXIDE 10 MG/10ML IV SOLN","drug_information":{"unit":9.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9017","type":"HCPCS"},{"code":"25021022610","type":"NDC"}],"standard_charges":[{"gross_charge":418.13,"discounted_cash":418.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN SODIUM 40 MG/0.4ML IJ SOSY","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00781324664","type":"NDC"}],"standard_charges":[{"gross_charge":383.22,"discounted_cash":383.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1071","type":"HCPCS"},{"code":"00143965901","type":"NDC"}],"standard_charges":[{"gross_charge":163.6,"discounted_cash":163.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZOLEDRONIC ACID 4 MG/5ML IV CONC","drug_information":{"unit":1.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"67457039054","type":"NDC"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":202.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUMATRIPTAN SUCCINATE 6 MG/0.5ML SC SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3030","type":"HCPCS"},{"code":"55150017305","type":"NDC"}],"standard_charges":[{"gross_charge":411.11,"discounted_cash":411.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ADENOSINE 6 MG/2ML IV SOLN","drug_information":{"unit":0.33,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"67457085502","type":"NDC"}],"standard_charges":[{"gross_charge":362.03,"discounted_cash":362.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEOSTIGMINE METHYLSULFATE 3 MG/3ML IV SOSY","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"76045038330","type":"NDC"}],"standard_charges":[{"gross_charge":394.78,"discounted_cash":394.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FULVESTRANT 250 MG/5ML IM SOSY","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"00143902202","type":"NDC"}],"standard_charges":[{"gross_charge":690.19,"discounted_cash":690.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) PF 5000 UNIT/0.5ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71839011825","type":"NDC"}],"standard_charges":[{"gross_charge":379.67,"discounted_cash":379.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPINEPHRINE (ANAPHYLAXIS) 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0169","type":"HCPCS"},{"code":"54288011925","type":"NDC"}],"standard_charges":[{"gross_charge":246.23,"discounted_cash":246.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"96372","type":"HCPCS"},{"code":"00409656201","type":"NDC"}],"standard_charges":[{"gross_charge":175.6,"discounted_cash":175.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN SODIUM 30 MG/0.3ML IJ SOSY","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00955100310","type":"NDC"}],"standard_charges":[{"gross_charge":388.67,"discounted_cash":388.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IBUTILIDE FUMARATE 1 MG/10ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1742","type":"HCPCS"},{"code":"67457036610","type":"NDC"}],"standard_charges":[{"gross_charge":1642.75,"discounted_cash":1642.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FONDAPARINUX SODIUM 7.5 MG/0.6ML SC SOLN","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"55150023210","type":"NDC"}],"standard_charges":[{"gross_charge":229.64,"discounted_cash":229.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE SULFATE 1 MG/ML IJ SOLN (WRAPPED)","drug_information":{"unit":6.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"73702024232","type":"NDC"}],"standard_charges":[{"gross_charge":1632.25,"discounted_cash":1632.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NALOXONE HCL 2 MG/2ML IJ SOSY","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2312","type":"HCPCS"},{"code":"55150034510","type":"NDC"}],"standard_charges":[{"gross_charge":493.59,"discounted_cash":493.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PALONOSETRON HCL 0.25 MG/5ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"16714083401","type":"NDC"}],"standard_charges":[{"gross_charge":5300.93,"discounted_cash":5300.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENOBARBITAL SODIUM 130 MG/ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2560","type":"HCPCS"},{"code":"42494041625","type":"NDC"}],"standard_charges":[{"gross_charge":1220.52,"discounted_cash":1220.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENOBARBITAL SODIUM 130 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2560","type":"HCPCS"},{"code":"00641047725","type":"NDC"}],"standard_charges":[{"gross_charge":608.46,"discounted_cash":608.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1050","type":"HCPCS"},{"code":"70121146702","type":"NDC"}],"standard_charges":[{"gross_charge":571.54,"discounted_cash":571.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN SODIUM 60 MG/0.6ML IJ SOSY","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00781325666","type":"NDC"}],"standard_charges":[{"gross_charge":267.13,"discounted_cash":267.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":0.02,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"63323075101","type":"NDC"}],"standard_charges":[{"gross_charge":327.4,"discounted_cash":327.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PAMIDRONATE DISODIUM 90 MG/10ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2430","type":"HCPCS"},{"code":"61703032618","type":"NDC"}],"standard_charges":[{"gross_charge":600.73,"discounted_cash":600.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL CITRATE (PF) 25 MCG/0.5ML IJ SOSY","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"00641624910","type":"NDC"}],"standard_charges":[{"gross_charge":375.26,"discounted_cash":375.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HALOPERIDOL LACTATE 5 MG/ML IJ SOLN","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1630","type":"HCPCS"},{"code":"76045073710","type":"NDC"}],"standard_charges":[{"gross_charge":334.31,"discounted_cash":334.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IRINOTECAN HCL 40 MG/2ML IV SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"00143970201","type":"NDC"}],"standard_charges":[{"gross_charge":53.28,"discounted_cash":53.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NALBUPHINE HCL 10 MG/ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2300","type":"HCPCS"},{"code":"00409146301","type":"NDC"}],"standard_charges":[{"gross_charge":387.26,"discounted_cash":387.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DICYCLOMINE HCL 10 MG/ML IM SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"63323084202","type":"NDC"}],"standard_charges":[{"gross_charge":164.37,"discounted_cash":164.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN SODIUM 40 MG/0.4ML IJ SOSY","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00955100410","type":"NDC"}],"standard_charges":[{"gross_charge":380.59,"discounted_cash":380.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPREDNISOLONE ACETATE 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"70121157305","type":"NDC"}],"standard_charges":[{"gross_charge":134.42,"discounted_cash":134.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN SODIUM 60 MG/0.6ML IJ SOSY","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"25021041077","type":"NDC"}],"standard_charges":[{"gross_charge":343.53,"discounted_cash":343.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN SODIUM 80 MG/0.8ML IJ SOSY","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"25021041078","type":"NDC"}],"standard_charges":[{"gross_charge":342.54,"discounted_cash":342.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ORPHENADRINE CITRATE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2360","type":"HCPCS"},{"code":"25021065102","type":"NDC"}],"standard_charges":[{"gross_charge":111.33,"discounted_cash":111.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1050","type":"HCPCS"},{"code":"00548540025","type":"NDC"}],"standard_charges":[{"gross_charge":196.43,"discounted_cash":196.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUMATRIPTAN SUCCINATE 6 MG/0.5ML SC SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3030","type":"HCPCS"},{"code":"55150017301","type":"NDC"}],"standard_charges":[{"gross_charge":411.11,"discounted_cash":411.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYKLOKAPRON 1000 MG/10ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3290","type":"HCPCS"},{"code":"00013111415","type":"NDC"}],"standard_charges":[{"gross_charge":405.6,"discounted_cash":405.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERIBULIN MESYLATE 1 MG/2ML IV SOLN","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9179","type":"HCPCS"},{"code":"10019008001","type":"NDC"}],"standard_charges":[{"gross_charge":467.06,"discounted_cash":467.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENOBARBITAL SODIUM 130 MG/ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2560","type":"HCPCS"},{"code":"54288013710","type":"NDC"}],"standard_charges":[{"gross_charge":1865.18,"discounted_cash":1865.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LABETALOL HCL 20 MG/4ML IV SOSY","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"70092100944","type":"NDC"}],"standard_charges":[{"gross_charge":424.32,"discounted_cash":424.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORAZEPAM 2 MG/ML IJ SOLN","drug_information":{"unit":0.13,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"00409198530","type":"NDC"}],"standard_charges":[{"gross_charge":341.67,"discounted_cash":341.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"00703024101","type":"NDC"}],"standard_charges":[{"gross_charge":400.92,"discounted_cash":400.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDRALAZINE HCL 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"63323061416","type":"NDC"}],"standard_charges":[{"gross_charge":398.01,"discounted_cash":398.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDRALAZINE HCL 20 MG/ML IJ SOLN","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"63323061401","type":"NDC"}],"standard_charges":[{"gross_charge":353.57,"discounted_cash":353.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NALOXONE HCL 2 MG/2ML IJ SOSY","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"76329336901","type":"NDC"}],"standard_charges":[{"gross_charge":367.08,"discounted_cash":367.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NALOXONE HCL 0.4 MG/ML IJ SOLN","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2312","type":"HCPCS"},{"code":"67457029202","type":"NDC"}],"standard_charges":[{"gross_charge":342.08,"discounted_cash":342.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DROPERIDOL 2.5 MG/ML IJ SOLN","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1790","type":"HCPCS"},{"code":"00143951525","type":"NDC"}],"standard_charges":[{"gross_charge":361.19,"discounted_cash":361.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLADRIBINE 10 MG/10ML IV SOLN","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9065","type":"HCPCS"},{"code":"63323014010","type":"NDC"}],"standard_charges":[{"gross_charge":376.23,"discounted_cash":376.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDRALAZINE HCL 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"00641623125","type":"NDC"}],"standard_charges":[{"gross_charge":142.7,"discounted_cash":142.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN SODIUM 40 MG/0.4ML IJ SOSY","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00548560200","type":"NDC"}],"standard_charges":[{"gross_charge":141.64,"discounted_cash":141.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FONDAPARINUX SODIUM 2.5 MG/0.5ML SC SOLN","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"67457058210","type":"NDC"}],"standard_charges":[{"gross_charge":385.38,"discounted_cash":385.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DICYCLOMINE HCL 10 MG/ML IM SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"72266012705","type":"NDC"}],"standard_charges":[{"gross_charge":482.08,"discounted_cash":482.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BENZTROPINE MESYLATE 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0515","type":"HCPCS"},{"code":"68382086010","type":"NDC"}],"standard_charges":[{"gross_charge":224.58,"discounted_cash":224.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN SODIUM 40 MG/0.4ML IJ SOSY","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"16714001610","type":"NDC"}],"standard_charges":[{"gross_charge":300.79,"discounted_cash":300.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DESMOPRESSIN ACETATE PF 4 MCG/ML IJ SOLN","drug_information":{"unit":0.723,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"69918089910","type":"NDC"}],"standard_charges":[{"gross_charge":431.78,"discounted_cash":431.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXORUBICIN HCL LIPOSOMAL 2 MG/ML IV SUSP","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2050","type":"HCPCS"},{"code":"47335005040","type":"NDC"}],"standard_charges":[{"gross_charge":1879.32,"discounted_cash":1879.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE 1 MG/ML (50 ML) IN NACL PCA","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"73013104001","type":"NDC"}],"standard_charges":[{"gross_charge":1845.4,"discounted_cash":1845.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATROPINE SULFATE 1 MG/10ML IJ SOSY","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"00409163010","type":"NDC"}],"standard_charges":[{"gross_charge":385.62,"discounted_cash":385.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN","drug_information":{"unit":0.04,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"C9399","type":"HCPCS"},{"code":"71288050503","type":"NDC"}],"standard_charges":[{"gross_charge":326.31,"discounted_cash":326.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"68462075625","type":"NDC"}],"standard_charges":[{"gross_charge":340.4,"discounted_cash":340.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00641040012","type":"NDC"}],"standard_charges":[{"gross_charge":354.6,"discounted_cash":354.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288040302","type":"NDC"}],"standard_charges":[{"gross_charge":365.67,"discounted_cash":365.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"72485010105","type":"NDC"}],"standard_charges":[{"gross_charge":344.84,"discounted_cash":344.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL URETHRAL/MUCOSAL 2 % EX PRSY","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"76329301205","type":"NDC"}],"standard_charges":[{"gross_charge":55.74,"discounted_cash":55.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROTAMINE SULFATE 10 MG/ML IV SOLN","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2720","type":"HCPCS"},{"code":"63323022930","type":"NDC"}],"standard_charges":[{"gross_charge":402.74,"discounted_cash":402.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZOLEDRONIC ACID 4 MG/5ML IV CONC","drug_information":{"unit":3.125,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"43598023311","type":"NDC"}],"standard_charges":[{"gross_charge":416.81,"discounted_cash":416.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZOLEDRONIC ACID 4 MG/5ML IV CONC","drug_information":{"unit":1.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"55111068507","type":"NDC"}],"standard_charges":[{"gross_charge":375.85,"discounted_cash":375.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ORPHENADRINE CITRATE 30 MG/ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2360","type":"HCPCS"},{"code":"00641618210","type":"NDC"}],"standard_charges":[{"gross_charge":423.12,"discounted_cash":423.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"00143962125","type":"NDC"}],"standard_charges":[{"gross_charge":379.11,"discounted_cash":379.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COCAINE HCL 40 MG/ML NA SOLN","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"C9046","type":"HCPCS"},{"code":"70839036204","type":"NDC"}],"standard_charges":[{"gross_charge":749.24,"discounted_cash":749.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NALOXONE HCL 0.4 MG/ML IJ SOLN","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"00409121501","type":"NDC"}],"standard_charges":[{"gross_charge":377.07,"discounted_cash":377.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1050","type":"HCPCS"},{"code":"66993037083","type":"NDC"}],"standard_charges":[{"gross_charge":764.95,"discounted_cash":764.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":0.15,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2598","type":"HCPCS"},{"code":"00548970100","type":"NDC"}],"standard_charges":[{"gross_charge":70.22,"discounted_cash":70.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VINCRISTINE SULFATE 1 MG/ML IV SOLN","drug_information":{"unit":0.69,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9370","type":"HCPCS"},{"code":"61703030906","type":"NDC"}],"standard_charges":[{"gross_charge":105.84,"discounted_cash":105.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXORUBICIN HCL LIPOSOMAL 2 MG/ML IV SUSP","drug_information":{"unit":6.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2050","type":"HCPCS"},{"code":"70710153101","type":"NDC"}],"standard_charges":[{"gross_charge":1749.63,"discounted_cash":1749.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IBANDRONATE SODIUM 3 MG/3ML IV SOLN","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1740","type":"HCPCS"},{"code":"60505609700","type":"NDC"}],"standard_charges":[{"gross_charge":704.8,"discounted_cash":704.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN SODIUM 80 MG/0.8ML IJ SOSY","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"16714003610","type":"NDC"}],"standard_charges":[{"gross_charge":336.83,"discounted_cash":336.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN SODIUM 80 MG/0.8ML IJ SOSY","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00548560400","type":"NDC"}],"standard_charges":[{"gross_charge":374.35,"discounted_cash":374.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLORPROMAZINE HCL 50 MG/2ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3230","type":"HCPCS"},{"code":"00641139835","type":"NDC"}],"standard_charges":[{"gross_charge":524.54,"discounted_cash":524.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUMATRIPTAN SUCCINATE 6 MG/0.5ML SC SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3030","type":"HCPCS"},{"code":"63323027301","type":"NDC"}],"standard_charges":[{"gross_charge":950.38,"discounted_cash":950.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYOSCYAMINE SULFATE 0.5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1980","type":"HCPCS"},{"code":"54288011105","type":"NDC"}],"standard_charges":[{"gross_charge":1690.84,"discounted_cash":1690.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXORUBICIN HCL LIPOSOMAL 2 MG/ML IV SUSP","drug_information":{"unit":5.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2050","type":"HCPCS"},{"code":"70710153001","type":"NDC"}],"standard_charges":[{"gross_charge":1484.48,"discounted_cash":1484.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IBANDRONATE SODIUM 3 MG/3ML IV SOLN","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1740","type":"HCPCS"},{"code":"55150019183","type":"NDC"}],"standard_charges":[{"gross_charge":1850.95,"discounted_cash":1850.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN SODIUM 100 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"16714004610","type":"NDC"}],"standard_charges":[{"gross_charge":409.23,"discounted_cash":409.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FULVESTRANT 250 MG/5ML IM SOSY","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9394","type":"HCPCS"},{"code":"63323071505","type":"NDC"}],"standard_charges":[{"gross_charge":3581.62,"discounted_cash":3581.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN SODIUM 30 MG/0.3ML IJ SOSY","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00548560100","type":"NDC"}],"standard_charges":[{"gross_charge":108.73,"discounted_cash":108.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSY","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1050","type":"HCPCS"},{"code":"70121148001","type":"NDC"}],"standard_charges":[{"gross_charge":1351.27,"discounted_cash":1351.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN SODIUM 120 MG/0.8ML IJ SOSY","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"16714005610","type":"NDC"}],"standard_charges":[{"gross_charge":500.24,"discounted_cash":500.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DESMOPRESSIN ACETATE PF 4 MCG/ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"43598093109","type":"NDC"}],"standard_charges":[{"gross_charge":257.83,"discounted_cash":257.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROXYZINE HCL 50 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3410","type":"HCPCS"},{"code":"00517560125","type":"NDC"}],"standard_charges":[{"gross_charge":448.1,"discounted_cash":448.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COCAINE HCL 40 MG/ML NA SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"C9046","type":"HCPCS"},{"code":"81665030102","type":"NDC"}],"standard_charges":[{"gross_charge":1199.19,"discounted_cash":1199.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IBANDRONATE SODIUM 3 MG/3ML IV SOLN","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1740","type":"HCPCS"},{"code":"67457052433","type":"NDC"}],"standard_charges":[{"gross_charge":1126.99,"discounted_cash":1126.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHYTONADIONE 10 MG/ML IJ SOLN","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"43598040516","type":"NDC"}],"standard_charges":[{"gross_charge":175.64,"discounted_cash":175.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"REGADENOSON 0.4 MG/5ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"55150044301","type":"NDC"}],"standard_charges":[{"gross_charge":2612.62,"discounted_cash":2612.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BEVACIZUMAB 1.25 MG/0.05ML IZ SOSY","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"C9257","type":"HCPCS"},{"code":"71266800601","type":"NDC"}],"standard_charges":[{"gross_charge":452.25,"discounted_cash":452.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FOMEPIZOLE 1.5 GM/1.5ML IV SOLN","drug_information":{"unit":1.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1451","type":"HCPCS"},{"code":"70710147801","type":"NDC"}],"standard_charges":[{"gross_charge":5843.73,"discounted_cash":5843.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOSULFAN BLUE 1 % SC SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9968","type":"HCPCS"},{"code":"67457022005","type":"NDC"}],"standard_charges":[{"gross_charge":4099.5,"discounted_cash":4099.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCETAXEL 80 MG/4ML IV CONC","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"45963076552","type":"NDC"}],"standard_charges":[{"gross_charge":1009.77,"discounted_cash":1009.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN","drug_information":{"unit":0.38,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1071","type":"HCPCS"},{"code":"00574082001","type":"NDC"}],"standard_charges":[{"gross_charge":113.15,"discounted_cash":113.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2598","type":"HCPCS"},{"code":"63323093001","type":"NDC"}],"standard_charges":[{"gross_charge":371.01,"discounted_cash":371.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDRALAZINE HCL 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"55150040025","type":"NDC"}],"standard_charges":[{"gross_charge":198.66,"discounted_cash":198.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLORPROMAZINE HCL 25 MG/ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3230","type":"HCPCS"},{"code":"00641139735","type":"NDC"}],"standard_charges":[{"gross_charge":916.36,"discounted_cash":916.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE HCL PF 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"63323085225","type":"NDC"}],"standard_charges":[{"gross_charge":398.87,"discounted_cash":398.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"JUBBONTI 60 MG/ML SC SOSY","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5136","type":"HCPCS"},{"code":"61314024063","type":"NDC"}],"standard_charges":[{"gross_charge":28521.78,"discounted_cash":28521.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CETIRIZINE HCL CHILDRENS 5 MG/5ML PO SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"68094000462","type":"NDC"}],"standard_charges":[{"gross_charge":53.96,"discounted_cash":53.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DAPTOMYCIN 500 MG IV SOLR","drug_information":{"unit":2.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0878","type":"HCPCS"},{"code":"67457094115","type":"NDC"}],"standard_charges":[{"gross_charge":1187.68,"discounted_cash":1187.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZACITIDINE 100 MG IJ SUSR","drug_information":{"unit":0.44,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J9025","type":"HCPCS"},{"code":"43598046562","type":"NDC"}],"standard_charges":[{"gross_charge":141.71,"discounted_cash":141.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZACITIDINE 100 MG IJ SUSR","drug_information":{"unit":0.358,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J9025","type":"HCPCS"},{"code":"43598030562","type":"NDC"}],"standard_charges":[{"gross_charge":112.5,"discounted_cash":112.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BORTEZOMIB 3.5 MG IJ SOLR","drug_information":{"unit":0.057,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J9041","type":"HCPCS"},{"code":"43598042660","type":"NDC"}],"standard_charges":[{"gross_charge":34.56,"discounted_cash":34.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"25021014330","type":"NDC"}],"standard_charges":[{"gross_charge":361.58,"discounted_cash":361.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN HCL 1 G IV SOLR","drug_information":{"unit":0.5,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J3371","type":"HCPCS"},{"code":"67457034001","type":"NDC"}],"standard_charges":[{"gross_charge":382.69,"discounted_cash":382.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTAZIDIME 1 G IJ SOLR","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0713","type":"HCPCS"},{"code":"25021012720","type":"NDC"}],"standard_charges":[{"gross_charge":231.09,"discounted_cash":231.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN HCL 750 MG IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"00409653102","type":"NDC"}],"standard_charges":[{"gross_charge":221.7,"discounted_cash":221.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFOXITIN SODIUM 2 G IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0694","type":"HCPCS"},{"code":"25021011020","type":"NDC"}],"standard_charges":[{"gross_charge":173.22,"discounted_cash":173.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"68001050831","type":"NDC"}],"standard_charges":[{"gross_charge":83.92,"discounted_cash":83.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN HCL 750 MG IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"71288002421","type":"NDC"}],"standard_charges":[{"gross_charge":142.82,"discounted_cash":142.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZACITIDINE 100 MG IJ SUSR","drug_information":{"unit":0.35,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J9025","type":"HCPCS"},{"code":"00781349194","type":"NDC"}],"standard_charges":[{"gross_charge":96.78,"discounted_cash":96.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DAPTOMYCIN 500 MG IV SOLR","drug_information":{"unit":0.5,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0878","type":"HCPCS"},{"code":"72603015201","type":"NDC"}],"standard_charges":[{"gross_charge":161.92,"discounted_cash":161.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEROPENEM 2 G IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"44567040206","type":"NDC"}],"standard_charges":[{"gross_charge":533.85,"discounted_cash":533.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERTAPENEM SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"60505619604","type":"NDC"}],"standard_charges":[{"gross_charge":378.45,"discounted_cash":378.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFOXITIN SODIUM 2 G IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0694","type":"HCPCS"},{"code":"44567024625","type":"NDC"}],"standard_charges":[{"gross_charge":316.26,"discounted_cash":316.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"55150020210","type":"NDC"}],"standard_charges":[{"gross_charge":371.58,"discounted_cash":371.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"00781926195","type":"NDC"}],"standard_charges":[{"gross_charge":440.9,"discounted_cash":440.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"60505615704","type":"NDC"}],"standard_charges":[{"gross_charge":509.8,"discounted_cash":509.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN-SULBACTAM SODIUM 1.5 (1-0.5) G IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"55150011620","type":"NDC"}],"standard_charges":[{"gross_charge":457.3,"discounted_cash":457.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"68001050782","type":"NDC"}],"standard_charges":[{"gross_charge":61.22,"discounted_cash":61.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"72485040401","type":"NDC"}],"standard_charges":[{"gross_charge":55.31,"discounted_cash":55.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFEPIME HCL 1 G IJ SOLR","drug_information":{"unit":0.01,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"60505614604","type":"NDC"}],"standard_charges":[{"gross_charge":326.38,"discounted_cash":326.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEROPENEM 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"63323050720","type":"NDC"}],"standard_charges":[{"gross_charge":396.29,"discounted_cash":396.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFEPIME HCL 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"00409956610","type":"NDC"}],"standard_charges":[{"gross_charge":393.2,"discounted_cash":393.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEUCOVORIN CALCIUM 100 MG IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"25021081430","type":"NDC"}],"standard_charges":[{"gross_charge":99.61,"discounted_cash":99.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN HCL 750 MG IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"68462047774","type":"NDC"}],"standard_charges":[{"gross_charge":123.11,"discounted_cash":123.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEROPENEM 1 G IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"55150020830","type":"NDC"}],"standard_charges":[{"gross_charge":203.01,"discounted_cash":203.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"65219043620","type":"NDC"}],"standard_charges":[{"gross_charge":360.81,"discounted_cash":360.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"44567080310","type":"NDC"}],"standard_charges":[{"gross_charge":78.22,"discounted_cash":78.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEUCOVORIN CALCIUM 100 MG IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"67457052810","type":"NDC"}],"standard_charges":[{"gross_charge":99.36,"discounted_cash":99.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEUCOVORIN CALCIUM 50 MG IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"71288016010","type":"NDC"}],"standard_charges":[{"gross_charge":125.85,"discounted_cash":125.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZITHROMYCIN 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"55150017410","type":"NDC"}],"standard_charges":[{"gross_charge":376.12,"discounted_cash":376.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREVNAR 20 0.5 ML IM SUSY","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90677","type":"HCPCS"},{"code":"00005200002","type":"NDC"}],"standard_charges":[{"gross_charge":3994.49,"discounted_cash":3994.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POLOCAINE-MPF 1.5 % IJ SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0670","type":"HCPCS"},{"code":"63323029337","type":"NDC"}],"standard_charges":[{"gross_charge":356.12,"discounted_cash":356.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MENQUADFI 0.5 ML IM SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90734","type":"HCPCS"},{"code":"49281059005","type":"NDC"}],"standard_charges":[{"gross_charge":2910.46,"discounted_cash":2910.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BOOSTRIX 5-2.5-18.5 LF-MCG/0.5 IM SUSY","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90715","type":"HCPCS"},{"code":"58160084252","type":"NDC"}],"standard_charges":[{"gross_charge":759.45,"discounted_cash":759.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VAXNEUVANCE 0.5 ML IM SUSY","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90671","type":"HCPCS"},{"code":"00006432903","type":"NDC"}],"standard_charges":[{"gross_charge":3356.03,"discounted_cash":3356.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OPDIVO 120 MG/12ML IV SOLN","drug_information":{"unit":12.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9299","type":"HCPCS"},{"code":"00003375614","type":"NDC"}],"standard_charges":[{"gross_charge":8669.99,"discounted_cash":8669.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SENSORCAINE-MPF 0.75 % IJ SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323047237","type":"NDC"}],"standard_charges":[{"gross_charge":335.09,"discounted_cash":335.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MARCAINE 0.75 % IJ SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409158210","type":"NDC"}],"standard_charges":[{"gross_charge":414.18,"discounted_cash":414.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SIMPONI ARIA 50 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1602","type":"HCPCS"},{"code":"57894035001","type":"NDC"}],"standard_charges":[{"gross_charge":9150.24,"discounted_cash":9150.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INJECTAFER 750 MG/15ML IV SOLN","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1439","type":"HCPCS"},{"code":"00517065001","type":"NDC"}],"standard_charges":[{"gross_charge":1786.88,"discounted_cash":1786.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL CITRATE 2500 MCG/50ML IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"70092166474","type":"NDC"}],"standard_charges":[{"gross_charge":1241.65,"discounted_cash":1241.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KEDRAB 300 UNIT/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90377","type":"HCPCS"},{"code":"76125015002","type":"NDC"}],"standard_charges":[{"gross_charge":1311.69,"discounted_cash":1311.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ADRENALIN-NACL 4-0.9 MG/250ML-% IV SOLN","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0163","type":"HCPCS"},{"code":"42023031510","type":"NDC"}],"standard_charges":[{"gross_charge":200.13,"discounted_cash":200.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYPERRAB 300 UNIT/ML IJ SOLN","drug_information":{"unit":0.7,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90375","type":"HCPCS"},{"code":"13533031801","type":"NDC"}],"standard_charges":[{"gross_charge":2500.46,"discounted_cash":2500.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYPERRAB 1500 UNIT/5ML IJ SOLN","drug_information":{"unit":4.8,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90375","type":"HCPCS"},{"code":"13533031805","type":"NDC"}],"standard_charges":[{"gross_charge":15923.1,"discounted_cash":15923.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RETACRIT 2000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130510","type":"NDC"}],"standard_charges":[{"gross_charge":393.61,"discounted_cash":393.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RETACRIT 3000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130610","type":"NDC"}],"standard_charges":[{"gross_charge":585.42,"discounted_cash":585.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RETACRIT 4000 UNIT/ML IJ SOLN","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130710","type":"NDC"}],"standard_charges":[{"gross_charge":228.53,"discounted_cash":228.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RETACRIT 10000 UNIT/ML IJ SOLN","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130810","type":"NDC"}],"standard_charges":[{"gross_charge":580.66,"discounted_cash":580.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RETACRIT 40000 UNIT/ML IJ SOLN","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130904","type":"NDC"}],"standard_charges":[{"gross_charge":1823.02,"discounted_cash":1823.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPINEPHRINE 1 MG/10ML IV SOSY","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0171","type":"HCPCS"},{"code":"76329331801","type":"NDC"}],"standard_charges":[{"gross_charge":248.8,"discounted_cash":248.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FULPHILA 6 MG/0.6ML SC SOSY","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5108","type":"HCPCS"},{"code":"83257000541","type":"NDC"}],"standard_charges":[{"gross_charge":29281.78,"discounted_cash":29281.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM-SODIUM CHLORIDE 50-0.9 MG/50ML-% IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2251","type":"HCPCS"},{"code":"00143937910","type":"NDC"}],"standard_charges":[{"gross_charge":73.6,"discounted_cash":73.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"60505615904","type":"NDC"}],"standard_charges":[{"gross_charge":370.26,"discounted_cash":370.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTAZIDIME 1 G IJ SOLR","drug_information":{"unit":2.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0713","type":"HCPCS"},{"code":"44567023525","type":"NDC"}],"standard_charges":[{"gross_charge":138.06,"discounted_cash":138.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE SODIUM 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"00409733503","type":"NDC"}],"standard_charges":[{"gross_charge":393.69,"discounted_cash":393.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEROPENEM 1 G IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"72485041210","type":"NDC"}],"standard_charges":[{"gross_charge":109.17,"discounted_cash":109.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFEPIME HCL 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"44567024010","type":"NDC"}],"standard_charges":[{"gross_charge":107.15,"discounted_cash":107.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEROPENEM 1 G IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"63323050825","type":"NDC"}],"standard_charges":[{"gross_charge":410.59,"discounted_cash":410.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXACILLIN SODIUM 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2700","type":"HCPCS"},{"code":"63323081220","type":"NDC"}],"standard_charges":[{"gross_charge":135.42,"discounted_cash":135.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREVNAR 20 0.5 ML IM SUSY","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90677","type":"HCPCS"},{"code":"00005200010","type":"NDC"}],"standard_charges":[{"gross_charge":4015.16,"discounted_cash":4015.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN HCL 750 MG IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"63323020326","type":"NDC"}],"standard_charges":[{"gross_charge":126.69,"discounted_cash":126.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFEPIME HCL 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"25021012120","type":"NDC"}],"standard_charges":[{"gross_charge":115.46,"discounted_cash":115.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"70095002403","type":"NDC"}],"standard_charges":[{"gross_charge":419.85,"discounted_cash":419.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE SODIUM 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"25021010720","type":"NDC"}],"standard_charges":[{"gross_charge":418.68,"discounted_cash":418.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"00641611710","type":"NDC"}],"standard_charges":[{"gross_charge":374.73,"discounted_cash":374.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEROPENEM 1 G IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"00409341210","type":"NDC"}],"standard_charges":[{"gross_charge":404.61,"discounted_cash":404.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEROPENEM 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"55150020720","type":"NDC"}],"standard_charges":[{"gross_charge":115.29,"discounted_cash":115.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"44567080210","type":"NDC"}],"standard_charges":[{"gross_charge":56.94,"discounted_cash":56.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEROPENEM 1 G IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"00781309895","type":"NDC"}],"standard_charges":[{"gross_charge":109.6,"discounted_cash":109.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN SODIUM 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"00781927395","type":"NDC"}],"standard_charges":[{"gross_charge":357.13,"discounted_cash":357.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN SODIUM 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"00781340895","type":"NDC"}],"standard_charges":[{"gross_charge":357.13,"discounted_cash":357.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"70095002402","type":"NDC"}],"standard_charges":[{"gross_charge":420.03,"discounted_cash":420.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFOXITIN SODIUM 1 G IV SOLR","drug_information":{"unit":2.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0694","type":"HCPCS"},{"code":"25021010910","type":"NDC"}],"standard_charges":[{"gross_charge":181.07,"discounted_cash":181.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEROPENEM 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"00781300095","type":"NDC"}],"standard_charges":[{"gross_charge":391.64,"discounted_cash":391.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFOXITIN SODIUM 2 G IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0694","type":"HCPCS"},{"code":"63323034225","type":"NDC"}],"standard_charges":[{"gross_charge":137.42,"discounted_cash":137.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"81284015310","type":"NDC"}],"standard_charges":[{"gross_charge":55.17,"discounted_cash":55.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEROPENEM 1 G IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"63323050830","type":"NDC"}],"standard_charges":[{"gross_charge":139.46,"discounted_cash":139.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEUCOVORIN CALCIUM 200 MG IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"00143955301","type":"NDC"}],"standard_charges":[{"gross_charge":194.73,"discounted_cash":194.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEFEROXAMINE MESYLATE 500 MG IJ SOLR (95 MG/ML WET VIAL)","drug_information":{"unit":2.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0895","type":"HCPCS"},{"code":"60505623606","type":"NDC"}],"standard_charges":[{"gross_charge":414.38,"discounted_cash":414.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEUCOVORIN CALCIUM 350 MG/17.5 ML (20 MG/ML) IJ WET SOLR VIAL","drug_information":{"unit":0.137,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"00143955201","type":"NDC"}],"standard_charges":[{"gross_charge":68.51,"discounted_cash":68.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEUCOVORIN CALCIUM 100 MG IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"71288016120","type":"NDC"}],"standard_charges":[{"gross_charge":228.08,"discounted_cash":228.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN HCL 1 G IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"70594012302","type":"NDC"}],"standard_charges":[{"gross_charge":384.26,"discounted_cash":384.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"55150012030","type":"NDC"}],"standard_charges":[{"gross_charge":358.42,"discounted_cash":358.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROTONIX 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"00008092355","type":"NDC"}],"standard_charges":[{"gross_charge":384.22,"discounted_cash":384.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZYNRELEF 200-6 MG/7ML IJ SOLN","drug_information":{"unit":7.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0668","type":"HCPCS"},{"code":"47426030301","type":"NDC"}],"standard_charges":[{"gross_charge":2707.64,"discounted_cash":2707.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CATHFLO ACTIVASE 2 MG IJ SOLR","drug_information":{"unit":0.5,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2997","type":"HCPCS"},{"code":"50242004110","type":"NDC"}],"standard_charges":[{"gross_charge":1882.24,"discounted_cash":1882.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CATHFLO ACTIVASE 2 MG IJ SOLR","drug_information":{"unit":0.5,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2997","type":"HCPCS"},{"code":"50242004164","type":"NDC"}],"standard_charges":[{"gross_charge":1882.36,"discounted_cash":1882.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZITHROMAX 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"00069315083","type":"NDC"}],"standard_charges":[{"gross_charge":358.87,"discounted_cash":358.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"UNASYN 1.5 (1-0.5) G IJ SOLR","drug_information":{"unit":2.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"00049001383","type":"NDC"}],"standard_charges":[{"gross_charge":371.3,"discounted_cash":371.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"UNASYN 3 (2-1) G IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"00049001483","type":"NDC"}],"standard_charges":[{"gross_charge":375.83,"discounted_cash":375.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"XYLOCAINE/EPINEPHRINE 1 %-1:100000 IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"63323048227","type":"NDC"}],"standard_charges":[{"gross_charge":329.41,"discounted_cash":329.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEROPENEM 1 G IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"00143943110","type":"NDC"}],"standard_charges":[{"gross_charge":396.45,"discounted_cash":396.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN HCL 750 MG IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"63323020320","type":"NDC"}],"standard_charges":[{"gross_charge":126.69,"discounted_cash":126.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"00781311395","type":"NDC"}],"standard_charges":[{"gross_charge":370.97,"discounted_cash":370.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MICAFUNGIN SODIUM 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2248","type":"HCPCS"},{"code":"16714030110","type":"NDC"}],"standard_charges":[{"gross_charge":586.45,"discounted_cash":586.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN SODIUM 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"55150011420","type":"NDC"}],"standard_charges":[{"gross_charge":56.1,"discounted_cash":56.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"55150012150","type":"NDC"}],"standard_charges":[{"gross_charge":75.34,"discounted_cash":75.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DAPTOMYCIN 350 MG IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0878","type":"HCPCS"},{"code":"71839010801","type":"NDC"}],"standard_charges":[{"gross_charge":269.14,"discounted_cash":269.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BORTEZOMIB 3.5 MG IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J9041","type":"HCPCS"},{"code":"72603027001","type":"NDC"}],"standard_charges":[{"gross_charge":133.39,"discounted_cash":133.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MICAFUNGIN SODIUM 100 MG IV SOLR","drug_information":{"unit":1.5,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2248","type":"HCPCS"},{"code":"63323072912","type":"NDC"}],"standard_charges":[{"gross_charge":841.13,"discounted_cash":841.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZACITIDINE 100 MG IJ SUSR","drug_information":{"unit":0.35,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J9025","type":"HCPCS"},{"code":"72485020101","type":"NDC"}],"standard_charges":[{"gross_charge":126.52,"discounted_cash":126.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERTAPENEM SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"43598090158","type":"NDC"}],"standard_charges":[{"gross_charge":422.59,"discounted_cash":422.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DAPTOMYCIN 500 MG IV SOLR","drug_information":{"unit":0.1,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0878","type":"HCPCS"},{"code":"71839010701","type":"NDC"}],"standard_charges":[{"gross_charge":380.94,"discounted_cash":380.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"72603012810","type":"NDC"}],"standard_charges":[{"gross_charge":335.5,"discounted_cash":335.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEUCOVORIN CALCIUM 200 MG IJ SOLR","drug_information":{"unit":0.75,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"71288016230","type":"NDC"}],"standard_charges":[{"gross_charge":154.42,"discounted_cash":154.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZACITIDINE 100 MG IJ SUSR","drug_information":{"unit":0.302,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J9025","type":"HCPCS"},{"code":"16729030610","type":"NDC"}],"standard_charges":[{"gross_charge":185.36,"discounted_cash":185.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DAPTOMYCIN 350 MG IV SOLR","drug_information":{"unit":0.286,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0878","type":"HCPCS"},{"code":"71288001715","type":"NDC"}],"standard_charges":[{"gross_charge":426.95,"discounted_cash":426.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAZOLAMIDE SODIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J1120","type":"HCPCS"},{"code":"00143950301","type":"NDC"}],"standard_charges":[{"gross_charge":263.68,"discounted_cash":263.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BORTEZOMIB 3.5 MG IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J9041","type":"HCPCS"},{"code":"55150033701","type":"NDC"}],"standard_charges":[{"gross_charge":386.84,"discounted_cash":386.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE SODIUM-DEXTROSE 2-2.22 GM-%(50ML) IV SOLR","drug_information":{"unit":0.5,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"00264315511","type":"NDC"}],"standard_charges":[{"gross_charge":96.04,"discounted_cash":96.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERTAPENEM SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"25021019920","type":"NDC"}],"standard_charges":[{"gross_charge":317.34,"discounted_cash":317.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DAPTOMYCIN 500 MG IV SOLR","drug_information":{"unit":0.1,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0878","type":"HCPCS"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"gross_charge":396.29,"discounted_cash":396.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZACITIDINE 100 MG IJ SUSR","drug_information":{"unit":1.365,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J9025","type":"HCPCS"},{"code":"00143960601","type":"NDC"}],"standard_charges":[{"gross_charge":207.14,"discounted_cash":207.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEUCOVORIN CALCIUM 350 MG/17.5 ML (20 MG/ML) IJ WET SOLR VIAL","drug_information":{"unit":0.16,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"71288016330","type":"NDC"}],"standard_charges":[{"gross_charge":78.32,"discounted_cash":78.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DAPTOMYCIN 500 MG IV SOLR","drug_information":{"unit":0.1,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0878","type":"HCPCS"},{"code":"43598041311","type":"NDC"}],"standard_charges":[{"gross_charge":372.3,"discounted_cash":372.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BORTEZOMIB 3.5 MG IJ SOLR","drug_information":{"unit":0.057,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J9041","type":"HCPCS"},{"code":"71288011810","type":"NDC"}],"standard_charges":[{"gross_charge":36.7,"discounted_cash":36.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DAPTOMYCIN 350 MG IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0878","type":"HCPCS"},{"code":"72603014701","type":"NDC"}],"standard_charges":[{"gross_charge":310.72,"discounted_cash":310.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MITOMYCIN 20 MG IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J9280","type":"HCPCS"},{"code":"72819015302","type":"NDC"}],"standard_charges":[{"gross_charge":551.22,"discounted_cash":551.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZACITIDINE 100 MG IJ SUSR","drug_information":{"unit":0.358,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J9025","type":"HCPCS"},{"code":"60505627101","type":"NDC"}],"standard_charges":[{"gross_charge":216.35,"discounted_cash":216.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAZOLAMIDE SODIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J1120","type":"HCPCS"},{"code":"39822019001","type":"NDC"}],"standard_charges":[{"gross_charge":578.26,"discounted_cash":578.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN HCL 2 G IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"72078006699","type":"NDC"}],"standard_charges":[{"gross_charge":823.16,"discounted_cash":823.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEUCOVORIN CALCIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"71288016450","type":"NDC"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":239.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZACITIDINE 100 MG IJ SUSR","drug_information":{"unit":0.4,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J9025","type":"HCPCS"},{"code":"71288011530","type":"NDC"}],"standard_charges":[{"gross_charge":210.7,"discounted_cash":210.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERTAPENEM SODIUM 1 G IJ SOLR","drug_information":{"unit":0.5,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"00409351022","type":"NDC"}],"standard_charges":[{"gross_charge":326.64,"discounted_cash":326.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEROPENEM 1 G IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"00409139122","type":"NDC"}],"standard_charges":[{"gross_charge":404.61,"discounted_cash":404.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WYOST 120 MG/1.7ML SC SOLN","drug_information":{"unit":1.7,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5136","type":"HCPCS"},{"code":"61314022894","type":"NDC"}],"standard_charges":[{"gross_charge":53983.3,"discounted_cash":53983.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMIODARONE HCL 150 MG/3ML IV SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"67457015303","type":"NDC"}],"standard_charges":[{"gross_charge":409.08,"discounted_cash":409.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMIODARONE HCL 150 MG/3ML IV SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"00143987510","type":"NDC"}],"standard_charges":[{"gross_charge":377.92,"discounted_cash":377.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 200 MG/10ML IV SOSY","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"69374091910","type":"NDC"}],"standard_charges":[{"gross_charge":331.93,"discounted_cash":331.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 200 MG/10ML IV SOSY","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"71266200102","type":"NDC"}],"standard_charges":[{"gross_charge":1145.05,"discounted_cash":1145.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 200 MG/10ML IV SOSY","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"71266200108","type":"NDC"}],"standard_charges":[{"gross_charge":616.9,"discounted_cash":616.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 200 MG/10ML IV SOSY","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"70092108746","type":"NDC"}],"standard_charges":[{"gross_charge":163.12,"discounted_cash":163.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TECENTRIQ 1200 MG/20ML IV SOLN","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9022","type":"HCPCS"},{"code":"50242091701","type":"NDC"}],"standard_charges":[{"gross_charge":24000.18,"discounted_cash":24000.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL (CARDIAC) PF 100 MG/5ML IV SOSY","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409132305","type":"NDC"}],"standard_charges":[{"gross_charge":386.0,"discounted_cash":386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL 100 MG/5ML IJ SOSY","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"76329339001","type":"NDC"}],"standard_charges":[{"gross_charge":425.23,"discounted_cash":425.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUAD 0.5 ML IM SUSY","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90653","type":"HCPCS"},{"code":"70461002503","type":"NDC"}],"standard_charges":[{"gross_charge":1064.73,"discounted_cash":1064.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLENE BLUE 50 MG/10ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9968","type":"HCPCS"},{"code":"70710183805","type":"NDC"}],"standard_charges":[{"gross_charge":3266.6,"discounted_cash":3266.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROVAYBLUE 50 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9968","type":"HCPCS"},{"code":"00517037405","type":"NDC"}],"standard_charges":[{"gross_charge":203.01,"discounted_cash":203.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROVAYBLUE 50 MG/10ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9968","type":"HCPCS"},{"code":"00517038105","type":"NDC"}],"standard_charges":[{"gross_charge":1823.77,"discounted_cash":1823.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NESACAINE-MPF 3 % IJ SOLN","drug_information":{"unit":1.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2401","type":"HCPCS"},{"code":"63323047827","type":"NDC"}],"standard_charges":[{"gross_charge":371.37,"discounted_cash":371.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE HCL-NACL 10-0.9 MG/50ML-% IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"70092128674","type":"NDC"}],"standard_charges":[{"gross_charge":304.45,"discounted_cash":304.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE HCL-NACL 20-0.9 MG/100ML-% IJ SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"70092111675","type":"NDC"}],"standard_charges":[{"gross_charge":252.45,"discounted_cash":252.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EOVIST 0.25 MMOL/ML IV SOLN","drug_information":{"unit":4.5,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"A9581","type":"HCPCS"},{"code":"50419032005","type":"NDC"}],"standard_charges":[{"gross_charge":198.08,"discounted_cash":198.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARDENE IV 20-0.86 MG/200ML-% IV SOLN","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"J2404","type":"HCPCS"},{"code":"43066002610","type":"NDC"}],"standard_charges":[{"gross_charge":228.4,"discounted_cash":228.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NICARDIPINE HCL IN NACL 40-0.9 MG/200ML-% IV SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2404","type":"HCPCS"},{"code":"00143963310","type":"NDC"}],"standard_charges":[{"gross_charge":335.92,"discounted_cash":335.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOTAREM 10 MMOL/20ML IV SOLN","drug_information":{"unit":9.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"A9575","type":"HCPCS"},{"code":"67684200103","type":"NDC"}],"standard_charges":[{"gross_charge":33.25,"discounted_cash":33.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TEVIMBRA 100 MG/10ML IV SOLN","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9329","type":"HCPCS"},{"code":"72579012101","type":"NDC"}],"standard_charges":[{"gross_charge":23821.18,"discounted_cash":23821.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"L.E.T. (RACEPINEPHRINE) 4-0.05-0.5 % EX SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"70092165844","type":"NDC"}],"standard_charges":[{"gross_charge":124.06,"discounted_cash":124.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TREMFYA 200 MG/20ML IV SOLN","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1628","type":"HCPCS"},{"code":"57894065002","type":"NDC"}],"standard_charges":[{"gross_charge":260827.18,"discounted_cash":260827.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TECENTRIQ HYBREZA 1875-30000 MG-UT/15ML SC SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9024","type":"HCPCS"},{"code":"50242093301","type":"NDC"}],"standard_charges":[{"gross_charge":23812.67,"discounted_cash":23812.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZYVOX 600 MG/300ML IV SOLN","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"00009514004","type":"NDC"}],"standard_charges":[{"gross_charge":89.2,"discounted_cash":89.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZYVOX 600 MG/300ML IV SOLN","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"00009780702","type":"NDC"}],"standard_charges":[{"gross_charge":89.2,"discounted_cash":89.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYKLOKAPRON 1000 MG/10ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3290","type":"HCPCS"},{"code":"00013111421","type":"NDC"}],"standard_charges":[{"gross_charge":165.76,"discounted_cash":165.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN HCL 1 G IV SOLR","drug_information":{"unit":0.25,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"63323028426","type":"NDC"}],"standard_charges":[{"gross_charge":344.44,"discounted_cash":344.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENICILLIN G POTASSIUM 5000000 UNITS IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2540","type":"HCPCS"},{"code":"44567031110","type":"NDC"}],"standard_charges":[{"gross_charge":428.43,"discounted_cash":428.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"00781311495","type":"NDC"}],"standard_charges":[{"gross_charge":388.23,"discounted_cash":388.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"55150011710","type":"NDC"}],"standard_charges":[{"gross_charge":367.4,"discounted_cash":367.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 200 MG/10ML IV SOSY","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"73177011603","type":"NDC"}],"standard_charges":[{"gross_charge":291.4,"discounted_cash":291.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"55150011720","type":"NDC"}],"standard_charges":[{"gross_charge":367.4,"discounted_cash":367.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPRIVAN 1000 MG/100ML IV EMUL","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323026965","type":"NDC"}],"standard_charges":[{"gross_charge":430.8,"discounted_cash":430.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERAHEME 510 MG/17ML IV SOLN","drug_information":{"unit":17.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q0138","type":"HCPCS"},{"code":"59338077501","type":"NDC"}],"standard_charges":[{"gross_charge":956.52,"discounted_cash":956.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SYNVISC 16 MG/2ML IX SOSY","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7325","type":"HCPCS"},{"code":"58468009001","type":"NDC"}],"standard_charges":[{"gross_charge":8363.35,"discounted_cash":8363.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SYNVISC ONE 48 MG/6ML IX SOSY","drug_information":{"unit":6.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7325","type":"HCPCS"},{"code":"58468009003","type":"NDC"}],"standard_charges":[{"gross_charge":23348.31,"discounted_cash":23348.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GRANIX 300 MCG/0.5ML SC SOSY","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1447","type":"HCPCS"},{"code":"63459091036","type":"NDC"}],"standard_charges":[{"gross_charge":4587.52,"discounted_cash":4587.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GRANIX 300 MCG/0.5ML SC SOSY","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1447","type":"HCPCS"},{"code":"63459091017","type":"NDC"}],"standard_charges":[{"gross_charge":4587.67,"discounted_cash":4587.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GRANIX 300 MCG/0.5ML SC SOSY","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1447","type":"HCPCS"},{"code":"63459091011","type":"NDC"}],"standard_charges":[{"gross_charge":2533.2,"discounted_cash":2533.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GRANIX 480 MCG/0.8ML SC SOSY","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1447","type":"HCPCS"},{"code":"63459091211","type":"NDC"}],"standard_charges":[{"gross_charge":4033.64,"discounted_cash":4033.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GRANIX 480 MCG/0.8ML SC SOSY","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1447","type":"HCPCS"},{"code":"63459091217","type":"NDC"}],"standard_charges":[{"gross_charge":7299.54,"discounted_cash":7299.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GAZYVA 1000 MG/40ML IV SOLN","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9301","type":"HCPCS"},{"code":"50242007001","type":"NDC"}],"standard_charges":[{"gross_charge":1854.05,"discounted_cash":1854.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOTAREM 5 MMOL/10ML IV SOLN","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"A9575","type":"HCPCS"},{"code":"67684200101","type":"NDC"}],"standard_charges":[{"gross_charge":57.64,"discounted_cash":57.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOTAREM 7.5 MMOL/15ML IV SOLN","drug_information":{"unit":14.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"A9575","type":"HCPCS"},{"code":"67684200102","type":"NDC"}],"standard_charges":[{"gross_charge":43.39,"discounted_cash":43.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOTAREM 7.5 MMOL/15ML IV SOSY","drug_information":{"unit":8.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"A9575","type":"HCPCS"},{"code":"67684300102","type":"NDC"}],"standard_charges":[{"gross_charge":44.8,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOTAREM 10 MMOL/20ML IV SOSY","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"A9575","type":"HCPCS"},{"code":"67684300103","type":"NDC"}],"standard_charges":[{"gross_charge":73.87,"discounted_cash":73.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AVEED 750 MG/3ML IM SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3145","type":"HCPCS"},{"code":"67979051143","type":"NDC"}],"standard_charges":[{"gross_charge":15920.24,"discounted_cash":15920.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEFINITY 6.52 MG/ML IV SUSP","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9957","type":"HCPCS"},{"code":"11994001116","type":"NDC"}],"standard_charges":[{"gross_charge":130.12,"discounted_cash":130.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MONOVISC 88 MG/4ML IX SOSY","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7327","type":"HCPCS"},{"code":"59676082001","type":"NDC"}],"standard_charges":[{"gross_charge":11014.42,"discounted_cash":11014.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYRAMZA 100 MG/10ML IV SOLN","drug_information":{"unit":7.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9308","type":"HCPCS"},{"code":"00002766901","type":"NDC"}],"standard_charges":[{"gross_charge":2569.14,"discounted_cash":2569.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYRAMZA 500 MG/50ML IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9308","type":"HCPCS"},{"code":"00002767801","type":"NDC"}],"standard_charges":[{"gross_charge":16043.15,"discounted_cash":16043.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ORTHOVISC 30 MG/2ML IX SOSY","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7324","type":"HCPCS"},{"code":"59676036001","type":"NDC"}],"standard_charges":[{"gross_charge":8756.08,"discounted_cash":8756.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SARCLISA 100 MG/5ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9227","type":"HCPCS"},{"code":"00024065401","type":"NDC"}],"standard_charges":[{"gross_charge":2106.3,"discounted_cash":2106.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SARCLISA 500 MG/25ML IV SOLN","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9227","type":"HCPCS"},{"code":"00024065601","type":"NDC"}],"standard_charges":[{"gross_charge":8224.08,"discounted_cash":8224.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DARZALEX FASPRO 1800-30000 MG-UT/15ML SC SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9144","type":"HCPCS"},{"code":"57894050301","type":"NDC"}],"standard_charges":[{"gross_charge":21251.05,"discounted_cash":21251.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NYVEPRIA 6 MG/0.6ML SC SOSY","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5122","type":"HCPCS"},{"code":"00069032401","type":"NDC"}],"standard_charges":[{"gross_charge":31253.52,"discounted_cash":31253.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHESGO 60-60-2000 MG-MG-U/ML SC SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9316","type":"HCPCS"},{"code":"50242026001","type":"NDC"}],"standard_charges":[{"gross_charge":167001.95,"discounted_cash":167001.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHESGO 80-40-2000 MG-MG-U/ML SC SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9316","type":"HCPCS"},{"code":"50242024501","type":"NDC"}],"standard_charges":[{"gross_charge":229700.34,"discounted_cash":229700.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ULTOMIRIS 300 MG/3ML IV SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1303","type":"HCPCS"},{"code":"25682002501","type":"NDC"}],"standard_charges":[{"gross_charge":120469.24,"discounted_cash":120469.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AFLURIA PRESERVATIVE FREE 0.5 ML IM SUSY","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90656","type":"HCPCS"},{"code":"33332002503","type":"NDC"}],"standard_charges":[{"gross_charge":305.87,"discounted_cash":305.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OPDIVO QVANTIG 600-10000 MG-UT/5ML SC SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9289","type":"HCPCS"},{"code":"00003612001","type":"NDC"}],"standard_charges":[{"gross_charge":16980.81,"discounted_cash":16980.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GUAIFENESIN 200 MG/10ML PO LIQD","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"60687086356","type":"NDC"}],"standard_charges":[{"gross_charge":14.87,"discounted_cash":14.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SOLIRIS 300 MG/30ML IV SOLN","drug_information":{"unit":90.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1300","type":"HCPCS"},{"code":"25682000101","type":"NDC"}],"standard_charges":[{"gross_charge":368102.89,"discounted_cash":368102.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPRIVAN 1000 MG/100ML IV EMUL","drug_information":{"unit":1.264,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323026969","type":"NDC"}],"standard_charges":[{"gross_charge":328.02,"discounted_cash":328.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMIODARONE HCL 150 MG/3ML IV SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"63323061603","type":"NDC"}],"standard_charges":[{"gross_charge":390.66,"discounted_cash":390.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN HCL 750 MG IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"25021014720","type":"NDC"}],"standard_charges":[{"gross_charge":126.26,"discounted_cash":126.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DAPTOMYCIN 350 MG IV SOLR","drug_information":{"unit":0.286,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0873","type":"HCPCS"},{"code":"70594005301","type":"NDC"}],"standard_charges":[{"gross_charge":401.07,"discounted_cash":401.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"00781320895","type":"NDC"}],"standard_charges":[{"gross_charge":369.21,"discounted_cash":369.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFEPIME HCL 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"60505624504","type":"NDC"}],"standard_charges":[{"gross_charge":385.01,"discounted_cash":385.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"72485041710","type":"NDC"}],"standard_charges":[{"gross_charge":361.93,"discounted_cash":361.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"JEVTANA 60 MG/1.5ML IV SOLN","drug_information":{"unit":0.467,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J9043","type":"HCPCS"},{"code":"00024582411","type":"NDC"}],"standard_charges":[{"gross_charge":13203.75,"discounted_cash":13203.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERYTHROCIN LACTOBIONATE 500 MG IV SOLR","drug_information":{"unit":0.2,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J1364","type":"HCPCS"},{"code":"00409648201","type":"NDC"}],"standard_charges":[{"gross_charge":240.87,"discounted_cash":240.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEROL SULFATE 2.5 MG/0.5ML IN NEBU","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"259","type":"RC"},{"code":"00487990130","type":"NDC"}],"standard_charges":[{"gross_charge":43.37,"discounted_cash":43.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"60505614804","type":"NDC"}],"standard_charges":[{"gross_charge":354.36,"discounted_cash":354.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE SODIUM 250 MG IJ SOLR","drug_information":{"unit":2.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"00409733701","type":"NDC"}],"standard_charges":[{"gross_charge":372.95,"discounted_cash":372.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"25021075110","type":"NDC"}],"standard_charges":[{"gross_charge":376.01,"discounted_cash":376.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEROPENEM 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"00409022210","type":"NDC"}],"standard_charges":[{"gross_charge":376.01,"discounted_cash":376.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEROPENEM 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"00409139051","type":"NDC"}],"standard_charges":[{"gross_charge":376.01,"discounted_cash":376.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE SODIUM 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"60505614904","type":"NDC"}],"standard_charges":[{"gross_charge":392.36,"discounted_cash":392.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE SODIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"00409733801","type":"NDC"}],"standard_charges":[{"gross_charge":360.67,"discounted_cash":360.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE SODIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"60505615201","type":"NDC"}],"standard_charges":[{"gross_charge":345.62,"discounted_cash":345.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZITHROMYCIN 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"63323039814","type":"NDC"}],"standard_charges":[{"gross_charge":476.7,"discounted_cash":476.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FETROJA 1 G IV SOLR","drug_information":{"unit":0.25,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0699","type":"HCPCS"},{"code":"59630026610","type":"NDC"}],"standard_charges":[{"gross_charge":1126.97,"discounted_cash":1126.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFAZOLIN SODIUM 2 G IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0688","type":"HCPCS"},{"code":"00143913925","type":"NDC"}],"standard_charges":[{"gross_charge":397.05,"discounted_cash":397.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFAZOLIN SODIUM 2 G IJ SOLR","drug_information":{"unit":0.5,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"60505623105","type":"NDC"}],"standard_charges":[{"gross_charge":379.94,"discounted_cash":379.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFAZOLIN SODIUM 2 G IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0687","type":"HCPCS"},{"code":"44567084025","type":"NDC"}],"standard_charges":[{"gross_charge":404.51,"discounted_cash":404.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROTONIX 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"00008400110","type":"NDC"}],"standard_charges":[{"gross_charge":384.22,"discounted_cash":384.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE-PRILOCAINE 2.5-2.5 % EX CREA","drug_information":{"unit":5.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"81033002551","type":"NDC"}],"standard_charges":[{"gross_charge":81.2,"discounted_cash":81.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE-PRILOCAINE 2.5-2.5 % EX CREA","drug_information":{"unit":1.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"81033002550","type":"NDC"}],"standard_charges":[{"gross_charge":43.88,"discounted_cash":43.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DESITIN 40 % EX PSTE","drug_information":{"unit":114.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"69968006102","type":"NDC"}],"standard_charges":[{"gross_charge":99.89,"discounted_cash":99.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERYTHROMYCIN 5 MG/GM OP OINT","drug_information":{"unit":1.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"72485067031","type":"NDC"}],"standard_charges":[{"gross_charge":59.39,"discounted_cash":59.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":1.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"81033003250","type":"NDC"}],"standard_charges":[{"gross_charge":40.84,"discounted_cash":40.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"JEMPERLI 500 MG/10ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9272","type":"HCPCS"},{"code":"00173089803","type":"NDC"}],"standard_charges":[{"gross_charge":26087.47,"discounted_cash":26087.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RYBREVANT 350 MG/7ML IV SOLN","drug_information":{"unit":7.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9061","type":"HCPCS"},{"code":"57894050101","type":"NDC"}],"standard_charges":[{"gross_charge":7792.53,"discounted_cash":7792.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZYNRELEF 400-12 MG/14ML IJ SOLN","drug_information":{"unit":14.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0668","type":"HCPCS"},{"code":"47426050102","type":"NDC"}],"standard_charges":[{"gross_charge":5465.93,"discounted_cash":5465.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMIODARONE HCL 150 MG/3ML IV SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"00143987525","type":"NDC"}],"standard_charges":[{"gross_charge":353.17,"discounted_cash":353.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE SODIUM 1 G IJ SOLR","drug_information":{"unit":0.5,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"44567070125","type":"NDC"}],"standard_charges":[{"gross_charge":350.5,"discounted_cash":350.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DAPTOMYCIN 500 MG IV SOLR","drug_information":{"unit":0.9,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0878","type":"HCPCS"},{"code":"67457081350","type":"NDC"}],"standard_charges":[{"gross_charge":238.96,"discounted_cash":238.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE SODIUM 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"44567070295","type":"NDC"}],"standard_charges":[{"gross_charge":387.71,"discounted_cash":387.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE SODIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"44567070025","type":"NDC"}],"standard_charges":[{"gross_charge":355.71,"discounted_cash":355.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAZOLAMIDE SODIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J1120","type":"HCPCS"},{"code":"23155083131","type":"NDC"}],"standard_charges":[{"gross_charge":224.2,"discounted_cash":224.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEUCOVORIN CALCIUM 50 MG IJ SOLR","drug_information":{"unit":0.5,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"00143955501","type":"NDC"}],"standard_charges":[{"gross_charge":92.64,"discounted_cash":92.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DAPTOMYCIN 500 MG IV SOLR","drug_information":{"unit":0.7,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0878","type":"HCPCS"},{"code":"60505622904","type":"NDC"}],"standard_charges":[{"gross_charge":207.4,"discounted_cash":207.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DAPTOMYCIN 500 MG IV SOLR","drug_information":{"unit":0.4,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0873","type":"HCPCS"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"gross_charge":115.6,"discounted_cash":115.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DAPTOMYCIN 500 MG IV SOLR","drug_information":{"unit":0.1,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0873","type":"HCPCS"},{"code":"70594003402","type":"NDC"}],"standard_charges":[{"gross_charge":364.49,"discounted_cash":364.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN HCL 1 G IV SOLR","drug_information":{"unit":0.25,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"00409653321","type":"NDC"}],"standard_charges":[{"gross_charge":348.97,"discounted_cash":348.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"65219025945","type":"NDC"}],"standard_charges":[{"gross_charge":374.12,"discounted_cash":374.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"63323034610","type":"NDC"}],"standard_charges":[{"gross_charge":124.19,"discounted_cash":124.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERTAPENEM SODIUM 1 G IJ SOLR","drug_information":{"unit":0.5,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"42023022185","type":"NDC"}],"standard_charges":[{"gross_charge":130.02,"discounted_cash":130.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DAPTOMYCIN 500 MG IV SOLR","drug_information":{"unit":0.8,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0878","type":"HCPCS"},{"code":"25021017415","type":"NDC"}],"standard_charges":[{"gross_charge":331.89,"discounted_cash":331.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEUCOVORIN CALCIUM 350 MG/17.5 ML (20 MG/ML) IJ WET SOLR VIAL","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"67457053035","type":"NDC"}],"standard_charges":[{"gross_charge":179.36,"discounted_cash":179.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEUCOVORIN CALCIUM 350 MG/17.5 ML (20 MG/ML) IJ WET SOLR VIAL","drug_information":{"unit":0.137,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"25021081630","type":"NDC"}],"standard_charges":[{"gross_charge":43.74,"discounted_cash":43.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERTAPENEM SODIUM 1 G IJ SOLR","drug_information":{"unit":0.5,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"42023022110","type":"NDC"}],"standard_charges":[{"gross_charge":130.02,"discounted_cash":130.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MITOMYCIN 20 MG IV SOLR","drug_information":{"unit":0.788,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J9280","type":"HCPCS"},{"code":"25021025150","type":"NDC"}],"standard_charges":[{"gross_charge":274.93,"discounted_cash":274.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZITHROMYCIN 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"63323039810","type":"NDC"}],"standard_charges":[{"gross_charge":476.7,"discounted_cash":476.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 2.25 (2-0.25) G IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"60505615604","type":"NDC"}],"standard_charges":[{"gross_charge":475.25,"discounted_cash":475.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"00409733201","type":"NDC"}],"standard_charges":[{"gross_charge":375.04,"discounted_cash":375.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE SODIUM 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"44567070225","type":"NDC"}],"standard_charges":[{"gross_charge":391.67,"discounted_cash":391.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN HCL 1 G IV SOLR","drug_information":{"unit":0.05,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"63323028420","type":"NDC"}],"standard_charges":[{"gross_charge":328.78,"discounted_cash":328.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN HCL 1 G IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"25021015120","type":"NDC"}],"standard_charges":[{"gross_charge":385.37,"discounted_cash":385.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"00143985725","type":"NDC"}],"standard_charges":[{"gross_charge":361.18,"discounted_cash":361.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2471","type":"HCPCS"},{"code":"00143928410","type":"NDC"}],"standard_charges":[{"gross_charge":369.42,"discounted_cash":369.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN HCL 1 G IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"00143916210","type":"NDC"}],"standard_charges":[{"gross_charge":381.41,"discounted_cash":381.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"71288060011","type":"NDC"}],"standard_charges":[{"gross_charge":378.06,"discounted_cash":378.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE SODIUM 2 G IJ SOLR","drug_information":{"unit":0.5,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"00143985625","type":"NDC"}],"standard_charges":[{"gross_charge":360.98,"discounted_cash":360.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZITHROMYCIN 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"70436001982","type":"NDC"}],"standard_charges":[{"gross_charge":479.4,"discounted_cash":479.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE SODIUM 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"00781320995","type":"NDC"}],"standard_charges":[{"gross_charge":381.19,"discounted_cash":381.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE SODIUM 250 MG IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"60505615101","type":"NDC"}],"standard_charges":[{"gross_charge":340.74,"discounted_cash":340.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"44567070195","type":"NDC"}],"standard_charges":[{"gross_charge":362.72,"discounted_cash":362.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"25021010610","type":"NDC"}],"standard_charges":[{"gross_charge":388.72,"discounted_cash":388.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DROPERIDOL 2.5 MG/ML IJ SOLN","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1790","type":"HCPCS"},{"code":"00143951425","type":"NDC"}],"standard_charges":[{"gross_charge":351.55,"discounted_cash":351.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ADENOSINE 12 MG/4ML IV SOLN","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"67457085404","type":"NDC"}],"standard_charges":[{"gross_charge":229.26,"discounted_cash":229.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IRINOTECAN HCL 100 MG/5ML IV SOLN","drug_information":{"unit":1.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"00143970101","type":"NDC"}],"standard_charges":[{"gross_charge":77.16,"discounted_cash":77.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GABAPENTIN 300 MG/6ML PO SOLN UNIT DOSE","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"42192060840","type":"NDC"}],"standard_charges":[{"gross_charge":14.1,"discounted_cash":14.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL CITRATE (PF) 2500 MCG/50ML IJ SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"00409909461","type":"NDC"}],"standard_charges":[{"gross_charge":473.05,"discounted_cash":473.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHOCARBAMOL 1000 MG/10ML IJ SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2800","type":"HCPCS"},{"code":"71288071610","type":"NDC"}],"standard_charges":[{"gross_charge":382.07,"discounted_cash":382.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRANEXAMIC ACID 1000 MG/10ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3290","type":"HCPCS"},{"code":"55150018810","type":"NDC"}],"standard_charges":[{"gross_charge":382.07,"discounted_cash":382.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","drug_information":{"unit":0.667,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"25021070001","type":"NDC"}],"standard_charges":[{"gross_charge":336.98,"discounted_cash":336.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"31722011731","type":"NDC"}],"standard_charges":[{"gross_charge":382.89,"discounted_cash":382.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYCODONE HCL 5 MG/5ML PO SOLN UNIT DOSE","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00121482750","type":"NDC"}],"standard_charges":[{"gross_charge":49.7,"discounted_cash":49.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM HCL (PF) 5 MG/ML IJ SOLN","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"00409230801","type":"NDC"}],"standard_charges":[{"gross_charge":328.15,"discounted_cash":328.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 4 % IJ SOLN","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409428301","type":"NDC"}],"standard_charges":[{"gross_charge":331.17,"discounted_cash":331.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SENSORCAINE-MPF 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046638","type":"NDC"}],"standard_charges":[{"gross_charge":331.6,"discounted_cash":331.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LOVENOX 30 MG/0.3ML IJ SOSY","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00075801310","type":"NDC"}],"standard_charges":[{"gross_charge":394.74,"discounted_cash":394.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LOVENOX 30 MG/0.3ML IJ SOSY","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00075062430","type":"NDC"}],"standard_charges":[{"gross_charge":394.74,"discounted_cash":394.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LOVENOX 40 MG/0.4ML IJ SOSY","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00075062040","type":"NDC"}],"standard_charges":[{"gross_charge":382.73,"discounted_cash":382.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LOVENOX 40 MG/0.4ML IJ SOSY","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00075801410","type":"NDC"}],"standard_charges":[{"gross_charge":380.59,"discounted_cash":380.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TYSABRI 300 MG/15ML IV CONC","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2323","type":"HCPCS"},{"code":"64406000801","type":"NDC"}],"standard_charges":[{"gross_charge":149271.06,"discounted_cash":149271.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MULTIHANCE 529 MG/ML IV SOLN","drug_information":{"unit":8.6,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"A9577","type":"HCPCS"},{"code":"00270516414","type":"NDC"}],"standard_charges":[{"gross_charge":47.54,"discounted_cash":47.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MULTIHANCE 529 MG/ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"A9577","type":"HCPCS"},{"code":"00270516415","type":"NDC"}],"standard_charges":[{"gross_charge":112.06,"discounted_cash":112.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MULTIHANCE 529 MG/ML IV SOLN","drug_information":{"unit":5.5,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"A9577","type":"HCPCS"},{"code":"00270516413","type":"NDC"}],"standard_charges":[{"gross_charge":34.75,"discounted_cash":34.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ADACEL 5-2-15.5 LF-MCG/0.5 IM SUSY","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90715","type":"HCPCS"},{"code":"49281040020","type":"NDC"}],"standard_charges":[{"gross_charge":957.02,"discounted_cash":957.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"XYLOCAINE-MPF 1 % IJ SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323049226","type":"NDC"}],"standard_charges":[{"gross_charge":334.23,"discounted_cash":334.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"XYLOCAINE-MPF 1 % IJ SOLN","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323049237","type":"NDC"}],"standard_charges":[{"gross_charge":325.97,"discounted_cash":325.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"XYLOCAINE-MPF 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323049236","type":"NDC"}],"standard_charges":[{"gross_charge":335.21,"discounted_cash":335.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"XYLOCAINE-MPF 1 % IJ SOLN","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323049257","type":"NDC"}],"standard_charges":[{"gross_charge":327.17,"discounted_cash":327.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERBITUX 100 MG/50ML IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9055","type":"HCPCS"},{"code":"66733094823","type":"NDC"}],"standard_charges":[{"gross_charge":1818.13,"discounted_cash":1818.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACTULOSE 20 GM/30ML PO SOLN","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00116400541","type":"NDC"}],"standard_charges":[{"gross_charge":17.12,"discounted_cash":17.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARANESP (ALBUMIN FREE) 150 MCG/0.3ML IJ SOSY","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513002704","type":"NDC"}],"standard_charges":[{"gross_charge":11268.74,"discounted_cash":11268.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARANESP (ALBUMIN FREE) 200 MCG/0.4ML IJ SOSY","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513002801","type":"NDC"}],"standard_charges":[{"gross_charge":15021.71,"discounted_cash":15021.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARANESP (ALBUMIN FREE) 300 MCG/0.6ML IJ SOSY","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513011101","type":"NDC"}],"standard_charges":[{"gross_charge":22527.47,"discounted_cash":22527.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARANESP (ALBUMIN FREE) 500 MCG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513003201","type":"NDC"}],"standard_charges":[{"gross_charge":39911.14,"discounted_cash":39911.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL CITRATE (PF) 250 MCG/5ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"63323080605","type":"NDC"}],"standard_charges":[{"gross_charge":332.54,"discounted_cash":332.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ONIVYDE 43 MG/10ML IV SUSP","drug_information":{"unit":2.791,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9205","type":"HCPCS"},{"code":"15054004301","type":"NDC"}],"standard_charges":[{"gross_charge":1759.99,"discounted_cash":1759.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM 100 MG/ML PO SOLN UNIT DOSE","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"60687024977","type":"NDC"}],"standard_charges":[{"gross_charge":46.4,"discounted_cash":46.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM 500 MG/5ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"72485010610","type":"NDC"}],"standard_charges":[{"gross_charge":393.04,"discounted_cash":393.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHOTREXATE SODIUM (PF) 1 GM/40ML IJ SOLN","drug_information":{"unit":31.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9260","type":"HCPCS"},{"code":"61703040841","type":"NDC"}],"standard_charges":[{"gross_charge":138.22,"discounted_cash":138.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE HCL (PF) 0.75 % IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"55150017110","type":"NDC"}],"standard_charges":[{"gross_charge":344.68,"discounted_cash":344.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE HCL (PF) 0.5 % IJ SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409116201","type":"NDC"}],"standard_charges":[{"gross_charge":353.66,"discounted_cash":353.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZOLEDRONIC ACID 4 MG/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"25021082682","type":"NDC"}],"standard_charges":[{"gross_charge":160.8,"discounted_cash":160.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"55150032325","type":"NDC"}],"standard_charges":[{"gross_charge":334.23,"discounted_cash":334.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PAMIDRONATE DISODIUM 30 MG/10ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2430","type":"HCPCS"},{"code":"67457043010","type":"NDC"}],"standard_charges":[{"gross_charge":205.6,"discounted_cash":205.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NICARDIPINE HCL 2.5 MG/ML IV SOLN","drug_information":{"unit":0.04,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2404","type":"HCPCS"},{"code":"00143954210","type":"NDC"}],"standard_charges":[{"gross_charge":326.3,"discounted_cash":326.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"55150032225","type":"NDC"}],"standard_charges":[{"gross_charge":380.22,"discounted_cash":380.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXALIPLATIN 50 MG/10ML IV SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"60505613206","type":"NDC"}],"standard_charges":[{"gross_charge":25.1,"discounted_cash":25.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":0.005,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"00641614225","type":"NDC"}],"standard_charges":[{"gross_charge":325.13,"discounted_cash":325.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GUAIFENESIN-CODEINE 100-10 MG/5ML PO SOLN UNIT DOSE","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00121177540","type":"NDC"}],"standard_charges":[{"gross_charge":36.8,"discounted_cash":36.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLONIDINE HCL (ANALGESIA) 100 MCG/ML EP SOLN","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0735","type":"HCPCS"},{"code":"00143972401","type":"NDC"}],"standard_charges":[{"gross_charge":341.2,"discounted_cash":341.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYTARABINE (PF) 20 MG/ML IJ SOLN","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9100","type":"HCPCS"},{"code":"61703030538","type":"NDC"}],"standard_charges":[{"gross_charge":56.64,"discounted_cash":56.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"REGADENOSON 0.4 MG/5ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"00409140101","type":"NDC"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXALIPLATIN 100 MG/20ML IV SOLN","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"72266016201","type":"NDC"}],"standard_charges":[{"gross_charge":93.15,"discounted_cash":93.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCIUM CHLORIDE 10 % IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0618","type":"HCPCS"},{"code":"00409163110","type":"NDC"}],"standard_charges":[{"gross_charge":72.34,"discounted_cash":72.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCOPYRROLATE 0.4 MG/2ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"00143968125","type":"NDC"}],"standard_charges":[{"gross_charge":378.14,"discounted_cash":378.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL (CARDIAC) PF 100 MG/5ML IV SOLN","drug_information":{"unit":2.8,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323020805","type":"NDC"}],"standard_charges":[{"gross_charge":357.72,"discounted_cash":357.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ESMOLOL HCL 2500 MG/250ML IV SOLN","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1806","type":"HCPCS"},{"code":"44567081110","type":"NDC"}],"standard_charges":[{"gross_charge":435.75,"discounted_cash":435.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRANEXAMIC ACID 1000 MG/10ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3290","type":"HCPCS"},{"code":"23155016641","type":"NDC"}],"standard_charges":[{"gross_charge":371.8,"discounted_cash":371.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00409665106","type":"NDC"}],"standard_charges":[{"gross_charge":365.64,"discounted_cash":365.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRANEXAMIC ACID 1000 MG/10ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3290","type":"HCPCS"},{"code":"81284061110","type":"NDC"}],"standard_charges":[{"gross_charge":391.04,"discounted_cash":391.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SENNA 8.8 MG/5ML PO SYRP UNIT DOSE","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"48433021940","type":"NDC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM 500 MG/5ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"72205012025","type":"NDC"}],"standard_charges":[{"gross_charge":390.7,"discounted_cash":390.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GUAIFENESIN-CODEINE 200-20 MG/10ML PO SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00121155040","type":"NDC"}],"standard_charges":[{"gross_charge":45.2,"discounted_cash":45.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMANTADINE HCL 50 MG/5ML PO SOLN UNIT DOSE","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00121064610","type":"NDC"}],"standard_charges":[{"gross_charge":43.4,"discounted_cash":43.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"72603013325","type":"NDC"}],"standard_charges":[{"gross_charge":350.83,"discounted_cash":350.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILTIAZEM HCL 125 MG/25ML IV SOLN","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1163","type":"HCPCS"},{"code":"00641601510","type":"NDC"}],"standard_charges":[{"gross_charge":410.96,"discounted_cash":410.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZOLEDRONIC ACID 5 MG/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"25021083082","type":"NDC"}],"standard_charges":[{"gross_charge":258.95,"discounted_cash":258.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZOLEDRONIC ACID 5 MG/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"67457061910","type":"NDC"}],"standard_charges":[{"gross_charge":250.5,"discounted_cash":250.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 200 MCG/50ML IV SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"C9399","type":"HCPCS"},{"code":"71225013202","type":"NDC"}],"standard_charges":[{"gross_charge":335.34,"discounted_cash":335.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BEXSERO 0.5 ML IM SUSY","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90620","type":"HCPCS"},{"code":"58160097620","type":"NDC"}],"standard_charges":[{"gross_charge":2895.49,"discounted_cash":2895.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VASOSTRICT 20 UNIT/ML IV SOLN","drug_information":{"unit":0.15,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2598","type":"HCPCS"},{"code":"42023016483","type":"NDC"}],"standard_charges":[{"gross_charge":470.04,"discounted_cash":470.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OCTAGAM 30 GM/300ML IV SOLN","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1568","type":"HCPCS"},{"code":"68982085005","type":"NDC"}],"standard_charges":[{"gross_charge":5702.8,"discounted_cash":5702.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OCTAGAM 20 GM/200ML IV SOLN","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1568","type":"HCPCS"},{"code":"68982085004","type":"NDC"}],"standard_charges":[{"gross_charge":3828.0,"discounted_cash":3828.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZARXIO 300 MCG/0.5ML IJ SOSY","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5101","type":"HCPCS"},{"code":"61314031810","type":"NDC"}],"standard_charges":[{"gross_charge":2886.22,"discounted_cash":2886.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZARXIO 480 MCG/0.8ML IJ SOSY","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5101","type":"HCPCS"},{"code":"61314032610","type":"NDC"}],"standard_charges":[{"gross_charge":4067.72,"discounted_cash":4067.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZARXIO 480 MCG/0.8ML IJ SOSY","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5101","type":"HCPCS"},{"code":"61314032601","type":"NDC"}],"standard_charges":[{"gross_charge":4611.24,"discounted_cash":4611.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RITUXAN 100 MG/10ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9312","type":"HCPCS"},{"code":"50242005121","type":"NDC"}],"standard_charges":[{"gross_charge":2345.33,"discounted_cash":2345.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RITUXAN 500 MG/50ML IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9312","type":"HCPCS"},{"code":"50242005306","type":"NDC"}],"standard_charges":[{"gross_charge":10251.43,"discounted_cash":10251.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEULASTA 6 MG/0.6ML SC SOSY","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2506","type":"HCPCS"},{"code":"55513019001","type":"NDC"}],"standard_charges":[{"gross_charge":92216.05,"discounted_cash":92216.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEULASTA ONPRO 6 MG/0.6ML SC SOSY","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2506","type":"HCPCS"},{"code":"55513019201","type":"NDC"}],"standard_charges":[{"gross_charge":77975.93,"discounted_cash":77975.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEUPOGEN 300 MCG/0.5ML IJ SOSY","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1442","type":"HCPCS"},{"code":"55513092491","type":"NDC"}],"standard_charges":[{"gross_charge":6115.84,"discounted_cash":6115.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARANESP (ALBUMIN FREE) 40 MCG/0.4ML IJ SOSY","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513002104","type":"NDC"}],"standard_charges":[{"gross_charge":3012.33,"discounted_cash":3012.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARANESP (ALBUMIN FREE) 60 MCG/0.3ML IJ SOSY","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513002304","type":"NDC"}],"standard_charges":[{"gross_charge":4513.52,"discounted_cash":4513.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARANESP (ALBUMIN FREE) 100 MCG/0.5ML IJ SOSY","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513002504","type":"NDC"}],"standard_charges":[{"gross_charge":3012.32,"discounted_cash":3012.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIAZEPAM 10 MG/2ML IJ SOLN","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"76045020420","type":"NDC"}],"standard_charges":[{"gross_charge":399.06,"discounted_cash":399.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIAZEPAM 10 MG/2ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"62332081120","type":"NDC"}],"standard_charges":[{"gross_charge":117.95,"discounted_cash":117.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCUSATE SODIUM 100 MG/10ML PO LIQD","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00121187000","type":"NDC"}],"standard_charges":[{"gross_charge":8.08,"discounted_cash":8.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCUSATE SODIUM 100 MG/10ML PO LIQD","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00904727972","type":"NDC"}],"standard_charges":[{"gross_charge":5.28,"discounted_cash":5.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCUSATE SODIUM 100 MG/10ML PO LIQD","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"63739097610","type":"NDC"}],"standard_charges":[{"gross_charge":8.84,"discounted_cash":8.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILAUDID 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"76045000911","type":"NDC"}],"standard_charges":[{"gross_charge":387.79,"discounted_cash":387.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILAUDID 1 MG/ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"76045000906","type":"NDC"}],"standard_charges":[{"gross_charge":391.22,"discounted_cash":391.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILAUDID 2 MG/ML IJ SOLN","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"76045001011","type":"NDC"}],"standard_charges":[{"gross_charge":345.57,"discounted_cash":345.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INFED 50 MG/ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1750","type":"HCPCS"},{"code":"00023608210","type":"NDC"}],"standard_charges":[{"gross_charge":214.31,"discounted_cash":214.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"25021005201","type":"NDC"}],"standard_charges":[{"gross_charge":336.99,"discounted_cash":336.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"67457042312","type":"NDC"}],"standard_charges":[{"gross_charge":339.53,"discounted_cash":339.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323016501","type":"NDC"}],"standard_charges":[{"gross_charge":331.09,"discounted_cash":331.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323016516","type":"NDC"}],"standard_charges":[{"gross_charge":331.09,"discounted_cash":331.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN 650 MG/20.3ML PO SOLN","drug_information":{"unit":10.156,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"60687074037","type":"NDC"}],"standard_charges":[{"gross_charge":11.59,"discounted_cash":11.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN 650 MG/20.3ML PO SOLN","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"81033000230","type":"NDC"}],"standard_charges":[{"gross_charge":17.04,"discounted_cash":17.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATROPINE SULFATE 0.4 MG/ML IV SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0462","type":"HCPCS"},{"code":"00517100425","type":"NDC"}],"standard_charges":[{"gross_charge":380.77,"discounted_cash":380.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OCTAGAM 10 GM/100ML IV SOLN","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1568","type":"HCPCS"},{"code":"68982085003","type":"NDC"}],"standard_charges":[{"gross_charge":3837.6,"discounted_cash":3837.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRUMENBA 0.5 ML IM SUSY","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90621","type":"HCPCS"},{"code":"00005010005","type":"NDC"}],"standard_charges":[{"gross_charge":2787.72,"discounted_cash":2787.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PRIVIGEN 10 GM/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1459","type":"HCPCS"},{"code":"44206043710","type":"NDC"}],"standard_charges":[{"gross_charge":1530.0,"discounted_cash":1530.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PRIVIGEN 40 GM/400ML IV SOLN","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1459","type":"HCPCS"},{"code":"44206043940","type":"NDC"}],"standard_charges":[{"gross_charge":4584.4,"discounted_cash":4584.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VASOSTRICT 20 UNIT/ML IV SOLN","drug_information":{"unit":0.025,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2598","type":"HCPCS"},{"code":"42023016425","type":"NDC"}],"standard_charges":[{"gross_charge":352.06,"discounted_cash":352.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PRECEDEX 80 MCG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"C9399","type":"HCPCS"},{"code":"00409166020","type":"NDC"}],"standard_charges":[{"gross_charge":386.06,"discounted_cash":386.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROBAXIN 1000 MG/10ML IJ SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2800","type":"HCPCS"},{"code":"00641610310","type":"NDC"}],"standard_charges":[{"gross_charge":132.88,"discounted_cash":132.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GARDASIL 9 0.5 ML IM SUSY","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"90651","type":"HCPCS"},{"code":"00006412102","type":"NDC"}],"standard_charges":[{"gross_charge":5298.75,"discounted_cash":5298.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLULAVAL 0.5 ML IM SUSY","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90656","type":"HCPCS"},{"code":"19515090452","type":"NDC"}],"standard_charges":[{"gross_charge":373.84,"discounted_cash":373.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUARIX 0.5 ML IM SUSY","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90686","type":"HCPCS"},{"code":"58160091252","type":"NDC"}],"standard_charges":[{"gross_charge":294.68,"discounted_cash":294.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUZONE 0.5 ML IM SUSY","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90656","type":"HCPCS"},{"code":"49281042550","type":"NDC"}],"standard_charges":[{"gross_charge":412.05,"discounted_cash":412.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUZONE HIGH-DOSE 0.5 ML IM SUSY","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90662","type":"HCPCS"},{"code":"49281012565","type":"NDC"}],"standard_charges":[{"gross_charge":1414.9,"discounted_cash":1414.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUCELVAX 0.5 ML IM SUSY","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90661","type":"HCPCS"},{"code":"70461065503","type":"NDC"}],"standard_charges":[{"gross_charge":476.1,"discounted_cash":476.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OPDIVO 40 MG/4ML IV SOLN","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9299","type":"HCPCS"},{"code":"00003377211","type":"NDC"}],"standard_charges":[{"gross_charge":3232.3,"discounted_cash":3232.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OPDIVO 100 MG/10ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9299","type":"HCPCS"},{"code":"00003377412","type":"NDC"}],"standard_charges":[{"gross_charge":7119.09,"discounted_cash":7119.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KEYTRUDA 100 MG/4ML IV SOLN","drug_information":{"unit":8.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9271","type":"HCPCS"},{"code":"00006302602","type":"NDC"}],"standard_charges":[{"gross_charge":25710.51,"discounted_cash":25710.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KEYTRUDA 100 MG/4ML IV SOLN","drug_information":{"unit":8.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9271","type":"HCPCS"},{"code":"00006302604","type":"NDC"}],"standard_charges":[{"gross_charge":25675.61,"discounted_cash":25675.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEPO-MEDROL 40 MG/ML IJ SUSP","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"00009307301","type":"NDC"}],"standard_charges":[{"gross_charge":341.97,"discounted_cash":341.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEPO-MEDROL 40 MG/ML IJ SUSP","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"00009307303","type":"NDC"}],"standard_charges":[{"gross_charge":386.68,"discounted_cash":386.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEPO-MEDROL 80 MG/ML IJ SUSP","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"00009347503","type":"NDC"}],"standard_charges":[{"gross_charge":118.13,"discounted_cash":118.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PITOCIN 10 UNIT/ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2590","type":"HCPCS"},{"code":"42023011625","type":"NDC"}],"standard_charges":[{"gross_charge":401.34,"discounted_cash":401.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ADACEL 5-2-15.5 LF-MCG/0.5 IM SUSP","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90715","type":"HCPCS"},{"code":"49281040010","type":"NDC"}],"standard_charges":[{"gross_charge":956.85,"discounted_cash":956.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RELISTOR 12 MG/0.6ML SC SOLN","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2212","type":"HCPCS"},{"code":"65649055102","type":"NDC"}],"standard_charges":[{"gross_charge":2960.13,"discounted_cash":2960.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GAMMAGARD 10 GM/100ML IJ SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1569","type":"HCPCS"},{"code":"00944270005","type":"NDC"}],"standard_charges":[{"gross_charge":2213.6,"discounted_cash":2213.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GAMMAGARD 5 GM/50ML IJ SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1569","type":"HCPCS"},{"code":"00944270004","type":"NDC"}],"standard_charges":[{"gross_charge":1111.7,"discounted_cash":1111.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GAMMAGARD 20 GM/200ML IJ SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1569","type":"HCPCS"},{"code":"00944270006","type":"NDC"}],"standard_charges":[{"gross_charge":2215.2,"discounted_cash":2215.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GAMMAGARD 30 GM/300ML IJ SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1569","type":"HCPCS"},{"code":"00944270007","type":"NDC"}],"standard_charges":[{"gross_charge":2218.4,"discounted_cash":2218.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GAMUNEX-C 40 GM/400ML IJ SOLN","drug_information":{"unit":350.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1561","type":"HCPCS"},{"code":"13533080040","type":"NDC"}],"standard_charges":[{"gross_charge":5023.4,"discounted_cash":5023.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GAMUNEX-C 5 GM/50ML IJ SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1561","type":"HCPCS"},{"code":"13533080020","type":"NDC"}],"standard_charges":[{"gross_charge":769.4,"discounted_cash":769.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GAMUNEX-C 20 GM/200ML IJ SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1561","type":"HCPCS"},{"code":"13533080024","type":"NDC"}],"standard_charges":[{"gross_charge":794.6,"discounted_cash":794.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GAMUNEX-C 10 GM/100ML IJ SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1561","type":"HCPCS"},{"code":"13533080071","type":"NDC"}],"standard_charges":[{"gross_charge":788.7,"discounted_cash":788.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GAMMAKED 20 GM/200ML IJ SOLN","drug_information":{"unit":400.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1561","type":"HCPCS"},{"code":"76125090020","type":"NDC"}],"standard_charges":[{"gross_charge":8325.2,"discounted_cash":8325.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PRIVIGEN 20 GM/200ML IV SOLN","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1459","type":"HCPCS"},{"code":"44206043820","type":"NDC"}],"standard_charges":[{"gross_charge":3308.4,"discounted_cash":3308.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PRIVIGEN 5 GM/50ML IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1459","type":"HCPCS"},{"code":"44206043605","type":"NDC"}],"standard_charges":[{"gross_charge":873.1,"discounted_cash":873.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATROPINE SULFATE 1 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0462","type":"HCPCS"},{"code":"00517100125","type":"NDC"}],"standard_charges":[{"gross_charge":173.8,"discounted_cash":173.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15ML PO SOLN UNIT DOSE","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"60687041771","type":"NDC"}],"standard_charges":[{"gross_charge":25.64,"discounted_cash":25.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE HCL (PF) 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409115901","type":"NDC"}],"standard_charges":[{"gross_charge":333.57,"discounted_cash":333.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCIUM GLUCONATE 10 % IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"00143918025","type":"NDC"}],"standard_charges":[{"gross_charge":155.2,"discounted_cash":155.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHOTREXATE SODIUM (PF) 50 MG/2ML IJ SOLN","drug_information":{"unit":0.48,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9260","type":"HCPCS"},{"code":"00143951910","type":"NDC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARFORMOTEROL TARTRATE 15 MCG/2ML IN NEBU","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"60687077083","type":"NDC"}],"standard_charges":[{"gross_charge":40.7,"discounted_cash":40.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NICARDIPINE HCL 2.5 MG/ML IV SOLN","drug_information":{"unit":0.08,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2404","type":"HCPCS"},{"code":"00143968910","type":"NDC"}],"standard_charges":[{"gross_charge":327.8,"discounted_cash":327.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN PHOSPHATE 900 MG/6ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"25021011506","type":"NDC"}],"standard_charges":[{"gross_charge":379.29,"discounted_cash":379.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"72266011825","type":"NDC"}],"standard_charges":[{"gross_charge":347.08,"discounted_cash":347.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARFORMOTEROL TARTRATE 15 MCG/2ML IN NEBU","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"70748017560","type":"NDC"}],"standard_charges":[{"gross_charge":29.25,"discounted_cash":29.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM HCL 2 MG/ML PO SYRP UNIT DOSE","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"60687057686","type":"NDC"}],"standard_charges":[{"gross_charge":17.1,"discounted_cash":17.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATROPINE SULFATE 1 MG/10ML IJ SOSY","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"76329334001","type":"NDC"}],"standard_charges":[{"gross_charge":423.07,"discounted_cash":423.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1598","type":"HCPCS"},{"code":"63323057811","type":"NDC"}],"standard_charges":[{"gross_charge":376.01,"discounted_cash":376.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL CITRATE (PF) 100 MCG/2ML IJ SOLN","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"00409909422","type":"NDC"}],"standard_charges":[{"gross_charge":337.99,"discounted_cash":337.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TERBUTALINE SULFATE 1 MG/ML IJ SOLN","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3105","type":"HCPCS"},{"code":"63323066501","type":"NDC"}],"standard_charges":[{"gross_charge":337.6,"discounted_cash":337.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"00409233934","type":"NDC"}],"standard_charges":[{"gross_charge":364.77,"discounted_cash":364.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FORMOTEROL FUMARATE 20 MCG/2ML IN NEBU","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"70748026130","type":"NDC"}],"standard_charges":[{"gross_charge":45.61,"discounted_cash":45.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"REGADENOSON 0.4 MG/5ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"00641625301","type":"NDC"}],"standard_charges":[{"gross_charge":196.48,"discounted_cash":196.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"00781342292","type":"NDC"}],"standard_charges":[{"gross_charge":331.18,"discounted_cash":331.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"REGADENOSON 0.4 MG/5ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"76329332100","type":"NDC"}],"standard_charges":[{"gross_charge":185.44,"discounted_cash":185.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"72603025101","type":"NDC"}],"standard_charges":[{"gross_charge":355.18,"discounted_cash":355.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROPIVACAINE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"43066001510","type":"NDC"}],"standard_charges":[{"gross_charge":346.58,"discounted_cash":346.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"43598063710","type":"NDC"}],"standard_charges":[{"gross_charge":115.3,"discounted_cash":115.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOPROLOL TARTRATE 5 MG/5ML IV SOLN","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0616","type":"HCPCS"},{"code":"00409177805","type":"NDC"}],"standard_charges":[{"gross_charge":339.86,"discounted_cash":339.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NICARDIPINE HCL IN NACL 20-0.9 MG/200ML-% IV SOLN","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"J2404","type":"HCPCS"},{"code":"00143963410","type":"NDC"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":179.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ESMOLOL HCL 100 MG/10ML IV SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1805","type":"HCPCS"},{"code":"63323065210","type":"NDC"}],"standard_charges":[{"gross_charge":344.93,"discounted_cash":344.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 400 MCG/100ML IV SOLN","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"C9399","type":"HCPCS"},{"code":"66794023541","type":"NDC"}],"standard_charges":[{"gross_charge":386.75,"discounted_cash":386.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUOROURACIL 500 MG/10ML IV SOLN","drug_information":{"unit":16.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"63323011710","type":"NDC"}],"standard_charges":[{"gross_charge":78.62,"discounted_cash":78.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 2 % IJ SOLN","drug_information":{"unit":0.019,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409428202","type":"NDC"}],"standard_charges":[{"gross_charge":325.17,"discounted_cash":325.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILTIAZEM HCL-DEXTROSE 125-5 MG/125ML-% IV SOLN","drug_information":{"unit":125.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1163","type":"HCPCS"},{"code":"70092100736","type":"NDC"}],"standard_charges":[{"gross_charge":181.44,"discounted_cash":181.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"23155047342","type":"NDC"}],"standard_charges":[{"gross_charge":333.24,"discounted_cash":333.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM HCL (PF) 2 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"00409000125","type":"NDC"}],"standard_charges":[{"gross_charge":336.48,"discounted_cash":336.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00409272301","type":"NDC"}],"standard_charges":[{"gross_charge":330.38,"discounted_cash":330.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IODIXANOL 320 MG/ML IV SOLN","drug_information":{"unit":70.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"65219038310","type":"NDC"}],"standard_charges":[{"gross_charge":67.54,"discounted_cash":67.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"25021070101","type":"NDC"}],"standard_charges":[{"gross_charge":339.37,"discounted_cash":339.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXORUBICIN HCL 2 MG/ML IV SOLN","drug_information":{"unit":12.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9000","type":"HCPCS"},{"code":"00069034302","type":"NDC"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":107.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GUAIFENESIN 100 MG/5ML PO LIQUID UNIT DOSE","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00121174400","type":"NDC"}],"standard_charges":[{"gross_charge":19.16,"discounted_cash":19.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"71351002110","type":"NDC"}],"standard_charges":[{"gross_charge":375.58,"discounted_cash":375.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML IJ SOLN","drug_information":{"unit":0.001,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"00143968225","type":"NDC"}],"standard_charges":[{"gross_charge":325.02,"discounted_cash":325.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"65219057004","type":"NDC"}],"standard_charges":[{"gross_charge":382.89,"discounted_cash":382.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM 100 MG/ML PO SOLN UNIT DOSE","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00121479950","type":"NDC"}],"standard_charges":[{"gross_charge":47.96,"discounted_cash":47.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCRALFATE 1 GM/10ML PO SUSP UNIT DOSE","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"50268074514","type":"NDC"}],"standard_charges":[{"gross_charge":47.72,"discounted_cash":47.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILTIAZEM HCL 25 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1163","type":"HCPCS"},{"code":"70860030105","type":"NDC"}],"standard_charges":[{"gross_charge":334.88,"discounted_cash":334.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEROL SULFATE 0.63 MG/3ML IN NEBU","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"J7620","type":"HCPCS"},{"code":"00487030101","type":"NDC"}],"standard_charges":[{"gross_charge":20.61,"discounted_cash":20.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM HCL 2 MG/2ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"23155060041","type":"NDC"}],"standard_charges":[{"gross_charge":340.42,"discounted_cash":340.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FAMOTIDINE (PF) 20 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1308","type":"HCPCS"},{"code":"67457043322","type":"NDC"}],"standard_charges":[{"gross_charge":334.92,"discounted_cash":334.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GUAIFENESIN-DM 100-10 MG/5ML PO SYRP UNIT DOSE","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"69339014919","type":"NDC"}],"standard_charges":[{"gross_charge":28.28,"discounted_cash":28.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"55150016205","type":"NDC"}],"standard_charges":[{"gross_charge":329.2,"discounted_cash":329.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM HCL 2 MG/2ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"25021065502","type":"NDC"}],"standard_charges":[{"gross_charge":340.91,"discounted_cash":340.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM 500 MG/5ML IV SOLN","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"00143967325","type":"NDC"}],"standard_charges":[{"gross_charge":343.55,"discounted_cash":343.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 50 % IV SOLN","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"76329330201","type":"NDC"}],"standard_charges":[{"gross_charge":413.26,"discounted_cash":413.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 400 MCG/100ML IV SOLN","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"C9399","type":"HCPCS"},{"code":"00143952510","type":"NDC"}],"standard_charges":[{"gross_charge":371.43,"discounted_cash":371.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SENNA 8.8 MG/5ML PO SYRP UNIT DOSE","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"68094004962","type":"NDC"}],"standard_charges":[{"gross_charge":34.4,"discounted_cash":34.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VALPROIC ACID 250 MG/5ML PO SOLN UNIT DOSE","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00121467500","type":"NDC"}],"standard_charges":[{"gross_charge":16.82,"discounted_cash":16.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"63323028016","type":"NDC"}],"standard_charges":[{"gross_charge":345.25,"discounted_cash":345.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"63323028002","type":"NDC"}],"standard_charges":[{"gross_charge":330.06,"discounted_cash":330.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM HCL-SODIUM CHLORIDE 100-0.9 MG/100ML-% IV SOLN","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2251","type":"HCPCS"},{"code":"70092103036","type":"NDC"}],"standard_charges":[{"gross_charge":329.8,"discounted_cash":329.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"63323016226","type":"NDC"}],"standard_charges":[{"gross_charge":357.23,"discounted_cash":357.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"63323016202","type":"NDC"}],"standard_charges":[{"gross_charge":329.03,"discounted_cash":329.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVALBUTEROL HCL 1.25 MG/3ML IN NEBU","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"J7620","type":"HCPCS"},{"code":"76204090001","type":"NDC"}],"standard_charges":[{"gross_charge":29.53,"discounted_cash":29.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM 100 MG/ML PO SOLN UNIT DOSE","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"69339015717","type":"NDC"}],"standard_charges":[{"gross_charge":43.88,"discounted_cash":43.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOPAMIDOL 76 % IV SOLN","drug_information":{"unit":60.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"70436012782","type":"NDC"}],"standard_charges":[{"gross_charge":70.66,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN","drug_information":{"unit":0.33,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"00409379601","type":"NDC"}],"standard_charges":[{"gross_charge":329.32,"discounted_cash":329.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"36000028225","type":"NDC"}],"standard_charges":[{"gross_charge":337.75,"discounted_cash":337.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"66794020242","type":"NDC"}],"standard_charges":[{"gross_charge":336.99,"discounted_cash":336.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHOCARBAMOL 1000 MG/10ML IJ SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2800","type":"HCPCS"},{"code":"70069010105","type":"NDC"}],"standard_charges":[{"gross_charge":380.9,"discounted_cash":380.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMINOCAPROIC ACID 250 MG/ML IV SOLN","drug_information":{"unit":40.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0281","type":"HCPCS"},{"code":"00409434673","type":"NDC"}],"standard_charges":[{"gross_charge":205.84,"discounted_cash":205.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GUAIFENESIN-DM 100-10 MG/5ML PO SYRP UNIT DOSE","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00121063800","type":"NDC"}],"standard_charges":[{"gross_charge":18.02,"discounted_cash":18.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE HCL (PF) 0.75 % IJ SOLN","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409116501","type":"NDC"}],"standard_charges":[{"gross_charge":392.77,"discounted_cash":392.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUOROURACIL 1 GM/20ML IV SOLN","drug_information":{"unit":14.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"63323011720","type":"NDC"}],"standard_charges":[{"gross_charge":71.04,"discounted_cash":71.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRANEXAMIC ACID 1000 MG/10ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3290","type":"HCPCS"},{"code":"72603038710","type":"NDC"}],"standard_charges":[{"gross_charge":379.6,"discounted_cash":379.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VALPROIC ACID 250 MG/5ML PO SOLN UNIT DOSE","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00121135000","type":"NDC"}],"standard_charges":[{"gross_charge":27.2,"discounted_cash":27.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL CITRATE (PF) 250 MCG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"00641602810","type":"NDC"}],"standard_charges":[{"gross_charge":339.68,"discounted_cash":339.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"55150016102","type":"NDC"}],"standard_charges":[{"gross_charge":329.38,"discounted_cash":329.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NYSTATIN 100000 UNIT/ML MT SUSP BULK","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00121086850","type":"NDC"}],"standard_charges":[{"gross_charge":21.02,"discounted_cash":21.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL CITRATE (PF) 2500 MCG/50ML IJ SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"00641603001","type":"NDC"}],"standard_charges":[{"gross_charge":327.1,"discounted_cash":327.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIAZEPAM 5 MG/5ML PO SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00121090594","type":"NDC"}],"standard_charges":[{"gross_charge":57.8,"discounted_cash":57.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYCODONE HCL 5 MG/5ML PO SOLN UNIT DOSE","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"60687040677","type":"NDC"}],"standard_charges":[{"gross_charge":25.94,"discounted_cash":25.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"63323066401","type":"NDC"}],"standard_charges":[{"gross_charge":329.77,"discounted_cash":329.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"23155026441","type":"NDC"}],"standard_charges":[{"gross_charge":330.62,"discounted_cash":330.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERROUS SULFATE 300 (60 FE) MG/5ML PO SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00121053005","type":"NDC"}],"standard_charges":[{"gross_charge":34.1,"discounted_cash":34.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHOCARBAMOL 1000 MG/10ML IJ SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2800","type":"HCPCS"},{"code":"43598083936","type":"NDC"}],"standard_charges":[{"gross_charge":394.42,"discounted_cash":394.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACOSAMIDE 200 MG/20ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"C9254","type":"HCPCS"},{"code":"43598008758","type":"NDC"}],"standard_charges":[{"gross_charge":132.64,"discounted_cash":132.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"72266023425","type":"NDC"}],"standard_charges":[{"gross_charge":362.88,"discounted_cash":362.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCOPYRROLATE 0.4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1598","type":"HCPCS"},{"code":"63323057812","type":"NDC"}],"standard_charges":[{"gross_charge":362.27,"discounted_cash":362.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"72603015325","type":"NDC"}],"standard_charges":[{"gross_charge":356.37,"discounted_cash":356.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUOROURACIL 1 GM/20ML IV SOLN","drug_information":{"unit":7.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"70700018723","type":"NDC"}],"standard_charges":[{"gross_charge":87.65,"discounted_cash":87.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TERBUTALINE SULFATE 1 MG/ML IJ SOLN","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3105","type":"HCPCS"},{"code":"00143974610","type":"NDC"}],"standard_charges":[{"gross_charge":337.07,"discounted_cash":337.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ESMOLOL HCL 100 MG/10ML IV SOLN","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1805","type":"HCPCS"},{"code":"10019012001","type":"NDC"}],"standard_charges":[{"gross_charge":383.27,"discounted_cash":383.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":0.01,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"70121157705","type":"NDC"}],"standard_charges":[{"gross_charge":325.44,"discounted_cash":325.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL 1 % IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"69374052005","type":"NDC"}],"standard_charges":[{"gross_charge":377.0,"discounted_cash":377.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"72485010125","type":"NDC"}],"standard_charges":[{"gross_charge":332.98,"discounted_cash":332.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETYLCYSTEINE 200 MG/ML IV SOLN","drug_information":{"unit":16.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0132","type":"HCPCS"},{"code":"00574080530","type":"NDC"}],"standard_charges":[{"gross_charge":572.02,"discounted_cash":572.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"69374094634","type":"NDC"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":370.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":0.005,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"70069080125","type":"NDC"}],"standard_charges":[{"gross_charge":325.26,"discounted_cash":325.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM 500 MG/5ML IV SOLN","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"67457079005","type":"NDC"}],"standard_charges":[{"gross_charge":347.86,"discounted_cash":347.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFAZOLIN SODIUM-DEXTROSE 2-3 GM-%(50ML) IV SOLR","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"00264310511","type":"NDC"}],"standard_charges":[{"gross_charge":70.23,"discounted_cash":70.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRANEXAMIC ACID 1000 MG/10ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3290","type":"HCPCS"},{"code":"23155052441","type":"NDC"}],"standard_charges":[{"gross_charge":380.12,"discounted_cash":380.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"00409379325","type":"NDC"}],"standard_charges":[{"gross_charge":335.5,"discounted_cash":335.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROPIVACAINE HCL-NACL 0.2-0.9 % (ON-Q) IJ SOLN SINGLE LUMEN","drug_information":{"unit":545.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"71449007951","type":"NDC"}],"standard_charges":[{"gross_charge":570.26,"discounted_cash":570.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOBUTAMINE-DEXTROSE 2-5 MG/ML-% IV SOLN","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1250","type":"HCPCS"},{"code":"00338107502","type":"NDC"}],"standard_charges":[{"gross_charge":215.5,"discounted_cash":215.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZOLEDRONIC ACID 5 MG/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"55111068852","type":"NDC"}],"standard_charges":[{"gross_charge":113.35,"discounted_cash":113.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZOLEDRONIC ACID 5 MG/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"67457079410","type":"NDC"}],"standard_charges":[{"gross_charge":247.9,"discounted_cash":247.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCRALFATE 1 GM/10ML PO SUSP UNIT DOSE","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"60687073856","type":"NDC"}],"standard_charges":[{"gross_charge":45.92,"discounted_cash":45.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCRALFATE 1 GM/10ML PO SUSP UNIT DOSE","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00121097440","type":"NDC"}],"standard_charges":[{"gross_charge":59.6,"discounted_cash":59.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHOCARBAMOL 1000 MG/10ML IJ SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2800","type":"HCPCS"},{"code":"25021067510","type":"NDC"}],"standard_charges":[{"gross_charge":115.84,"discounted_cash":115.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"00409341401","type":"NDC"}],"standard_charges":[{"gross_charge":341.36,"discounted_cash":341.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"00409525515","type":"NDC"}],"standard_charges":[{"gross_charge":341.32,"discounted_cash":341.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"00409341411","type":"NDC"}],"standard_charges":[{"gross_charge":341.32,"discounted_cash":341.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"23155024041","type":"NDC"}],"standard_charges":[{"gross_charge":348.74,"discounted_cash":348.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERROUS SULFATE 300 (60 FE) MG/5ML PO SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"50268033624","type":"NDC"}],"standard_charges":[{"gross_charge":35.6,"discounted_cash":35.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMIODARONE HCL 450 MG/9ML IV SOLN","drug_information":{"unit":9.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"63323061609","type":"NDC"}],"standard_charges":[{"gross_charge":129.88,"discounted_cash":129.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 1.5 %-1:200000 IJ SOLN","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"00409120901","type":"NDC"}],"standard_charges":[{"gross_charge":329.53,"discounted_cash":329.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE 50 % IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323006443","type":"NDC"}],"standard_charges":[{"gross_charge":363.23,"discounted_cash":363.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"83634077941","type":"NDC"}],"standard_charges":[{"gross_charge":371.08,"discounted_cash":371.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"63323016216","type":"NDC"}],"standard_charges":[{"gross_charge":337.94,"discounted_cash":337.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"63323016201","type":"NDC"}],"standard_charges":[{"gross_charge":337.94,"discounted_cash":337.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYTOIN SODIUM 50 MG/ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1165","type":"HCPCS"},{"code":"00641049325","type":"NDC"}],"standard_charges":[{"gross_charge":365.97,"discounted_cash":365.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE 1 MG/ML (50 ML) IN NACL PCA","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"70092129474","type":"NDC"}],"standard_charges":[{"gross_charge":938.2,"discounted_cash":938.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML IJ SOLN","drug_information":{"unit":0.001,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"00781382596","type":"NDC"}],"standard_charges":[{"gross_charge":325.03,"discounted_cash":325.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETYLCYSTEINE 200 MG/ML IV SOLN","drug_information":{"unit":14.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0132","type":"HCPCS"},{"code":"63323096330","type":"NDC"}],"standard_charges":[{"gross_charge":246.08,"discounted_cash":246.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCRALFATE 1 GM/10ML PO SUSP UNIT DOSE","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"63739019351","type":"NDC"}],"standard_charges":[{"gross_charge":64.88,"discounted_cash":64.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENHYDRAMINE HCL 12.5 MG/5ML PO ELIX","drug_information":{"unit":1.667,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00121048900","type":"NDC"}],"standard_charges":[{"gross_charge":16.64,"discounted_cash":16.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCIUM GLUCONATE 10 % IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"63323036019","type":"NDC"}],"standard_charges":[{"gross_charge":420.03,"discounted_cash":420.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","drug_information":{"unit":0.667,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"68462075525","type":"NDC"}],"standard_charges":[{"gross_charge":351.47,"discounted_cash":351.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM HCL (PF) 2 MG/2ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"70069081610","type":"NDC"}],"standard_charges":[{"gross_charge":394.48,"discounted_cash":394.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCIUM CHLORIDE 10 % IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0618","type":"HCPCS"},{"code":"76329330401","type":"NDC"}],"standard_charges":[{"gross_charge":427.58,"discounted_cash":427.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN","drug_information":{"unit":0.02,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"C9399","type":"HCPCS"},{"code":"00143953225","type":"NDC"}],"standard_charges":[{"gross_charge":325.73,"discounted_cash":325.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPOFOL 200 MG/20ML IV EMUL","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"25021060820","type":"NDC"}],"standard_charges":[{"gross_charge":327.57,"discounted_cash":327.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NYSTATIN 100000 UNIT/ML MT SUSP BULK","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00904727670","type":"NDC"}],"standard_charges":[{"gross_charge":16.08,"discounted_cash":16.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409471302","type":"NDC"}],"standard_charges":[{"gross_charge":339.43,"discounted_cash":339.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"25021031104","type":"NDC"}],"standard_charges":[{"gross_charge":348.29,"discounted_cash":348.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 50 % IV SOLN","drug_information":{"unit":13.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"00409751716","type":"NDC"}],"standard_charges":[{"gross_charge":376.28,"discounted_cash":376.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHOCARBAMOL 1000 MG/10ML IJ SOLN","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2800","type":"HCPCS"},{"code":"55150022310","type":"NDC"}],"standard_charges":[{"gross_charge":358.83,"discounted_cash":358.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILTIAZEM HCL 25 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1163","type":"HCPCS"},{"code":"00641601310","type":"NDC"}],"standard_charges":[{"gross_charge":339.59,"discounted_cash":339.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPREDNISOLONE ACETATE 80 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"70121157405","type":"NDC"}],"standard_charges":[{"gross_charge":148.34,"discounted_cash":148.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FULVESTRANT 250 MG/5ML IM SOSY","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"43598026223","type":"NDC"}],"standard_charges":[{"gross_charge":2025.58,"discounted_cash":2025.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIAZEPAM 5 MG/ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"43598010610","type":"NDC"}],"standard_charges":[{"gross_charge":117.02,"discounted_cash":117.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN SODIUM 60 MG/0.6ML IJ SOSY","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"16714002610","type":"NDC"}],"standard_charges":[{"gross_charge":110.37,"discounted_cash":110.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXORUBICIN HCL LIPOSOMAL 2 MG/ML IV SUSP","drug_information":{"unit":8.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2050","type":"HCPCS"},{"code":"47335004940","type":"NDC"}],"standard_charges":[{"gross_charge":614.98,"discounted_cash":614.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DICYCLOMINE HCL 10 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"70069044105","type":"NDC"}],"standard_charges":[{"gross_charge":363.98,"discounted_cash":363.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN SODIUM 100 MG/ML IJ SOSY","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00548560500","type":"NDC"}],"standard_charges":[{"gross_charge":374.36,"discounted_cash":374.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"REGADENOSON 0.4 MG/5ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"67457099405","type":"NDC"}],"standard_charges":[{"gross_charge":153.76,"discounted_cash":153.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCIUM GLUCONATE 10 % IV SOLN","drug_information":{"unit":21.505,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"63323036059","type":"NDC"}],"standard_charges":[{"gross_charge":191.67,"discounted_cash":191.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"14789010810","type":"NDC"}],"standard_charges":[{"gross_charge":235.55,"discounted_cash":235.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE VISCOUS HCL 2 % MT SOLN","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00121495040","type":"NDC"}],"standard_charges":[{"gross_charge":17.42,"discounted_cash":17.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"63323096505","type":"NDC"}],"standard_charges":[{"gross_charge":486.16,"discounted_cash":486.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"23155047341","type":"NDC"}],"standard_charges":[{"gross_charge":351.98,"discounted_cash":351.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE 10 MEQ/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"14789010910","type":"NDC"}],"standard_charges":[{"gross_charge":218.65,"discounted_cash":218.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"65282160501","type":"NDC"}],"standard_charges":[{"gross_charge":350.01,"discounted_cash":350.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMANTADINE HCL 50 MG/5ML PO SOLN UNIT DOSE","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"60687079756","type":"NDC"}],"standard_charges":[{"gross_charge":37.52,"discounted_cash":37.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM 500 MG/5ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"72485010625","type":"NDC"}],"standard_charges":[{"gross_charge":380.38,"discounted_cash":380.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 2 % IJ SOLN","drug_information":{"unit":0.125,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409206605","type":"NDC"}],"standard_charges":[{"gross_charge":327.04,"discounted_cash":327.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCRALFATE 1 GM/10ML PO SUSP UNIT DOSE","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"69339020919","type":"NDC"}],"standard_charges":[{"gross_charge":44.48,"discounted_cash":44.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE-SODIUM BICARBONATE 1-8.4 % IJ SOSY","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"70092117546","type":"NDC"}],"standard_charges":[{"gross_charge":226.3,"discounted_cash":226.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXALIPLATIN 100 MG/20ML IV SOLN","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"71288017221","type":"NDC"}],"standard_charges":[{"gross_charge":50.14,"discounted_cash":50.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM BICARBONATE 8.4 % IV SOLN","drug_information":{"unit":1.0,"type":"UN"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"63323008950","type":"NDC"}],"standard_charges":[{"gross_charge":343.61,"discounted_cash":343.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM HCL (PF) 10 MG/2ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"00409230802","type":"NDC"}],"standard_charges":[{"gross_charge":361.33,"discounted_cash":361.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZOLEDRONIC ACID 5 MG/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"68001061133","type":"NDC"}],"standard_charges":[{"gross_charge":378.55,"discounted_cash":378.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"63323066416","type":"NDC"}],"standard_charges":[{"gross_charge":329.49,"discounted_cash":329.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE 50 % IJ SOLN","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323006403","type":"NDC"}],"standard_charges":[{"gross_charge":357.35,"discounted_cash":357.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL CITRATE (PF) 100 MCG/2ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"63323080602","type":"NDC"}],"standard_charges":[{"gross_charge":376.19,"discounted_cash":376.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHOCARBAMOL 1000 MG/10ML IJ SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2800","type":"HCPCS"},{"code":"63323077810","type":"NDC"}],"standard_charges":[{"gross_charge":413.27,"discounted_cash":413.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"00409610204","type":"NDC"}],"standard_charges":[{"gross_charge":369.5,"discounted_cash":369.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN SODIUM 150 MG/ML IJ SOSY","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"25021041171","type":"NDC"}],"standard_charges":[{"gross_charge":369.76,"discounted_cash":369.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","drug_information":{"unit":0.667,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"63323016116","type":"NDC"}],"standard_charges":[{"gross_charge":341.74,"discounted_cash":341.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN SODIUM 30 MG/0.3ML IJ SOSY","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"16714000610","type":"NDC"}],"standard_charges":[{"gross_charge":394.2,"discounted_cash":394.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PALONOSETRON HCL 0.25 MG/5ML IV SOSY","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"63323067389","type":"NDC"}],"standard_charges":[{"gross_charge":412.36,"discounted_cash":412.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":2.7,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288040202","type":"NDC"}],"standard_charges":[{"gross_charge":417.38,"discounted_cash":417.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PALONOSETRON HCL 0.25 MG/5ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"55111069407","type":"NDC"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE SULFATE (PF) 1 MG/ML IJ SOLN","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"00409381512","type":"NDC"}],"standard_charges":[{"gross_charge":337.9,"discounted_cash":337.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NICARDIPINE HCL 2.5 MG/ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2404","type":"HCPCS"},{"code":"55150018310","type":"NDC"}],"standard_charges":[{"gross_charge":335.92,"discounted_cash":335.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPERIDINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2175","type":"HCPCS"},{"code":"00641605325","type":"NDC"}],"standard_charges":[{"gross_charge":347.27,"discounted_cash":347.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROTAMINE SULFATE 10 MG/ML IV SOLN","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2720","type":"HCPCS"},{"code":"63323022905","type":"NDC"}],"standard_charges":[{"gross_charge":341.33,"discounted_cash":341.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCOPYRROLATE PF 0.4 MG/2ML IJ SOSY","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"70121169907","type":"NDC"}],"standard_charges":[{"gross_charge":390.47,"discounted_cash":390.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":3.6,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00641039112","type":"NDC"}],"standard_charges":[{"gross_charge":214.25,"discounted_cash":214.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DROPERIDOL 2.5 MG/ML IJ SOLN","drug_information":{"unit":0.125,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1790","type":"HCPCS"},{"code":"00517970225","type":"NDC"}],"standard_charges":[{"gross_charge":343.85,"discounted_cash":343.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DICYCLOMINE HCL 10 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"70436014781","type":"NDC"}],"standard_charges":[{"gross_charge":415.45,"discounted_cash":415.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DICYCLOMINE HCL 10 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"00641617310","type":"NDC"}],"standard_charges":[{"gross_charge":405.78,"discounted_cash":405.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN SODIUM 80 MG/0.8ML IJ SOSY","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71839011210","type":"NDC"}],"standard_charges":[{"gross_charge":347.06,"discounted_cash":347.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN SODIUM 40 MG/0.4ML IJ SOSY","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043383","type":"NDC"}],"standard_charges":[{"gross_charge":380.17,"discounted_cash":380.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN SODIUM 60 MG/0.6ML IJ SOSY","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71839011110","type":"NDC"}],"standard_charges":[{"gross_charge":405.78,"discounted_cash":405.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1050","type":"HCPCS"},{"code":"67457088701","type":"NDC"}],"standard_charges":[{"gross_charge":203.61,"discounted_cash":203.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PAPAVERINE HCL 30 MG/ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2440","type":"HCPCS"},{"code":"54288014210","type":"NDC"}],"standard_charges":[{"gross_charge":318.53,"discounted_cash":318.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN SODIUM 30 MG/0.3ML IJ SOSY","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043281","type":"NDC"}],"standard_charges":[{"gross_charge":390.09,"discounted_cash":390.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN SODIUM 120 MG/0.8ML IJ SOSY","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"25021041170","type":"NDC"}],"standard_charges":[{"gross_charge":124.89,"discounted_cash":124.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPREDNISOLONE ACETATE 80 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"60219157405","type":"NDC"}],"standard_charges":[{"gross_charge":148.07,"discounted_cash":148.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VINCRISTINE SULFATE 1 MG/ML IV SOLN","drug_information":{"unit":1.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9370","type":"HCPCS"},{"code":"61703030916","type":"NDC"}],"standard_charges":[{"gross_charge":120.23,"discounted_cash":120.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATOVAQUONE 750 MG/5ML PO SUSP","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"60687053436","type":"NDC"}],"standard_charges":[{"gross_charge":203.04,"discounted_cash":203.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NALOXONE HCL 0.4 MG/ML IJ SOLN","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2312","type":"HCPCS"},{"code":"36000030810","type":"NDC"}],"standard_charges":[{"gross_charge":350.3,"discounted_cash":350.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE SULFATE (PF) 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"00409189323","type":"NDC"}],"standard_charges":[{"gross_charge":413.97,"discounted_cash":413.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEOSTIGMINE METHYLSULFATE 5 MG/5ML IV SOSY","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"71449012511","type":"NDC"}],"standard_charges":[{"gross_charge":413.4,"discounted_cash":413.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE SULFATE 1 MG/ML IJ SOLN (WRAPPED)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"70092113343","type":"NDC"}],"standard_charges":[{"gross_charge":141.52,"discounted_cash":141.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IRON SUCROSE 20 MG/ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"67457063910","type":"NDC"}],"standard_charges":[{"gross_charge":1141.27,"discounted_cash":1141.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1938","type":"HCPCS"},{"code":"83634030204","type":"NDC"}],"standard_charges":[{"gross_charge":456.29,"discounted_cash":456.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN SODIUM 30 MG/0.3ML IJ SOSY","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"25021041070","type":"NDC"}],"standard_charges":[{"gross_charge":376.95,"discounted_cash":376.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN SODIUM 100 MG/ML IJ SOSY","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"25021041071","type":"NDC"}],"standard_charges":[{"gross_charge":343.25,"discounted_cash":343.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FULVESTRANT 250 MG/5ML IM SOSY","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"70121146302","type":"NDC"}],"standard_charges":[{"gross_charge":1395.58,"discounted_cash":1395.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"REGADENOSON 0.4 MG/5ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"36000036401","type":"NDC"}],"standard_charges":[{"gross_charge":170.8,"discounted_cash":170.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":0.01,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"72205026425","type":"NDC"}],"standard_charges":[{"gross_charge":325.21,"discounted_cash":325.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"25021048101","type":"NDC"}],"standard_charges":[{"gross_charge":328.9,"discounted_cash":328.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323020102","type":"NDC"}],"standard_charges":[{"gross_charge":365.61,"discounted_cash":365.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"00641604225","type":"NDC"}],"standard_charges":[{"gross_charge":347.98,"discounted_cash":347.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"C9399","type":"HCPCS"},{"code":"55150020902","type":"NDC"}],"standard_charges":[{"gross_charge":327.08,"discounted_cash":327.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIGOXIN 0.25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1160","type":"HCPCS"},{"code":"00641141035","type":"NDC"}],"standard_charges":[{"gross_charge":376.05,"discounted_cash":376.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXALIPLATIN 50 MG/10ML IV SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"25021023310","type":"NDC"}],"standard_charges":[{"gross_charge":85.81,"discounted_cash":85.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00409272001","type":"NDC"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":325.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IRINOTECAN HCL 100 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"60505612801","type":"NDC"}],"standard_charges":[{"gross_charge":40.64,"discounted_cash":40.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":0.01,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"70756062125","type":"NDC"}],"standard_charges":[{"gross_charge":325.52,"discounted_cash":325.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"00409610202","type":"NDC"}],"standard_charges":[{"gross_charge":418.81,"discounted_cash":418.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ADENOSINE 12 MG/4ML IV SOLN","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"63323065104","type":"NDC"}],"standard_charges":[{"gross_charge":178.58,"discounted_cash":178.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FORMOTEROL FUMARATE 20 MCG/2ML IN NEBU","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"00378163193","type":"NDC"}],"standard_charges":[{"gross_charge":52.79,"discounted_cash":52.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML IJ SOLN","drug_information":{"unit":0.001,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"00517460125","type":"NDC"}],"standard_charges":[{"gross_charge":325.09,"discounted_cash":325.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LABETALOL HCL 20 MG/4ML IV SOSY","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"71506004645","type":"NDC"}],"standard_charges":[{"gross_charge":379.21,"discounted_cash":379.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPREDNISOLONE ACETATE 40 MG/ML IJ SUSP","drug_information":{"unit":40.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"70121157301","type":"NDC"}],"standard_charges":[{"gross_charge":3323.6,"discounted_cash":3323.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PALONOSETRON HCL 0.25 MG/5ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"00703409401","type":"NDC"}],"standard_charges":[{"gross_charge":265.78,"discounted_cash":265.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUMATRIPTAN SUCCINATE 6 MG/0.5ML SC SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3030","type":"HCPCS"},{"code":"00143963805","type":"NDC"}],"standard_charges":[{"gross_charge":422.08,"discounted_cash":422.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPINEPHRINE PF 1 MG/ML IJ SOLN","drug_information":{"unit":0.003,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0171","type":"HCPCS"},{"code":"54288010310","type":"NDC"}],"standard_charges":[{"gross_charge":325.86,"discounted_cash":325.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIAZEPAM 5 MG/ML IJ SOLN","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"69339013634","type":"NDC"}],"standard_charges":[{"gross_charge":395.48,"discounted_cash":395.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPREDNISOLONE ACETATE 80 MG/ML IJ SUSP","drug_information":{"unit":0.125,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"70121157401","type":"NDC"}],"standard_charges":[{"gross_charge":355.9,"discounted_cash":355.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IRON SUCROSE 20 MG/ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"67457063810","type":"NDC"}],"standard_charges":[{"gross_charge":585.93,"discounted_cash":585.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NALOXONE HCL 2 MG/2ML IJ SOSY","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"00641620510","type":"NDC"}],"standard_charges":[{"gross_charge":141.47,"discounted_cash":141.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERUMOXYTOL 510 MG/17ML IV SOLN","drug_information":{"unit":17.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q0138","type":"HCPCS"},{"code":"00781315401","type":"NDC"}],"standard_charges":[{"gross_charge":443.12,"discounted_cash":443.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FULVESTRANT 250 MG/5ML IM SOSY","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"25021047174","type":"NDC"}],"standard_charges":[{"gross_charge":2083.33,"discounted_cash":2083.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":0.025,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2598","type":"HCPCS"},{"code":"00517102025","type":"NDC"}],"standard_charges":[{"gross_charge":349.22,"discounted_cash":349.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN SODIUM 40 MG/0.4ML IJ SOSY","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"63323056497","type":"NDC"}],"standard_charges":[{"gross_charge":359.48,"discounted_cash":359.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDRALAZINE HCL 20 MG/ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"00517090125","type":"NDC"}],"standard_charges":[{"gross_charge":174.38,"discounted_cash":174.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUTORPHANOL TARTRATE 2 MG/ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0595","type":"HCPCS"},{"code":"00409162601","type":"NDC"}],"standard_charges":[{"gross_charge":154.53,"discounted_cash":154.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIAZEPAM 5 MG/ML IJ SOLN","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"00409127332","type":"NDC"}],"standard_charges":[{"gross_charge":386.76,"discounted_cash":386.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXORUBICIN HCL 2 MG/ML IV SOLN","drug_information":{"unit":8.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9000","type":"HCPCS"},{"code":"63323088330","type":"NDC"}],"standard_charges":[{"gross_charge":609.83,"discounted_cash":609.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROTAMINE SULFATE 10 MG/ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2720","type":"HCPCS"},{"code":"63323022995","type":"NDC"}],"standard_charges":[{"gross_charge":261.16,"discounted_cash":261.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPTIFIBATIDE 75 MG/100ML IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1327","type":"HCPCS"},{"code":"70436016380","type":"NDC"}],"standard_charges":[{"gross_charge":1039.0,"discounted_cash":1039.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NA FERRIC GLUC CPLX IN SUCROSE 12.5 MG/ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"00143957010","type":"NDC"}],"standard_charges":[{"gross_charge":375.95,"discounted_cash":375.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLADRIBINE 10 MG/10ML IV SOLN","drug_information":{"unit":7.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9065","type":"HCPCS"},{"code":"00143987101","type":"NDC"}],"standard_charges":[{"gross_charge":322.27,"discounted_cash":322.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN","drug_information":{"unit":1.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"00362089805","type":"NDC"}],"standard_charges":[{"gross_charge":352.49,"discounted_cash":352.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"63323016101","type":"NDC"}],"standard_charges":[{"gross_charge":337.55,"discounted_cash":337.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GADOBUTROL 1 MMOL/ML IV SOLN","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"A9585","type":"HCPCS"},{"code":"65219028110","type":"NDC"}],"standard_charges":[{"gross_charge":11.1,"discounted_cash":11.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 10000 UNIT/ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00409272101","type":"NDC"}],"standard_charges":[{"gross_charge":356.1,"discounted_cash":356.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IRINOTECAN HCL 300 MG/15ML IV SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"55150035401","type":"NDC"}],"standard_charges":[{"gross_charge":234.2,"discounted_cash":234.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE HCL 0.2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"00641625910","type":"NDC"}],"standard_charges":[{"gross_charge":362.95,"discounted_cash":362.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPERIDINE HCL 25 MG/ML IJ SOLN","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2175","type":"HCPCS"},{"code":"00641605225","type":"NDC"}],"standard_charges":[{"gross_charge":346.38,"discounted_cash":346.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPTIFIBATIDE 20 MG/10ML IV SOLN","drug_information":{"unit":7.758,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1327","type":"HCPCS"},{"code":"55150021910","type":"NDC"}],"standard_charges":[{"gross_charge":322.31,"discounted_cash":322.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN SODIUM 40 MG/0.4ML IJ SOSY","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"25021041076","type":"NDC"}],"standard_charges":[{"gross_charge":385.31,"discounted_cash":385.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN SODIUM 30 MG/0.3ML IJ SOSY","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00781323863","type":"NDC"}],"standard_charges":[{"gross_charge":395.96,"discounted_cash":395.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN SODIUM 80 MG/0.8ML IJ SOSY","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043587","type":"NDC"}],"standard_charges":[{"gross_charge":351.12,"discounted_cash":351.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN SODIUM 60 MG/0.6ML IJ SOSY","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043485","type":"NDC"}],"standard_charges":[{"gross_charge":347.41,"discounted_cash":347.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN SODIUM 40 MG/0.4ML IJ SOSY","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71839011010","type":"NDC"}],"standard_charges":[{"gross_charge":380.85,"discounted_cash":380.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2598","type":"HCPCS"},{"code":"25021047401","type":"NDC"}],"standard_charges":[{"gross_charge":106.5,"discounted_cash":106.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"16714013025","type":"NDC"}],"standard_charges":[{"gross_charge":342.16,"discounted_cash":342.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN SODIUM 100 MG/ML IJ SOSY","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00781326869","type":"NDC"}],"standard_charges":[{"gross_charge":353.11,"discounted_cash":353.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FULVESTRANT 250 MG/5ML IM SOSY","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"16714007002","type":"NDC"}],"standard_charges":[{"gross_charge":1443.67,"discounted_cash":1443.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIAZEPAM 5 MG/ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"00641624410","type":"NDC"}],"standard_charges":[{"gross_charge":413.67,"discounted_cash":413.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXALIPLATIN 100 MG/20ML IV SOLN","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"25021023320","type":"NDC"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":371.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXALIPLATIN 50 MG/10ML IV SOLN","drug_information":{"unit":4.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"00781331570","type":"NDC"}],"standard_charges":[{"gross_charge":198.13,"discounted_cash":198.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"81298578105","type":"NDC"}],"standard_charges":[{"gross_charge":350.34,"discounted_cash":350.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHOTREXATE SODIUM (PF) 50 MG/2ML IJ SOLN","drug_information":{"unit":0.48,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9260","type":"HCPCS"},{"code":"00703367101","type":"NDC"}],"standard_charges":[{"gross_charge":50.03,"discounted_cash":50.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPREDNISOLONE ACETATE 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"60219157305","type":"NDC"}],"standard_charges":[{"gross_charge":424.11,"discounted_cash":424.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NALOXONE HCL 0.4 MG/ML IJ SOLN","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"70069007110","type":"NDC"}],"standard_charges":[{"gross_charge":362.7,"discounted_cash":362.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE SULFATE 1 MG/ML IJ SOLN (WRAPPED)","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"73177010501","type":"NDC"}],"standard_charges":[{"gross_charge":170.8,"discounted_cash":170.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DICYCLOMINE HCL 10 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"00517198005","type":"NDC"}],"standard_charges":[{"gross_charge":403.86,"discounted_cash":403.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARSENIC TRIOXIDE 10 MG/10ML IV SOLN","drug_information":{"unit":9.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9017","type":"HCPCS"},{"code":"70121148307","type":"NDC"}],"standard_charges":[{"gross_charge":185.82,"discounted_cash":185.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE HCL 0.25 MG/0.5ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"00409180501","type":"NDC"}],"standard_charges":[{"gross_charge":362.97,"discounted_cash":362.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IRON SUCROSE 20 MG/ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"00781348695","type":"NDC"}],"standard_charges":[{"gross_charge":855.46,"discounted_cash":855.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN SODIUM 100 MG/ML IJ SOSY","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043689","type":"NDC"}],"standard_charges":[{"gross_charge":371.25,"discounted_cash":371.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHOTREXATE SODIUM (PF) 50 MG/2ML IJ SOLN","drug_information":{"unit":0.48,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9260","type":"HCPCS"},{"code":"16729027730","type":"NDC"}],"standard_charges":[{"gross_charge":30.52,"discounted_cash":30.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"REGADENOSON 0.4 MG/5ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"71288020185","type":"NDC"}],"standard_charges":[{"gross_charge":178.72,"discounted_cash":178.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML IJ SOLN","drug_information":{"unit":0.001,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1598","type":"HCPCS"},{"code":"63323057801","type":"NDC"}],"standard_charges":[{"gross_charge":325.06,"discounted_cash":325.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":0.005,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"71288080702","type":"NDC"}],"standard_charges":[{"gross_charge":325.1,"discounted_cash":325.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 400 MCG/100ML IV SOLN","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"C9399","type":"HCPCS"},{"code":"71225012606","type":"NDC"}],"standard_charges":[{"gross_charge":431.15,"discounted_cash":431.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCRALFATE 1 GM/10ML PO SUSP UNIT DOSE","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"68094004162","type":"NDC"}],"standard_charges":[{"gross_charge":52.88,"discounted_cash":52.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARFORMOTEROL TARTRATE 15 MCG/2ML IN NEBU","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"70756061270","type":"NDC"}],"standard_charges":[{"gross_charge":24.38,"discounted_cash":24.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":0.002,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"25021031501","type":"NDC"}],"standard_charges":[{"gross_charge":325.06,"discounted_cash":325.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HALOPERIDOL LACTATE 5 MG/ML IJ SOLN","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1630","type":"HCPCS"},{"code":"67457042612","type":"NDC"}],"standard_charges":[{"gross_charge":326.28,"discounted_cash":326.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"72603041225","type":"NDC"}],"standard_charges":[{"gross_charge":350.42,"discounted_cash":350.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLOROPROCAINE HCL (PF) 3 % IJ SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2401","type":"HCPCS"},{"code":"00143921010","type":"NDC"}],"standard_charges":[{"gross_charge":230.32,"discounted_cash":230.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYDO 2 % EX PRSY","drug_information":{"unit":11.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"25021067377","type":"NDC"}],"standard_charges":[{"gross_charge":62.46,"discounted_cash":62.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYDO 2 % EX PRSY","drug_information":{"unit":6.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"25021067376","type":"NDC"}],"standard_charges":[{"gross_charge":51.27,"discounted_cash":51.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRUXIMA 100 MG/10ML IV SOLN","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5115","type":"HCPCS"},{"code":"63459010310","type":"NDC"}],"standard_charges":[{"gross_charge":18732.22,"discounted_cash":18732.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRUXIMA 500 MG/50ML IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5115","type":"HCPCS"},{"code":"63459010450","type":"NDC"}],"standard_charges":[{"gross_charge":46368.1,"discounted_cash":46368.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LOVENOX 60 MG/0.6ML IJ SOSY","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00075801610","type":"NDC"}],"standard_charges":[{"gross_charge":352.85,"discounted_cash":352.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LOVENOX 60 MG/0.6ML IJ SOSY","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00075062160","type":"NDC"}],"standard_charges":[{"gross_charge":107.8,"discounted_cash":107.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LOVENOX 80 MG/0.8ML IJ SOSY","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00075801810","type":"NDC"}],"standard_charges":[{"gross_charge":351.85,"discounted_cash":351.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LOVENOX 80 MG/0.8ML IJ SOSY","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00075062280","type":"NDC"}],"standard_charges":[{"gross_charge":135.74,"discounted_cash":135.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LOVENOX 100 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00075062300","type":"NDC"}],"standard_charges":[{"gross_charge":175.65,"discounted_cash":175.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LOVENOX 100 MG/ML IJ SOSY","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00075802010","type":"NDC"}],"standard_charges":[{"gross_charge":353.3,"discounted_cash":353.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"00409000925","type":"NDC"}],"standard_charges":[{"gross_charge":329.35,"discounted_cash":329.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"60505613005","type":"NDC"}],"standard_charges":[{"gross_charge":332.09,"discounted_cash":332.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"23155054742","type":"NDC"}],"standard_charges":[{"gross_charge":338.53,"discounted_cash":338.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"00409475503","type":"NDC"}],"standard_charges":[{"gross_charge":333.69,"discounted_cash":333.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"00641607825","type":"NDC"}],"standard_charges":[{"gross_charge":353.62,"discounted_cash":353.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"23155054842","type":"NDC"}],"standard_charges":[{"gross_charge":342.22,"discounted_cash":342.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"55150012502","type":"NDC"}],"standard_charges":[{"gross_charge":363.3,"discounted_cash":363.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"36000001225","type":"NDC"}],"standard_charges":[{"gross_charge":354.52,"discounted_cash":354.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"23155054841","type":"NDC"}],"standard_charges":[{"gross_charge":361.9,"discounted_cash":361.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"XYLOCAINE-MPF 0.5 % IJ SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323049157","type":"NDC"}],"standard_charges":[{"gross_charge":390.52,"discounted_cash":390.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"XGEVA 120 MG/1.7ML SC SOLN","drug_information":{"unit":1.7,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0897","type":"HCPCS"},{"code":"55513073001","type":"NDC"}],"standard_charges":[{"gross_charge":63123.81,"discounted_cash":63123.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ESMOLOL HCL-SODIUM CHLORIDE 2500 MG/250ML IV SOLN","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1805","type":"HCPCS"},{"code":"44567045010","type":"NDC"}],"standard_charges":[{"gross_charge":445.5,"discounted_cash":445.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEIN 25 % IV SOLN","drug_information":{"unit":250.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9047","type":"HCPCS"},{"code":"68516521601","type":"NDC"}],"standard_charges":[{"gross_charge":726.0,"discounted_cash":726.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FAMOTIDINE (PF) 20 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1308","type":"HCPCS"},{"code":"63323073916","type":"NDC"}],"standard_charges":[{"gross_charge":336.23,"discounted_cash":336.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRANEXAMIC ACID 1000 MG/10ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3290","type":"HCPCS"},{"code":"72485051010","type":"NDC"}],"standard_charges":[{"gross_charge":396.24,"discounted_cash":396.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":0.125,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"00641037625","type":"NDC"}],"standard_charges":[{"gross_charge":327.76,"discounted_cash":327.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM 500 MG/5ML IV SOLN","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"55150017705","type":"NDC"}],"standard_charges":[{"gross_charge":370.27,"discounted_cash":370.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"00338007225","type":"NDC"}],"standard_charges":[{"gross_charge":334.37,"discounted_cash":334.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288042296","type":"NDC"}],"standard_charges":[{"gross_charge":353.62,"discounted_cash":353.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"00338006910","type":"NDC"}],"standard_charges":[{"gross_charge":353.13,"discounted_cash":353.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GABAPENTIN 250 MG/5ML PO SOLN","drug_information":{"unit":6.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"42192060845","type":"NDC"}],"standard_charges":[{"gross_charge":51.18,"discounted_cash":51.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":0.005,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"00641622925","type":"NDC"}],"standard_charges":[{"gross_charge":325.13,"discounted_cash":325.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACOSAMIDE 200 MG/20ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"C9254","type":"HCPCS"},{"code":"31722020331","type":"NDC"}],"standard_charges":[{"gross_charge":139.84,"discounted_cash":139.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRANEXAMIC ACID 1000 MG/10ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3290","type":"HCPCS"},{"code":"39822100001","type":"NDC"}],"standard_charges":[{"gross_charge":136.96,"discounted_cash":136.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PALONOSETRON HCL 0.25 MG/5ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"60505619301","type":"NDC"}],"standard_charges":[{"gross_charge":391.56,"discounted_cash":391.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXALIPLATIN 100 MG/20ML IV SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"60505613207","type":"NDC"}],"standard_charges":[{"gross_charge":24.1,"discounted_cash":24.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":0.008,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"72485050425","type":"NDC"}],"standard_charges":[{"gross_charge":325.3,"discounted_cash":325.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCIUM GLUCONATE 10 % IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"65219063019","type":"NDC"}],"standard_charges":[{"gross_charge":185.44,"discounted_cash":185.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"00641600810","type":"NDC"}],"standard_charges":[{"gross_charge":396.14,"discounted_cash":396.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL CITRATE (PF) 250 MCG/5ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"00409909425","type":"NDC"}],"standard_charges":[{"gross_charge":337.79,"discounted_cash":337.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"62332060025","type":"NDC"}],"standard_charges":[{"gross_charge":347.51,"discounted_cash":347.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML INJ (WRAPPED)","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"25021005301","type":"NDC"}],"standard_charges":[{"gross_charge":333.76,"discounted_cash":333.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ADENOSINE 6 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"63323065102","type":"NDC"}],"standard_charges":[{"gross_charge":370.54,"discounted_cash":370.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIGOXIN 0.25 MG/ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1160","type":"HCPCS"},{"code":"00781305995","type":"NDC"}],"standard_charges":[{"gross_charge":349.27,"discounted_cash":349.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LABETALOL HCL 20 MG/4ML IV SOSY","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"70092155844","type":"NDC"}],"standard_charges":[{"gross_charge":366.51,"discounted_cash":366.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"00703450204","type":"NDC"}],"standard_charges":[{"gross_charge":380.12,"discounted_cash":380.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXALIPLATIN 100 MG/20ML IV SOLN","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"67457044220","type":"NDC"}],"standard_charges":[{"gross_charge":85.76,"discounted_cash":85.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMINOPHYLLINE 25 MG/ML IV SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0280","type":"HCPCS"},{"code":"00409592101","type":"NDC"}],"standard_charges":[{"gross_charge":360.69,"discounted_cash":360.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"REGADENOSON 0.4 MG/5ML IV SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"43598061611","type":"NDC"}],"standard_charges":[{"gross_charge":207.04,"discounted_cash":207.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NICARDIPINE HCL 2.5 MG/ML IV SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2404","type":"HCPCS"},{"code":"00517073510","type":"NDC"}],"standard_charges":[{"gross_charge":449.95,"discounted_cash":449.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"70121104902","type":"NDC"}],"standard_charges":[{"gross_charge":345.5,"discounted_cash":345.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROTAMINE SULFATE 10 MG/ML IV SOLN","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2720","type":"HCPCS"},{"code":"63323022994","type":"NDC"}],"standard_charges":[{"gross_charge":345.42,"discounted_cash":345.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 2 % IJ SOLN","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"71351002310","type":"NDC"}],"standard_charges":[{"gross_charge":392.5,"discounted_cash":392.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"00409379501","type":"NDC"}],"standard_charges":[{"gross_charge":338.12,"discounted_cash":338.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FAMOTIDINE (PF) 20 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1308","type":"HCPCS"},{"code":"63323073912","type":"NDC"}],"standard_charges":[{"gross_charge":336.23,"discounted_cash":336.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBURX 25 % IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9046","type":"HCPCS"},{"code":"44206025105","type":"NDC"}],"standard_charges":[{"gross_charge":210.4,"discounted_cash":210.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEIN 25 % IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9047","type":"HCPCS"},{"code":"68516521609","type":"NDC"}],"standard_charges":[{"gross_charge":216.1,"discounted_cash":216.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEIN 25 % IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9046","type":"HCPCS"},{"code":"68516521602","type":"NDC"}],"standard_charges":[{"gross_charge":220.9,"discounted_cash":220.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SENSORCAINE-MPF 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046617","type":"NDC"}],"standard_charges":[{"gross_charge":331.85,"discounted_cash":331.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SENSORCAINE-MPF 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046637","type":"NDC"}],"standard_charges":[{"gross_charge":327.62,"discounted_cash":327.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MARCAINE PRESERVATIVE FREE 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409156029","type":"NDC"}],"standard_charges":[{"gross_charge":330.54,"discounted_cash":330.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SENSORCAINE-MPF 0.5 % IJ SOLN","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046639","type":"NDC"}],"standard_charges":[{"gross_charge":326.0,"discounted_cash":326.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN SODIUM 60 MG/0.6ML IJ SOSY","drug_information":{"unit":0.6,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00548560300","type":"NDC"}],"standard_charges":[{"gross_charge":207.4,"discounted_cash":207.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHYTONADIONE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"68462075825","type":"NDC"}],"standard_charges":[{"gross_charge":294.78,"discounted_cash":294.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1071","type":"HCPCS"},{"code":"00574082701","type":"NDC"}],"standard_charges":[{"gross_charge":171.88,"discounted_cash":171.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE HCL PF 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"00409263401","type":"NDC"}],"standard_charges":[{"gross_charge":282.81,"discounted_cash":282.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL CITRATE (PF) 100 MCG/2ML IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"00641602725","type":"NDC"}],"standard_charges":[{"gross_charge":337.22,"discounted_cash":337.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMINOPHYLLINE 25 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0280","type":"HCPCS"},{"code":"00409592201","type":"NDC"}],"standard_charges":[{"gross_charge":347.59,"discounted_cash":347.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409471332","type":"NDC"}],"standard_charges":[{"gross_charge":331.49,"discounted_cash":331.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GENTAMICIN SULFATE 10 MG/ML IJ SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"63323017302","type":"NDC"}],"standard_charges":[{"gross_charge":393.4,"discounted_cash":393.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARFORMOTEROL TARTRATE 15 MCG/2ML IN NEBU","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"60687077084","type":"NDC"}],"standard_charges":[{"gross_charge":42.3,"discounted_cash":42.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"36000032010","type":"NDC"}],"standard_charges":[{"gross_charge":341.26,"discounted_cash":341.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"00143918310","type":"NDC"}],"standard_charges":[{"gross_charge":356.16,"discounted_cash":356.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FORMOTEROL FUMARATE 20 MCG/2ML IN NEBU","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"70756060870","type":"NDC"}],"standard_charges":[{"gross_charge":34.68,"discounted_cash":34.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORAZEPAM 2 MG/ML IJ SOLN","drug_information":{"unit":0.125,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"00641604425","type":"NDC"}],"standard_charges":[{"gross_charge":331.63,"discounted_cash":331.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ADENOSINE 6 MG/2ML IV SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"25021031802","type":"NDC"}],"standard_charges":[{"gross_charge":391.56,"discounted_cash":391.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROGLYCERIN 5 MG/ML IV SOLN","drug_information":{"unit":0.02,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"J2305","type":"HCPCS"},{"code":"00517481025","type":"NDC"}],"standard_charges":[{"gross_charge":326.02,"discounted_cash":326.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL 2 % IJ SOLN","drug_information":{"unit":0.125,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323020202","type":"NDC"}],"standard_charges":[{"gross_charge":330.78,"discounted_cash":330.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"62332059925","type":"NDC"}],"standard_charges":[{"gross_charge":365.25,"discounted_cash":365.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLONIDINE HCL (ANALGESIA) 100 MCG/ML EP SOLN","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0735","type":"HCPCS"},{"code":"39822200001","type":"NDC"}],"standard_charges":[{"gross_charge":350.49,"discounted_cash":350.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE SULFATE (PF) 0.5 MG/ML IJ SOLN","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"00409381412","type":"NDC"}],"standard_charges":[{"gross_charge":156.02,"discounted_cash":156.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROMETHAZINE HCL 25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2550","type":"HCPCS"},{"code":"00641092825","type":"NDC"}],"standard_charges":[{"gross_charge":379.65,"discounted_cash":379.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZOLEDRONIC ACID 4 MG/5ML IV CONC","drug_information":{"unit":4.375,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"72603019801","type":"NDC"}],"standard_charges":[{"gross_charge":164.14,"discounted_cash":164.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FOSPHENYTOIN SODIUM 100 MG PE/2ML IJ SOLN","drug_information":{"unit":45.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2009","type":"HCPCS"},{"code":"63323040302","type":"NDC"}],"standard_charges":[{"gross_charge":2095.39,"discounted_cash":2095.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ORPHENADRINE CITRATE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2360","type":"HCPCS"},{"code":"00641618225","type":"NDC"}],"standard_charges":[{"gross_charge":379.52,"discounted_cash":379.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 100 MG/5ML IV SOSY","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"69374092005","type":"NDC"}],"standard_charges":[{"gross_charge":384.4,"discounted_cash":384.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IRINOTECAN HCL 40 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"60505612800","type":"NDC"}],"standard_charges":[{"gross_charge":46.18,"discounted_cash":46.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MARCAINE PRESERVATIVE FREE 0.25 % IJ SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409155910","type":"NDC"}],"standard_charges":[{"gross_charge":417.56,"discounted_cash":417.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SENSORCAINE-MPF 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046438","type":"NDC"}],"standard_charges":[{"gross_charge":330.08,"discounted_cash":330.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SENSORCAINE-MPF 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046417","type":"NDC"}],"standard_charges":[{"gross_charge":330.29,"discounted_cash":330.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SENSORCAINE-MPF 0.25 % IJ SOLN","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046437","type":"NDC"}],"standard_charges":[{"gross_charge":327.1,"discounted_cash":327.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBURX 25 % IV SOLN","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9046","type":"HCPCS"},{"code":"44206025110","type":"NDC"}],"standard_charges":[{"gross_charge":87.88,"discounted_cash":87.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLEXBUMIN 25 % IV SOLN","drug_information":{"unit":300.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9046","type":"HCPCS"},{"code":"00944049302","type":"NDC"}],"standard_charges":[{"gross_charge":522.4,"discounted_cash":522.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUKED 25 25 % IV SOLN","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9046","type":"HCPCS"},{"code":"76125079210","type":"NDC"}],"standard_charges":[{"gross_charge":263.2,"discounted_cash":263.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEIN 25 % IV SOLN","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9047","type":"HCPCS"},{"code":"68516521600","type":"NDC"}],"standard_charges":[{"gross_charge":221.8,"discounted_cash":221.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KEDBUMIN 25 % IV SOLN","drug_information":{"unit":200.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9047","type":"HCPCS"},{"code":"76179002504","type":"NDC"}],"standard_charges":[{"gross_charge":430.0,"discounted_cash":430.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RECOMBIVAX HB 10 MCG/ML IJ SUSY","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"90746","type":"HCPCS"},{"code":"00006409402","type":"NDC"}],"standard_charges":[{"gross_charge":526.37,"discounted_cash":526.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"STERILE TOPICAL L.E.T. GEL 4-0.18-0.5 % EX GEL","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"71266629001","type":"NDC"}],"standard_charges":[{"gross_charge":101.4,"discounted_cash":101.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VUEWAY 0.5 MMOL/ML IV SOLN","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"A9573","type":"HCPCS"},{"code":"00270703042","type":"NDC"}],"standard_charges":[{"gross_charge":10.47,"discounted_cash":10.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ELUCIREM 0.5 MMOL/ML IV SOLN","drug_information":{"unit":5.6,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"A9573","type":"HCPCS"},{"code":"67684423102","type":"NDC"}],"standard_charges":[{"gross_charge":179.14,"discounted_cash":179.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ELUCIREM 0.5 MMOL/ML IV SOLN","drug_information":{"unit":7.7,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"A9573","type":"HCPCS"},{"code":"67684423202","type":"NDC"}],"standard_charges":[{"gross_charge":85.38,"discounted_cash":85.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VUEWAY 0.5 MMOL/ML IV SOLN","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"A9573","type":"HCPCS"},{"code":"00270702540","type":"NDC"}],"standard_charges":[{"gross_charge":13.92,"discounted_cash":13.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VUEWAY 0.5 MMOL/ML IV SOLN","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"A9573","type":"HCPCS"},{"code":"00270702038","type":"NDC"}],"standard_charges":[{"gross_charge":10.99,"discounted_cash":10.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMJUDO 300 MG/15ML IV SOLN","drug_information":{"unit":15.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9347","type":"HCPCS"},{"code":"00310453530","type":"NDC"}],"standard_charges":[{"gross_charge":88393.67,"discounted_cash":88393.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ELAHERE 100 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9063","type":"HCPCS"},{"code":"72903085301","type":"NDC"}],"standard_charges":[{"gross_charge":1386.85,"discounted_cash":1386.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILTIAZEM HCL 125 MG/25ML IV SOLN","drug_information":{"unit":25.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1163","type":"HCPCS"},{"code":"25021031925","type":"NDC"}],"standard_charges":[{"gross_charge":385.95,"discounted_cash":385.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VEGZELMA 100 MG/4ML IV SOLN","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5129","type":"HCPCS"},{"code":"72606001101","type":"NDC"}],"standard_charges":[{"gross_charge":1082.83,"discounted_cash":1082.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TEZSPIRE 210 MG/1.91ML SC SOAJ","drug_information":{"unit":1.91,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2356","type":"HCPCS"},{"code":"55513012301","type":"NDC"}],"standard_charges":[{"gross_charge":88412.84,"discounted_cash":88412.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DUPIXENT 300 MG/2ML SC SOSY","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"C9399","type":"HCPCS"},{"code":"00024591401","type":"NDC"}],"standard_charges":[{"gross_charge":32834.21,"discounted_cash":32834.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OCREVUS 300 MG/10ML IV SOLN","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2350","type":"HCPCS"},{"code":"50242015001","type":"NDC"}],"standard_charges":[{"gross_charge":730465.76,"discounted_cash":730465.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMFINZI 500 MG/10ML IV SOLN","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9173","type":"HCPCS"},{"code":"00310461150","type":"NDC"}],"standard_charges":[{"gross_charge":27531.11,"discounted_cash":27531.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RITUXAN HYCELA 1400-23400 MG -UT/11.7ML SC SOLN","drug_information":{"unit":11.7,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9311","type":"HCPCS"},{"code":"50242010801","type":"NDC"}],"standard_charges":[{"gross_charge":11354.92,"discounted_cash":11354.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"XYLOCAINE-MPF 1 % IJ SOLN","drug_information":{"unit":30.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323049231","type":"NDC"}],"standard_charges":[{"gross_charge":388.96,"discounted_cash":388.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"XYLOCAINE-MPF 1 % IJ SOLN","drug_information":{"unit":0.02,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323049227","type":"NDC"}],"standard_charges":[{"gross_charge":325.4,"discounted_cash":325.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"XYLOCAINE-MPF 1 % IJ SOLN","drug_information":{"unit":0.001,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323049216","type":"NDC"}],"standard_charges":[{"gross_charge":325.02,"discounted_cash":325.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"XYLOCAINE-MPF 1 % IJ SOLN","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323049297","type":"NDC"}],"standard_charges":[{"gross_charge":386.36,"discounted_cash":386.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"XYLOCAINE-MPF 2 % IJ SOLN","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323049526","type":"NDC"}],"standard_charges":[{"gross_charge":327.54,"discounted_cash":327.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"XYLOCAINE-MPF 2 % IJ SOLN","drug_information":{"unit":0.01,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323049527","type":"NDC"}],"standard_charges":[{"gross_charge":325.37,"discounted_cash":325.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"XYLOCAINE-MPF 2 % IJ SOLN","drug_information":{"unit":40.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323049697","type":"NDC"}],"standard_charges":[{"gross_charge":540.04,"discounted_cash":540.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"XYLOCAINE-MPF 2 % IJ SOLN","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323049507","type":"NDC"}],"standard_charges":[{"gross_charge":330.43,"discounted_cash":330.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POLOCAINE-MPF 2 % IJ SOLN","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0670","type":"HCPCS"},{"code":"63323029427","type":"NDC"}],"standard_charges":[{"gross_charge":326.53,"discounted_cash":326.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VEGZELMA 400 MG/16ML IV SOLN","drug_information":{"unit":16.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5129","type":"HCPCS"},{"code":"72606001201","type":"NDC"}],"standard_charges":[{"gross_charge":4963.32,"discounted_cash":4963.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GNP DICLOFENAC SODIUM 1 % EX GEL","drug_information":{"unit":100.0,"type":"GR"},"code_information":[{"code":"259","type":"RC"},{"code":"46122075252","type":"NDC"}],"standard_charges":[{"gross_charge":67.95,"discounted_cash":67.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HC R&B PRIVATE ROOM DAILY","code_information":[{"code":"1110000001","type":"CDM"},{"code":"0111","type":"RC"},{"code":"1110000001","type":"HCPCS"}],"standard_charges":[{"gross_charge":3724.26,"discounted_cash":3724.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENERAL ROOM WITH TELEMETRY DAILY","code_information":[{"code":"1200000002","type":"CDM"},{"code":"0121","type":"RC"},{"code":"1200000002","type":"HCPCS"}],"standard_charges":[{"gross_charge":3476.06,"discounted_cash":3476.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC R&B SEMI-PRIVATE ROOM DAILY - MED/SURG","code_information":[{"code":"1210000001","type":"CDM"},{"code":"0121","type":"RC"},{"code":"1210000001","type":"HCPCS"}],"standard_charges":[{"gross_charge":3476.06,"discounted_cash":3476.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC R&B OBSERVATION - OPERATIONS CHARGE","code_information":[{"code":"1210000003","type":"CDM"},{"code":"0121","type":"RC"},{"code":"1210000003","type":"HCPCS"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OB SEMI-PRIVATE ROOM DAILY","code_information":[{"code":"1220000001","type":"CDM"},{"code":"0122","type":"RC"},{"code":"1220000001","type":"HCPCS"}],"standard_charges":[{"gross_charge":3139.77,"discounted_cash":3139.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SEMI-PRIVATE PED ROOM DAILY","code_information":[{"code":"1230000001","type":"CDM"},{"code":"0123","type":"RC"},{"code":"1230000001","type":"HCPCS"}],"standard_charges":[{"gross_charge":2858.35,"discounted_cash":2858.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC R&B SEMI-PRIVATE ROOM DAILY - BH ADULT","code_information":[{"code":"1240000002","type":"CDM"},{"code":"0124","type":"RC"},{"code":"1240000002","type":"HCPCS"}],"standard_charges":[{"gross_charge":4297.45,"discounted_cash":4297.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HOSPICE SEMI-PRIVATE ROOM DAILY","code_information":[{"code":"1250000001","type":"CDM"},{"code":"0125","type":"RC"},{"code":"1250000001","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.51,"discounted_cash":300.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC R&B SEMI-PRIVATE ROOM DAILY - BH CHEMICAL","code_information":[{"code":"1260000001","type":"CDM"},{"code":"0126","type":"RC"},{"code":"1260000001","type":"HCPCS"}],"standard_charges":[{"gross_charge":4049.26,"discounted_cash":4049.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SEMI-PRIVATE ONCOLOGY ROOM DAILY","code_information":[{"code":"1270000001","type":"CDM"},{"code":"0127","type":"RC"},{"code":"1270000001","type":"HCPCS"}],"standard_charges":[{"gross_charge":2788.23,"discounted_cash":2788.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NURSERY 1 ROOM DAILY","code_information":[{"code":"1710000001","type":"CDM"},{"code":"0171","type":"RC"},{"code":"1710000001","type":"HCPCS"}],"standard_charges":[{"gross_charge":2354.63,"discounted_cash":2354.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NURSERY 2 ROOM DAILY","code_information":[{"code":"1720000001","type":"CDM"},{"code":"0172","type":"RC"},{"code":"1720000001","type":"HCPCS"}],"standard_charges":[{"gross_charge":2354.63,"discounted_cash":2354.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NICU 2 ROOM DAILY","code_information":[{"code":"1720000002","type":"CDM"},{"code":"0172","type":"RC"},{"code":"1720000002","type":"HCPCS"}],"standard_charges":[{"gross_charge":6735.88,"discounted_cash":6735.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NURSERY 3 ROOM DAILY","code_information":[{"code":"1730000001","type":"CDM"},{"code":"0173","type":"RC"},{"code":"1730000001","type":"HCPCS"}],"standard_charges":[{"gross_charge":6735.88,"discounted_cash":6735.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NICU 3 ROOM DAILY","code_information":[{"code":"1730000002","type":"CDM"},{"code":"0173","type":"RC"},{"code":"1730000002","type":"HCPCS"}],"standard_charges":[{"gross_charge":6735.88,"discounted_cash":6735.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NICU 4 ROOM DAILY","code_information":[{"code":"1740000002","type":"CDM"},{"code":"0174","type":"RC"},{"code":"1740000002","type":"HCPCS"}],"standard_charges":[{"gross_charge":6735.88,"discounted_cash":6735.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ICU ROOM DAILY","code_information":[{"code":"2000000001","type":"CDM"},{"code":"0200","type":"RC"},{"code":"2000000001","type":"HCPCS"}],"standard_charges":[{"gross_charge":5129.98,"discounted_cash":5129.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ICU SURG ROOM DAILY","code_information":[{"code":"2010000001","type":"CDM"},{"code":"0201","type":"RC"},{"code":"2010000001","type":"HCPCS"}],"standard_charges":[{"gross_charge":5129.98,"discounted_cash":5129.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ICU MEDICAL ROOM DAILY","code_information":[{"code":"2020000001","type":"CDM"},{"code":"0202","type":"RC"},{"code":"2020000001","type":"HCPCS"}],"standard_charges":[{"gross_charge":5129.98,"discounted_cash":5129.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ICU PED ROOM DAILY","code_information":[{"code":"2030000001","type":"CDM"},{"code":"0203","type":"RC"},{"code":"2030000001","type":"HCPCS"}],"standard_charges":[{"gross_charge":5129.98,"discounted_cash":5129.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTERMEDIATE ICU ROOM DAILY","code_information":[{"code":"2060000001","type":"CDM"},{"code":"0206","type":"RC"},{"code":"2060000001","type":"HCPCS"}],"standard_charges":[{"gross_charge":3620.75,"discounted_cash":3620.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC R&B PRIVATE INTERMEDIATE PCU ROOM DAILY","code_information":[{"code":"2060000002","type":"CDM"},{"code":"0206","type":"RC"},{"code":"2060000002","type":"HCPCS"}],"standard_charges":[{"gross_charge":3732.05,"discounted_cash":3732.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ICU CARD ROOM DAILY","code_information":[{"code":"2100000001","type":"CDM"},{"code":"0210","type":"RC"},{"code":"2100000001","type":"HCPCS"}],"standard_charges":[{"gross_charge":4685.89,"discounted_cash":4685.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTERMEDIATE CCU ROOM DAILY","code_information":[{"code":"2140000001","type":"CDM"},{"code":"0214","type":"RC"},{"code":"2140000001","type":"HCPCS"}],"standard_charges":[{"gross_charge":3620.75,"discounted_cash":3620.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IV INF HYDRATION, 30-60 MIN","code_information":[{"code":"2609636001","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96360","type":"HCPCS"}],"standard_charges":[{"gross_charge":1092.24,"discounted_cash":1092.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IV INF HYDRATION, EA ADDL HR","code_information":[{"code":"2609636101","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96361","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.62,"discounted_cash":356.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IV INF NON-CHEMO, THER/PROPH/DIAG, INITIAL, TO 1 HR","code_information":[{"code":"2609636501","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":1390.46,"discounted_cash":1390.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IV INF NON-CHEMO, THER/PROPH/DIAG, EA ADD HOUR","code_information":[{"code":"2609636601","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96366","type":"HCPCS"}],"standard_charges":[{"gross_charge":503.25,"discounted_cash":503.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IV INF NON-CHEMO, THER/PROPH/DIAG, SEQUENTIAL, NEW DRUG, TO 1 HR","code_information":[{"code":"2609636701","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96367","type":"HCPCS"}],"standard_charges":[{"gross_charge":492.07,"discounted_cash":492.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IV INF NON-CHEMO, THER/PROPH/DIAG, CONCURRENT","code_information":[{"code":"2609636801","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96368","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.96,"discounted_cash":383.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SC INF W/ PUMP, NON-CHEMO, THER/PROPH, INITIAL, TO 1 HR","code_information":[{"code":"2609636901","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96369","type":"HCPCS"}],"standard_charges":[{"gross_charge":905.98,"discounted_cash":905.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SC INF, NON-CHEMO, THER/PROPH, EA ADDL HOUR","code_information":[{"code":"2609637001","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96370","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.08,"discounted_cash":178.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SC INF, NON-CHEMO, THER/PROPH, ADDL PUMP W/ NEW SITE","code_information":[{"code":"2609637101","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96371","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.62,"discounted_cash":301.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJ NON-CHEMO, THER/PROPH/DIAG, SUBQ/IM","code_information":[{"code":"2609637201","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":708.28,"discounted_cash":708.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJ NON-CHEMO, THER/PROPH/DIAG, IV PUSH, SGL/INITIAL DRUG","code_information":[{"code":"2609637401","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96374","type":"HCPCS"}],"standard_charges":[{"gross_charge":803.95,"discounted_cash":803.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJ NON-CHEMO, THER/PROPH/DIAG, EA IV PUSH, SEQUENTIAL, NEW DRUG","code_information":[{"code":"2609637501","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96375","type":"HCPCS"}],"standard_charges":[{"gross_charge":794.02,"discounted_cash":794.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJ NON-CHEMO, THER/PROPH/DIAG, EA IV PUSH, SEQUENTIAL, SAME DRUG","code_information":[{"code":"2609637601","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96376","type":"HCPCS"}],"standard_charges":[{"gross_charge":611.35,"discounted_cash":611.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REFILL/MAINT, PORTABLE PUMP","code_information":[{"code":"2609652101","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96521","type":"HCPCS"}],"standard_charges":[{"gross_charge":1383.46,"discounted_cash":1383.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IRRIG IMPLANTED DRUG DELIVERY DEVICE","code_information":[{"code":"2609652301","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96523","type":"HCPCS"}],"standard_charges":[{"gross_charge":599.49,"discounted_cash":599.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TIXAGEVIMAB AND CILGAVIMAB INFUSION","code_information":[{"code":"260M022001","type":"CDM"},{"code":"0260","type":"RC"},{"code":"M0220","type":"HCPCS"}],"standard_charges":[{"gross_charge":678.21,"discounted_cash":678.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BEBTELOVIMAB ADMIN W/ POST ADMIN MONITOR","code_information":[{"code":"260M022201","type":"CDM"},{"code":"0260","type":"RC"},{"code":"M0222","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.11,"discounted_cash":390.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CASIRIVI AND IMDEVI INFUSION REPEAT DOSE","code_information":[{"code":"260M024001","type":"CDM"},{"code":"0260","type":"RC"},{"code":"M0240","type":"HCPCS"}],"standard_charges":[{"gross_charge":2842.36,"discounted_cash":2842.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CASIRIVI AND IMDEVI INFUSION","code_information":[{"code":"260M024301","type":"CDM"},{"code":"0260","type":"RC"},{"code":"M0243","type":"HCPCS"}],"standard_charges":[{"gross_charge":1051.79,"discounted_cash":1051.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SOTROVIMAB INFUSION","code_information":[{"code":"260M024701","type":"CDM"},{"code":"0260","type":"RC"},{"code":"M0247","type":"HCPCS"}],"standard_charges":[{"gross_charge":2842.36,"discounted_cash":2842.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOCILIZUMAB 1ST DOSE INFUSION","code_information":[{"code":"260M024901","type":"CDM"},{"code":"0260","type":"RC"},{"code":"M0249","type":"HCPCS"}],"standard_charges":[{"gross_charge":1001.7,"discounted_cash":1001.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOCILIZUMAB 2ND DOSE INFUSION","code_information":[{"code":"260M025001","type":"CDM"},{"code":"0260","type":"RC"},{"code":"M0250","type":"HCPCS"}],"standard_charges":[{"gross_charge":1001.7,"discounted_cash":1001.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IV INF BY PUMP, NON-CHEMO, 8+ HOURS","code_information":[{"code":"261C895701","type":"CDM"},{"code":"0261","type":"RC"},{"code":"C8957","type":"HCPCS"}],"standard_charges":[{"gross_charge":1383.46,"discounted_cash":1383.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUPPLY CHARGE SKIN SUB (TOT SZ 44 SC) APLIGRAF PER SQ CM","code_information":[{"code":"278Q410102","type":"CDM"},{"code":"0278","type":"RC"},{"code":"Q4101","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.18,"discounted_cash":285.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUPPLY CHARGE SKIN SUB (TOT SZ 6 SC) THERASKIN PER SQ CM","code_information":[{"code":"278Q412103","type":"CDM"},{"code":"0278","type":"RC"},{"code":"Q4121","type":"HCPCS"}],"standard_charges":[{"gross_charge":1624.72,"discounted_cash":1624.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUPPLY CHARGE SKIN SUB (TOT SZ 2 SC) GRAFIX PRIME/GRAFIXPL PRIME/STRAVIX/STRAVIXPL PER SQ CM","code_information":[{"code":"278Q413302","type":"CDM"},{"code":"0278","type":"RC"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":2061.55,"discounted_cash":2061.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUPPLY CHARGE SKIN SUB (TOT SZ 4 SC) KERECIS OMEGA3 PER SQ CM","code_information":[{"code":"278Q415803","type":"CDM"},{"code":"0278","type":"RC"},{"code":"Q4158","type":"HCPCS"}],"standard_charges":[{"gross_charge":1332.38,"discounted_cash":1332.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUPPLY CHARGE SKIN SUB (TOT SZ 3 SC) EPIFIX PER SQ CM","code_information":[{"code":"278Q418603","type":"CDM"},{"code":"0278","type":"RC"},{"code":"Q4186","type":"HCPCS"}],"standard_charges":[{"gross_charge":1939.65,"discounted_cash":1939.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUPPLY CHARGE SKIN SUB (TOT SZ 6 SC) EPIFIX PER SQ CM","code_information":[{"code":"278Q418605","type":"CDM"},{"code":"0278","type":"RC"},{"code":"Q4186","type":"HCPCS"}],"standard_charges":[{"gross_charge":1848.37,"discounted_cash":1848.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUPPLY CHARGE SKIN SUB (TOT SZ 8 SC) PURAPLY PER SQ CM","code_information":[{"code":"278Q419502","type":"CDM"},{"code":"0278","type":"RC"},{"code":"Q4195","type":"HCPCS"}],"standard_charges":[{"gross_charge":998.07,"discounted_cash":998.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUPPLY CHARGE SKIN SUB (TOT SZ 6 SC) MATRION PER SQ CM","code_information":[{"code":"278Q420102","type":"CDM"},{"code":"0278","type":"RC"},{"code":"Q4201","type":"HCPCS"}],"standard_charges":[{"gross_charge":1154.76,"discounted_cash":1154.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUPPLY CHARGE SKIN SUB (TOT SZ 12 SC) MATRION PER SQ CM","code_information":[{"code":"278Q420103","type":"CDM"},{"code":"0278","type":"RC"},{"code":"Q4201","type":"HCPCS"}],"standard_charges":[{"gross_charge":730.82,"discounted_cash":730.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHG COLLECTION VENOUS BLOOD,VENIPUNCTURE - DRAW CHARGE","code_information":[{"code":"3003641501","type":"CDM"},{"code":"0300","type":"RC"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.15,"discounted_cash":22.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHG COLLECTION CAPILLARY BLOOD SPECIMEN - DRAW CHARGE","code_information":[{"code":"3003641601","type":"CDM"},{"code":"0300","type":"RC"},{"code":"36416","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.36,"discounted_cash":13.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHG COLLECTION CAPILLARY BLOOD SPECIMEN - RESPIRATORY","code_information":[{"code":"3003641603","type":"CDM"},{"code":"0300","type":"RC"},{"code":"36416","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.36,"discounted_cash":13.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE","code_information":[{"code":"3003659101","type":"CDM"},{"code":"0300","type":"RC"},{"code":"36591","type":"HCPCS"}],"standard_charges":[{"gross_charge":498.62,"discounted_cash":498.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COLLECT BLOOD FROM CATHETER VENOUS NOS","code_information":[{"code":"3003659201","type":"CDM"},{"code":"0300","type":"RC"},{"code":"36592","type":"HCPCS"}],"standard_charges":[{"gross_charge":498.62,"discounted_cash":498.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WITHDRAWAL OF ARTERIAL BLOOD","code_information":[{"code":"3003660001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"36600","type":"HCPCS"}],"standard_charges":[{"gross_charge":827.22,"discounted_cash":827.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - BRCA1 VARIANTS","code_information":[{"code":"3008116201","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81162","type":"HCPCS"}],"standard_charges":[{"gross_charge":12186.24,"discounted_cash":12186.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - BCR/ABL1 MAJOR BREAK","code_information":[{"code":"3008120601","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81206","type":"HCPCS"}],"standard_charges":[{"gross_charge":1095.19,"discounted_cash":1095.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - BCR/ABL1 MINOR BREAK","code_information":[{"code":"3008120701","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81207","type":"HCPCS"}],"standard_charges":[{"gross_charge":967.2,"discounted_cash":967.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - BCR/ABL1 OTHER BREAK","code_information":[{"code":"3008120801","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81208","type":"HCPCS"}],"standard_charges":[{"gross_charge":1433.54,"discounted_cash":1433.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - BRAF V600E MUTATION","code_information":[{"code":"3008121001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81210","type":"HCPCS"}],"standard_charges":[{"gross_charge":1170.88,"discounted_cash":1170.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - CALR EXON 9 VARIANT","code_information":[{"code":"3008121901","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81219","type":"HCPCS"}],"standard_charges":[{"gross_charge":812.49,"discounted_cash":812.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CALRETICULIN (CALR) MUTATION ANALYSIS (CSI) - ARUP","code_information":[{"code":"3008121902","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81219","type":"HCPCS"}],"standard_charges":[{"gross_charge":812.49,"discounted_cash":812.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CFTR GENE ANALYSIS COMMON VARIANTS - CYSTIC FIBROSIS DIAGNOSTIC STDY","code_information":[{"code":"3008122001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81220","type":"HCPCS"}],"standard_charges":[{"gross_charge":3717.42,"discounted_cash":3717.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - CYP2C19 VARIANT","code_information":[{"code":"3008122501","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81225","type":"HCPCS"}],"standard_charges":[{"gross_charge":1945.52,"discounted_cash":1945.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - SNP VARIANTS","code_information":[{"code":"3008122901","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81229","type":"HCPCS"}],"standard_charges":[{"gross_charge":8567.61,"discounted_cash":8567.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC F2 GENE ANALYSIS 20210G >A VARIANT - PROTHROMBIN GENE MUTATION","code_information":[{"code":"3008124001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81240","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":485.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FACTOR 2 GENE MUTATION","code_information":[{"code":"3008124002","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81240","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":485.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT - FACTOR V LEIDEN","code_information":[{"code":"3008124101","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81241","type":"HCPCS"}],"standard_charges":[{"gross_charge":541.63,"discounted_cash":541.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FMR1 GENE DETECTION - CHROMOSOME ANALYSIS, FRAG X DNA","code_information":[{"code":"3008124301","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81243","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.65,"discounted_cash":380.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FRAGILE X COMPREHENSIVE (CHILDREN)","code_information":[{"code":"3008124302","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81243","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.65,"discounted_cash":380.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FMR1 (FRAG X DNA) WITH REFLEX TO METHYLATION ANALYSIS - ARUP","code_information":[{"code":"3008124303","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81243","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.65,"discounted_cash":380.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS - HEMOCHROMATOSIS MUT","code_information":[{"code":"3008125601","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81256","type":"HCPCS"}],"standard_charges":[{"gross_charge":482.55,"discounted_cash":482.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - HBA1/HBA2 VARIANTS","code_information":[{"code":"3008125901","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81259","type":"HCPCS"}],"standard_charges":[{"gross_charge":2100.0,"discounted_cash":2100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALPHA THALASSEMIA HBA1 & HBA2 SEQ - ARUP","code_information":[{"code":"3008125902","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81259","type":"HCPCS"}],"standard_charges":[{"gross_charge":2100.0,"discounted_cash":2100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - IGH B CELL REARRANGEMENT","code_information":[{"code":"3008126101","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81261","type":"HCPCS"}],"standard_charges":[{"gross_charge":1322.24,"discounted_cash":1322.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COMPARATIVE ANAL STR MARKERS PATIENT&COMP SPEC - ADDITIONAL CHARGE","code_information":[{"code":"3008126501","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81265","type":"HCPCS"}],"standard_charges":[{"gross_charge":815.75,"discounted_cash":815.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - JAK2 V617F VARIANT","code_information":[{"code":"3008127001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.15,"discounted_cash":612.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - HTT ALLELES","code_information":[{"code":"3008127101","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81271","type":"HCPCS"}],"standard_charges":[{"gross_charge":914.89,"discounted_cash":914.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC  GENE ANALYSIS - MLH1 PROMOTER METHYLATION","code_information":[{"code":"3008128801","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81288","type":"HCPCS"}],"standard_charges":[{"gross_charge":1284.4,"discounted_cash":1284.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MTHFR MUTATION PCR","code_information":[{"code":"3008129101","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81291","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.3,"discounted_cash":436.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SNRPN/UBE3A METHYLATION ANALYSIS - PRADER-WILLI PANEL","code_information":[{"code":"3008133101","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81331","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.75,"discounted_cash":178.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - SERPINA1 VARIANTS","code_information":[{"code":"3008133201","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81332","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.61,"discounted_cash":291.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TPMT VARIANTS - TPMT AND NUDT15 GENETICS - ARUP","code_information":[{"code":"3008133501","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81335","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.0,"discounted_cash":699.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - TRB VARIANTS","code_information":[{"code":"3008134001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81340","type":"HCPCS"}],"standard_charges":[{"gross_charge":1395.7,"discounted_cash":1395.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - TRG T CELL VARIANTS","code_information":[{"code":"3008134201","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81342","type":"HCPCS"}],"standard_charges":[{"gross_charge":1345.62,"discounted_cash":1345.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - UGT1A1 VARIANT","code_information":[{"code":"3008135001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81350","type":"HCPCS"}],"standard_charges":[{"gross_charge":1562.65,"discounted_cash":1562.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HLA TYPING - SOLID ORGAN TRANS","code_information":[{"code":"3008137002","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81370","type":"HCPCS"}],"standard_charges":[{"gross_charge":1407.42,"discounted_cash":1407.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HLA PLATELET TYPING","code_information":[{"code":"3008137203","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81372","type":"HCPCS"}],"standard_charges":[{"gross_charge":1412.57,"discounted_cash":1412.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HLA TYPING - CLASS I ONE LOCUS","code_information":[{"code":"3008137301","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81373","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.01,"discounted_cash":446.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HLA TYPING - B27","code_information":[{"code":"3008137401","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81374","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.16,"discounted_cash":260.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HLA B27 ANTIGEN","code_information":[{"code":"3008137402","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81374","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.16,"discounted_cash":260.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HLA TYPING - CLASS II ONE LOCUS","code_information":[{"code":"3008137601","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81376","type":"HCPCS"}],"standard_charges":[{"gross_charge":815.83,"discounted_cash":815.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HLA B5701","code_information":[{"code":"3008138101","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81381","type":"HCPCS"}],"standard_charges":[{"gross_charge":1134.15,"discounted_cash":1134.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HLA TYPING - CLASS II DRB1 DRB3 DQB1 DQA1 DPB1 DPA12","code_information":[{"code":"3008138201","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81382","type":"HCPCS"}],"standard_charges":[{"gross_charge":825.85,"discounted_cash":825.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - LEVEL 2","code_information":[{"code":"3008140102","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81401","type":"HCPCS"}],"standard_charges":[{"gross_charge":914.89,"discounted_cash":914.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - LEVEL 4","code_information":[{"code":"3008140301","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81403","type":"HCPCS"}],"standard_charges":[{"gross_charge":1236.54,"discounted_cash":1236.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - LEVEL 6","code_information":[{"code":"3008140501","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81405","type":"HCPCS"}],"standard_charges":[{"gross_charge":2012.3,"discounted_cash":2012.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - LEVEL 8","code_information":[{"code":"3008140701","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81407","type":"HCPCS"}],"standard_charges":[{"gross_charge":5651.81,"discounted_cash":5651.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE SEQUENCE PANEL","code_information":[{"code":"3008145501","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81455","type":"HCPCS"}],"standard_charges":[{"gross_charge":19497.53,"discounted_cash":19497.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - UNLISTED PROCEDURE","code_information":[{"code":"3008147901","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":1446.9,"discounted_cash":1446.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALPHA-1-ANTITRYPSIN PHENOTYPE","code_information":[{"code":"3008210401","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82104","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.09,"discounted_cash":107.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD GAS - ABG W 02 SAT","code_information":[{"code":"3008280501","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.25,"discounted_cash":582.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD GAS - CBG W 02 SAT","code_information":[{"code":"3008280502","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.25,"discounted_cash":582.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MUSK AUTOANTIBODY","code_information":[{"code":"3008351905","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.43,"discounted_cash":122.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHOSPHO-TAU(181) - ALZHEMIER'S DISEASE MARKERS, CSF - ARUP","code_information":[{"code":"3008439302","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84393","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.0,"discounted_cash":500.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHOSPHO-TAU 217, PLASMA - ARUP","code_information":[{"code":"3008439304","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84393","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":575.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOTAL TAU - ALZHEMIER'S DISEASE MARKERS, CSF - ARUP","code_information":[{"code":"3008439402","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84394","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.0,"discounted_cash":500.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RBC ANTIBODY SCREEN - ANTIBODY SCREEN","code_information":[{"code":"3008685001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86850","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.07,"discounted_cash":368.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RBC ANTIBODY ELUTION - ELUTION & ANTIBODY IDENTIFICATION, RBC","code_information":[{"code":"3008686001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86860","type":"HCPCS"}],"standard_charges":[{"gross_charge":1101.73,"discounted_cash":1101.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RBC ANTIBODY IDENTIFICATION - ANTIBODY IDENTIFICATION","code_information":[{"code":"3008687001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86870","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIRECT COOMBS (ANTIGLOBULIN TEST)","code_information":[{"code":"3008688002","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86880","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.14,"discounted_cash":411.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTIHUMAN GLOBULIN INDIR QUAL EA REAGENT CELL - COOMBS TEST, IND","code_information":[{"code":"3008688501","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86885","type":"HCPCS"}],"standard_charges":[{"gross_charge":996.14,"discounted_cash":996.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTIHUMAN GLOBULIN INDIR QUAL EA REAGENT CELL - COOMBS TEST, IND - WEAK D","code_information":[{"code":"3008688502","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86885","type":"HCPCS"}],"standard_charges":[{"gross_charge":996.14,"discounted_cash":996.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTIHUMAN GLOBULIN INDIRECT EA ANTIBODY TITER - ANTIBODY TITER","code_information":[{"code":"3008688601","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86886","type":"HCPCS"}],"standard_charges":[{"gross_charge":996.14,"discounted_cash":996.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RBC AUTOLOGOUS UNUSED","code_information":[{"code":"3008689001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86890","type":"HCPCS"}],"standard_charges":[{"gross_charge":996.14,"discounted_cash":996.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD TYPING SEROLOGIC ABO - BLOOD TYPE","code_information":[{"code":"3008690002","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86900","type":"HCPCS"}],"standard_charges":[{"gross_charge":827.22,"discounted_cash":827.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD TYPING SEROLOGIC ABO - BLOOD GROUP","code_information":[{"code":"3008690004","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86900","type":"HCPCS"}],"standard_charges":[{"gross_charge":827.22,"discounted_cash":827.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD TYPING SEROLOGIC RH (D) - CORD BLOOD TYPE","code_information":[{"code":"3008690101","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86901","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.89,"discounted_cash":249.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD TYPING SEROLOGIC RH (D) - BLOOD TYPE","code_information":[{"code":"3008690102","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86901","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.89,"discounted_cash":249.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD TYPING SEROLOGIC RH (D) - BLOOD TYPE REF LAB","code_information":[{"code":"3008690103","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86901","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.89,"discounted_cash":249.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH - BLOOD TYPING, ANTIGEN","code_information":[{"code":"3008690201","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA - BLOOD TYPING,  ANTIGEN REFRD","code_information":[{"code":"3008690202","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD TYPING ANTIGEN SCREEN PATIENT SERUM/UNIT - BLOOD TYPING, PAT","code_information":[{"code":"3008690401","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86904","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.94,"discounted_cash":225.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH - BLOOD TYPING, RBC","code_information":[{"code":"3008690501","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86905","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATIENT RBC PHENOTYPE REFERRED","code_information":[{"code":"3008690502","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86905","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD TYPING - RH PHENOTYPE COMPLETE","code_information":[{"code":"3008690601","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86906","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.94,"discounted_cash":225.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CROSSMATCH - IMMEDIATE SPIN","code_information":[{"code":"3008692001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86920","type":"HCPCS"}],"standard_charges":[{"gross_charge":1101.73,"discounted_cash":1101.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CROSSMATCH - ANTIHUMAN GLOBULIN","code_information":[{"code":"3008692201","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86922","type":"HCPCS"}],"standard_charges":[{"gross_charge":1101.73,"discounted_cash":1101.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CROSSMATCH - ANTIHUMAN GLOBULIN REF LAB","code_information":[{"code":"3008692202","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86922","type":"HCPCS"}],"standard_charges":[{"gross_charge":1101.73,"discounted_cash":1101.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD COMPATIBILITY - CROSSMATCH -COMPUTER","code_information":[{"code":"3008692301","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86923","type":"HCPCS"}],"standard_charges":[{"gross_charge":1101.73,"discounted_cash":1101.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FFP THAWING - EACH","code_information":[{"code":"3008692701","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86927","type":"HCPCS"}],"standard_charges":[{"gross_charge":996.14,"discounted_cash":996.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD COMPATIBILITY ANTIBODY IDENTIFICATION - PRETREATMENT","code_information":[{"code":"3008697001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86970","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.94,"discounted_cash":225.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD COMPATIBILITY ANTIBODY IDENTIFICATION - PRETREATMENT ENZYME","code_information":[{"code":"3008697101","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86971","type":"HCPCS"}],"standard_charges":[{"gross_charge":1945.52,"discounted_cash":1945.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD COMPATIBILITY ANTIBODY IDENTIFICATION - PRETREATMENT SEPARATION","code_information":[{"code":"3008697201","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86972","type":"HCPCS"}],"standard_charges":[{"gross_charge":996.14,"discounted_cash":996.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD COMPATIBILITY ANTIBODY IDENTIFICATION - PRETREATMENT DRUG","code_information":[{"code":"3008697501","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86975","type":"HCPCS"}],"standard_charges":[{"gross_charge":1995.41,"discounted_cash":1995.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD COMPATIBILITY ANTIBODY IDENTIFICATION - PRETREATMENT ABSORPTION","code_information":[{"code":"3008697801","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86978","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.94,"discounted_cash":225.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD COMPONENT UNIT SPLITTING - EACH","code_information":[{"code":"3008698501","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86985","type":"HCPCS"}],"standard_charges":[{"gross_charge":996.14,"discounted_cash":996.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRANFUSION MEDICINE UNLISTED PROCEDURE","code_information":[{"code":"3008699901","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86999","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.72,"discounted_cash":85.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MONOCYTE MONOLAYER ASSAY (MMA) - ONEBLOOD","code_information":[{"code":"3008699902","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86999","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.72,"discounted_cash":85.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - O&P STAIN","code_information":[{"code":"3008720901","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87209","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SARS-COV2 + INFLUENZA A AND B PCR MULTIPLEX","code_information":[{"code":"3008763601","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87636","type":"HCPCS"}],"standard_charges":[{"gross_charge":952.73,"discounted_cash":952.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SARS-COV2 + INFLUENZA A AND B + RSV PCR MULTIPLEX","code_information":[{"code":"3008763701","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87637","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.21,"discounted_cash":499.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COVID-19, FLU A, FLU B, RSV PCR","code_information":[{"code":"3008763702","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87637","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.21,"discounted_cash":499.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CELL COUNT,MISC BODY FLUIDS - BODY FLUID CELL COUNT","code_information":[{"code":"3008905001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"89050","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.16,"discounted_cash":31.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BODY FLUID CELL COUNT W DIFF - BODY FLUID CELL COUNT W/DIFF","code_information":[{"code":"3008905102","type":"CDM"},{"code":"0300","type":"RC"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.85,"discounted_cash":41.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEUKOCYTE COUNT,FECAL - FECAL LEUKOCYTES","code_information":[{"code":"3008905501","type":"CDM"},{"code":"0300","type":"RC"},{"code":"89055","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.94,"discounted_cash":28.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXAM,SYNOVIAL FLUID CRYSTALS - SYNOVIAL FLUID CRYSTAL","code_information":[{"code":"3008906001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"89060","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.16,"discounted_cash":54.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CRYSTALS, BODY FLUID","code_information":[{"code":"3008906002","type":"CDM"},{"code":"0300","type":"RC"},{"code":"89060","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.16,"discounted_cash":54.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FERN TEST, AMNIOTIC FLUID","code_information":[{"code":"3008906003","type":"CDM"},{"code":"0300","type":"RC"},{"code":"89060","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.16,"discounted_cash":54.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NASAL SMEAR FOR EOSINOPHILS - EOSINOPHIL SMEAR","code_information":[{"code":"3008919001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"89190","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.27,"discounted_cash":20.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SEMEN ANALYSIS, PRESENCE - SEMEN ANALYSIS PRESENCE AND MOTILITY","code_information":[{"code":"3008932101","type":"CDM"},{"code":"0300","type":"RC"},{"code":"89321","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.48,"discounted_cash":80.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC  SPECIMEN HANDLING FEE","code_information":[{"code":"3009900101","type":"CDM"},{"code":"0300","type":"RC"},{"code":"99001","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.3,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLATELET PATHOGEN TESTING PER UNIT","code_information":[{"code":"300P910001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"P9100","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.14,"discounted_cash":411.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CATHETERIZATION FOR SPECIMEN COLLECTION","code_information":[{"code":"300P961201","type":"CDM"},{"code":"0300","type":"RC"},{"code":"P9612","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.91,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BASIC METABOLIC PANEL CALCIUM IONIZED","code_information":[{"code":"3018004701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80047","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":100.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BASIC METABOLIC PANEL CALCIUM TOTAL","code_information":[{"code":"3018004801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80048","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.78,"discounted_cash":62.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENERAL HEALTH PANEL - BUNDLED CHARGE","code_information":[{"code":"3018005001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80050","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.3,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ELECTROLYTE PANEL - BUNDLED CHARGE","code_information":[{"code":"3018005101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80051","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.71,"discounted_cash":51.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COMPREHENSIVE METABOLIC PANEL - CMP","code_information":[{"code":"3018005301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80053","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.55,"discounted_cash":77.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OBSTETRIC PANEL - BUNDLED CHARGE","code_information":[{"code":"3018005501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80055","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.43,"discounted_cash":319.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIPID PANEL - BUNDLED CHARGE","code_information":[{"code":"3018006101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.48,"discounted_cash":98.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIPID PROFILE BY NMR - NMR LIPOMED PROFILE - ARUP","code_information":[{"code":"3018006102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.48,"discounted_cash":98.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIPID PROFILE CARDIO IQ","code_information":[{"code":"3018006103","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.48,"discounted_cash":98.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIPID PANEL - CARDIO IQ - QWDL","code_information":[{"code":"3018006104","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.48,"discounted_cash":98.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIPID PROFILE- LIPOPROTEIN ELECTROPHORESIS - ARUP","code_information":[{"code":"3018006105","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.48,"discounted_cash":98.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RENAL FUNCTION PANEL - BUNDLED CHARGE","code_information":[{"code":"3018006901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80069","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.02,"discounted_cash":64.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS PANEL,ACUTE - BUNDLED CHARGE","code_information":[{"code":"3018007401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80074","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.06,"discounted_cash":352.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATIC FUNCTION PANEL - BUNDLED CHARGE","code_information":[{"code":"3018007601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80076","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.32,"discounted_cash":60.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OBSTETRIC PANEL W HIV","code_information":[{"code":"3018008101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80081","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.01,"discounted_cash":262.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACETAMINOPHEN (TYLENOL) LEVEL","code_information":[{"code":"3018014301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80143","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.87,"discounted_cash":137.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG ASSAY - ADALIMUMAB","code_information":[{"code":"3018014501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80145","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.1,"discounted_cash":257.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG ASSAY - ADALIMUMAB - ARUP","code_information":[{"code":"3018014502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80145","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.1,"discounted_cash":257.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMIKACIN LEVEL","code_information":[{"code":"3018015001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80150","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMIKACIN LEVEL - TGH","code_information":[{"code":"3018015006","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80150","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMIODARONE LEVEL","code_information":[{"code":"3018015101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80151","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.87,"discounted_cash":137.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMIODARONE LEVEL - ARUP","code_information":[{"code":"3018015102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80151","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.87,"discounted_cash":137.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF CARBAMAZEPINE TOTAL - CARBAMAZEPINE TOTAL","code_information":[{"code":"3018015601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80156","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.09,"discounted_cash":107.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARBAMAZEPINE LEVEL TOTAL - CARBAMAZEPINE FREE AND TOTAL - ARUP","code_information":[{"code":"3018015602","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80156","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.09,"discounted_cash":107.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ASSAY CARBAMAZEPINE, FREE - CARBAMAZEPINE FREE","code_information":[{"code":"3018015701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80157","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.38,"discounted_cash":46.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARBAMAZEPINE LEVEL FREE - CARBAMAZEPINE FREE AND TOTAL -ARUP","code_information":[{"code":"3018015702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80157","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.38,"discounted_cash":46.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF CYCLOSPORINE - CYCLOSPORINE","code_information":[{"code":"3018015801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80158","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.2,"discounted_cash":120.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOZAPINE (CLOZARIL) LEVEL","code_information":[{"code":"3018015901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80159","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.67,"discounted_cash":134.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOZAPINE (CLOZARIL) LEVEL - ARUP","code_information":[{"code":"3018015902","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80159","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.67,"discounted_cash":134.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIGOXIN LEVEL TOTAL","code_information":[{"code":"3018016201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80162","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.48,"discounted_cash":98.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VALPROIC ACID LEVEL TOTAL","code_information":[{"code":"3018016402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80164","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.71,"discounted_cash":99.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREEN QUANT DIPROPYLACETIC ACID TOTAL - VALPROIC ACID FREE","code_information":[{"code":"3018016403","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80164","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.71,"discounted_cash":99.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VALPROIC ACID LEVEL TOTAL QWDL","code_information":[{"code":"3018016404","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80164","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.71,"discounted_cash":99.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VALPROIC ACID TOTAL - VALPROIC ACID FREE AND TOTAL - ARUP","code_information":[{"code":"3018016405","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80164","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.71,"discounted_cash":99.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VALPROIC ACID LEVEL FREE ARUP","code_information":[{"code":"3018016501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80165","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.15,"discounted_cash":90.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VALPROIC ACID FREE - VALPROIC ACID FREE AND TOTAL - ARUP","code_information":[{"code":"3018016502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80165","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.15,"discounted_cash":90.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FELBAMATE","code_information":[{"code":"3018016701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80167","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.24,"discounted_cash":65.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ETHOSUXIMIDE - ETHOSUXIMIDE LEVEL","code_information":[{"code":"3018016801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80168","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.07,"discounted_cash":109.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ETHOSUXIMIDE LEVEL - ARUP","code_information":[{"code":"3018016802","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80168","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.07,"discounted_cash":109.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EVEROLIMUS (AFINITOR) LEVEL","code_information":[{"code":"3018016901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80169","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.27,"discounted_cash":91.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EVEROLIMUS (AFINITOR) LEVEL - ARUP","code_information":[{"code":"3018016902","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80169","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.27,"discounted_cash":91.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF GENTAMICIN - GENTAMICIN RANDOM","code_information":[{"code":"3018017002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80170","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.63,"discounted_cash":120.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG ASSAY - GABAPENTIN/NEURONTIN","code_information":[{"code":"3018017101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80171","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.69,"discounted_cash":144.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GABAPENTIN (NEURONTIN) LEVEL - ARUP","code_information":[{"code":"3018017102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80171","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.69,"discounted_cash":144.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF DRUG - LAMOTRIGINE/LAMICTAL LEVEL","code_information":[{"code":"3018017501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80175","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.48,"discounted_cash":98.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAMOTRIGINE (LAMICTAL) LEVEL - ARUP","code_information":[{"code":"3018017502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80175","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.48,"discounted_cash":98.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF LIDOCAINE - LIDOCAINE LEVEL","code_information":[{"code":"3018017601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80176","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.32,"discounted_cash":108.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIDOCAINE LEVEL - ARUP","code_information":[{"code":"3018017602","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80176","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.32,"discounted_cash":108.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEVETIRACETAM (KEPPRA) LEVEL","code_information":[{"code":"3018017701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80177","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.48,"discounted_cash":98.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LITHIUM LEVEL","code_information":[{"code":"3018017801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80178","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.24,"discounted_cash":49.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG THERAPEUTIC LEVEL - SALICYLATE LEVEL SERUM","code_information":[{"code":"3018017901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80179","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.87,"discounted_cash":137.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG ASSAY - MYCOPHENOLIC ACID","code_information":[{"code":"3018018001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80180","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYCOPHENOLIC ACID LEVEL - ARUP","code_information":[{"code":"3018018002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80180","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLECAINIDE (TAMBOCOR) LEVEL","code_information":[{"code":"3018018101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80181","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.24,"discounted_cash":65.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLECAINIDE (TAMBOCOR) LEVEL - ARUP","code_information":[{"code":"3018018102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80181","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.24,"discounted_cash":65.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF DRUG - OXCARBAZEPINE/TRILEPTAL LEVEL","code_information":[{"code":"3018018301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80183","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.04,"discounted_cash":89.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OXCARBAZEPINE (TRILEPTAL) LEVEL - ARUP","code_information":[{"code":"3018018302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80183","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.04,"discounted_cash":89.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHENOBARBITAL LEVEL","code_information":[{"code":"3018018401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80184","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.25,"discounted_cash":113.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHENOBARBITAL LEVEL - ARUP","code_information":[{"code":"3018018402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80184","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.25,"discounted_cash":113.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHENOBARBITAL LEVEL - PRIMIDONE AND METABOLITE - ARUP","code_information":[{"code":"3018018403","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80184","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.25,"discounted_cash":113.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHENYTOIN LEVEL TOTAL","code_information":[{"code":"3018018502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80185","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.48,"discounted_cash":98.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHENYTOIN LEVEL TOTAL - ARUP","code_information":[{"code":"3018018504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80185","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.48,"discounted_cash":98.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHENYTOIN LEVEL FREE","code_information":[{"code":"3018018601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80186","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.15,"discounted_cash":87.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHENYTOIN LEVEL FREE - ARUP","code_information":[{"code":"3018018603","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80186","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.15,"discounted_cash":87.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC POSACONAZOLE DRUG ASSAY","code_information":[{"code":"3018018701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80187","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.89,"discounted_cash":94.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC POSACONAZOLE LEVEL QUANT - ARUP","code_information":[{"code":"3018018702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80187","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.89,"discounted_cash":94.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PRIMIDONE LEVEL - ARUP","code_information":[{"code":"3018018801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80188","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.3,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PRIMIDONE LEVEL - PRIMIDONE AND METABOLITE - ARUP","code_information":[{"code":"3018018802","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80188","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.3,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ITRACONAZOLE LEVEL - ARUP","code_information":[{"code":"3018018902","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80189","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.89,"discounted_cash":94.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF PROCAINAMIDE W METABOLITES - PROCAINAMIDE + NAPA","code_information":[{"code":"3018019201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80192","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.41,"discounted_cash":112.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEFLUNOMIDE","code_information":[{"code":"3018019301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80193","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.1,"discounted_cash":257.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SIROLIMUS LEVEL","code_information":[{"code":"3018019501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80195","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.27,"discounted_cash":91.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TACROLIMUS LEVEL IMMUNOASSAY","code_information":[{"code":"3018019701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80197","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":100.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TACROLIMUS (TMS) - ARUP","code_information":[{"code":"3018019702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80197","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":100.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THEOPHYLLINE LEVEL","code_information":[{"code":"3018019801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80198","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.64,"discounted_cash":104.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOBRAMYCIN LEVEL","code_information":[{"code":"3018020002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80200","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.4,"discounted_cash":119.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF TOPIRAMATE - TOPIRAMATE LEVEL","code_information":[{"code":"3018020101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80201","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOPIRAMATE LEVEL - ARUP","code_information":[{"code":"3018020102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80201","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VANCOMYCIN LEVEL","code_information":[{"code":"3018020202","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80202","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.71,"discounted_cash":99.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG ASSAY - ZONISAMIDE","code_information":[{"code":"3018020301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80203","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.04,"discounted_cash":89.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ZONISAMIDE LEVEL- ARUP","code_information":[{"code":"3018020302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80203","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.04,"discounted_cash":89.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG THERAPEUTIC LEVEL - METHOTREXATE LEVEL","code_information":[{"code":"3018020401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80204","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.1,"discounted_cash":257.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG ASSAY - INFLIXIMAB","code_information":[{"code":"3018023001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80230","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG ASSAY - INFLIXIMAB - ARUP","code_information":[{"code":"3018023002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80230","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THERAPEUTIC DRUG ASSAY - LACOSAMIDE LEVEL","code_information":[{"code":"3018023501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80235","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.42,"discounted_cash":181.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LACOSAMIDE LEVEL - ARUP","code_information":[{"code":"3018023502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80235","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.42,"discounted_cash":181.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG ASSAY VEDOLIZUMAB","code_information":[{"code":"3018028001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80280","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG ASSAY - VORICONAZOLE","code_information":[{"code":"3018028501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80285","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.89,"discounted_cash":94.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VORICONAZOLE LEVEL - ARUP","code_information":[{"code":"3018028502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80285","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.89,"discounted_cash":94.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG ASSAY THERAPEUTIC - UNLISTED - DIGITOXIN LEVEL","code_information":[{"code":"3018029905","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.66,"discounted_cash":124.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF DRUG - THIOPURINE METABOLITES LEVEL","code_information":[{"code":"3018029919","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.39,"discounted_cash":161.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG ASSAY - DEXAMETHASONE","code_information":[{"code":"3018029922","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.66,"discounted_cash":124.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG ASSAY - DIGITOXIN","code_information":[{"code":"3018029923","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.66,"discounted_cash":124.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG ASSAY - UNLISTED","code_information":[{"code":"3018029926","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG ASSAY - PROPAFENONE","code_information":[{"code":"3018029929","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.66,"discounted_cash":124.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG ASSAY - USTEKINUMAB","code_information":[{"code":"3018029933","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.66,"discounted_cash":124.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEXAMETHASONE LEVEL - ARUP","code_information":[{"code":"3018029935","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.66,"discounted_cash":124.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG TEST PRSMV DIR OPT OBS - TOXICOLOGY SCREEN URINE","code_information":[{"code":"3018030505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80305","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.1,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREEN OPTICAL INSTRUMENT READ URINE","code_information":[{"code":"3018030601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80306","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.64,"discounted_cash":114.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CANNABINOID SCREEN URINE","code_information":[{"code":"3018030701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BENZODIAZEPINE LEVEL URINE QUAL","code_information":[{"code":"3018030702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COCAINE SCREEN URINE, ONE DRUG CLASS","code_information":[{"code":"3018030703","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OPIATE QUAL URINE","code_information":[{"code":"3018030705","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OXYCODONE SCREEN URINE","code_information":[{"code":"3018030706","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR - PHENCYCLIDINE (PCP) SCREEN UR","code_information":[{"code":"3018030707","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR - POCT TRICYCLIC ANTIDEPRESSANTS","code_information":[{"code":"3018030712","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC METHADONE SCREEN URINE","code_information":[{"code":"3018030714","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMPHETAMINE LEVEL QUAL URINE","code_information":[{"code":"3018030715","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR - DRUG SCREEN PANEL, EMERGENCY","code_information":[{"code":"3018030719","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRAMADOL LEVEL SCREEN URINE - ARUP","code_information":[{"code":"3018030720","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR - LSD SCREEN URINE","code_information":[{"code":"3018030721","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR - ACETAMINOPHEN/TYLENOL LEVEL","code_information":[{"code":"3018030723","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR - ALCOHOL LEVEL","code_information":[{"code":"3018030724","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR - DRUG SCREEN PANEL CHAIN OF CUSTODY","code_information":[{"code":"3018030725","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR - BREAST MILK","code_information":[{"code":"3018030726","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR - DRUG SCREEN PANEL COMPREHENSIVE MECONIUM","code_information":[{"code":"3018030727","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR - NICOTINE SCREEN URINE","code_information":[{"code":"3018030728","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR - DRUG SCREEN PANEL COMPREHENSIVE","code_information":[{"code":"3018030729","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":459.16,"discounted_cash":459.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREEN 9 TARGETS WITH CONFIRMATION/QUANTITATION URINE - ARUP","code_information":[{"code":"3018030730","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR - DRUG SCREEN PANEL UMBILICAL","code_information":[{"code":"3018030731","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR - DRUG SCREEN PANEL URINE","code_information":[{"code":"3018030732","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR - DRUG SCREEN PANEL COMPREHENSIVE MECONIUM AND CONFIRM","code_information":[{"code":"3018030733","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR - DRUG SCREEN PANEL COMPREHENSIVE 9 AND CONFIRM","code_information":[{"code":"3018030734","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR - DRUG SCREEN PANEL COMPREHENSIVE 7 AND CONFIRM","code_information":[{"code":"3018030735","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOXICOLOGY SCREEN URINE, 10 DRUG CLASSES","code_information":[{"code":"3018030736","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR - DRUG SCREEN PANEL SERUM AND CONFIRM","code_information":[{"code":"3018030737","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR - ETHYL GLUCURONIDE SCREEN URINE","code_information":[{"code":"3018030738","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR - SALICYLATE LEVEL SERUM","code_information":[{"code":"3018030739","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR - DRUG SCREEN PANEL TRANSPLANT","code_information":[{"code":"3018030740","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEROIN SCREEN SERUM/PLASMA WITH REFLEX - 1 DRUG CLASS - ARUP","code_information":[{"code":"3018030741","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREEN QUANT - TOXICOLOGY SCREEN BREAST MILK","code_information":[{"code":"3018030742","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREEN QUANT - LYSERGIC ACID DIETHYLAMIDE URINE","code_information":[{"code":"3018030743","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREEN QUANT - ANABOLIC STEROIDS SCREEN URINE","code_information":[{"code":"3018030744","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREEN QUANT - GAMMA HYDROXYBUTYRATE","code_information":[{"code":"3018030745","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREEN QUANT - BARBITURATES SCREEN URINE","code_information":[{"code":"3018030746","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREEN QUANT - METHADONE SCREEN URINE","code_information":[{"code":"3018030747","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREEN QUANT - FLUNITRAZEPAM LEVEL","code_information":[{"code":"3018030748","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEO/MATERNAL TOXICOLOGY SCREEN 8 DRUG CLASSES","code_information":[{"code":"3018030749","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYXR - FENTANYL QUALITATIVE URINE","code_information":[{"code":"3018030750","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COTININE URINE SCREEN - ARUP","code_information":[{"code":"3018030751","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREEN URINE - 8 TARGETS","code_information":[{"code":"3018030758","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOXICOLOGY SCREEN URINE, 9 DRUG CLASSES","code_information":[{"code":"3018030759","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URINE FENTANYL SCREEN","code_information":[{"code":"3018030760","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ETHYL GLUCURONIDE SCREEN WITH REFLEX CONFIRMATION - ARUP","code_information":[{"code":"3018030763","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREEN 7 WITH REFLEX CONFIRMATION URINE - ARUP","code_information":[{"code":"3018030764","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREEN 9 WITH REFLEX CONFIRMATION URINE - ARUP","code_information":[{"code":"3018030765","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DOA ALCOHOL URINE SCREEN WITH REFLEX TO CONFIRM - ARUP","code_information":[{"code":"3018030766","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREEN PANEL 9 WITH REFLEX CONFIRMATION SERUM OR PLASMA - ARUP","code_information":[{"code":"3018030767","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLUNITRAZEPAM (ROHYPNOL) - ARUP","code_information":[{"code":"3018030768","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GAMMA HYDROXYBUTYRIC (GHB) ACID SCREEN SERUM /PLASMA - ARUP","code_information":[{"code":"3018030769","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COTININE LEVEL URINE - ARUP","code_information":[{"code":"3018030772","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRICYCLIC LEVEL (ANTIDEPRESSANTS) URINE","code_information":[{"code":"3018030773","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FENTANYL SCREEN WITH REFLEX, URINE - ARUP","code_information":[{"code":"3018030774","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.15,"discounted_cash":415.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ALCOHOLS - ETHANOL URINE","code_information":[{"code":"3018032001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ALCOHOLS - ALCOHOLS","code_information":[{"code":"3018032005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ALCOHOLS - ISOPROPANOL","code_information":[{"code":"3018032006","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.88,"discounted_cash":27.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ALCOHOLS - METHANOL","code_information":[{"code":"3018032007","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ISOPROPYL ALCOHOL LEVEL - ARUP","code_information":[{"code":"3018032008","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC METHANOL LEVEL - ARUP","code_information":[{"code":"3018032009","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALCOHOL LEVEL URINE QUANT - ARUP","code_information":[{"code":"3018032010","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VOLATILES SCREEN - ARUP","code_information":[{"code":"3018032011","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG TEST DEFIN - ALCOHOL BIOMARKERS","code_information":[{"code":"3018032101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80321","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG DEFINITIVE EVAL - PHOSPHATIDYLETHANOL","code_information":[{"code":"3018032102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80321","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ETHYL GLUCURONIDE AND ETHYL SULFATE URINE QUANTITATIVE - ARUP","code_information":[{"code":"3018032103","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80321","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHOSPHATIDYLETHANOL (PETH) - ARUP","code_information":[{"code":"3018032104","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80321","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ETHYL GLUCURONIDE, CORDTISS, QUAL - ARUP","code_information":[{"code":"3018032105","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80321","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALKALOIDS NOT OTHERWISE SPECIFIED - NICOTINE SCREEN URINE","code_information":[{"code":"3018032301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80323","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NICOTINE AND METABOLITES QUANT - ARUP","code_information":[{"code":"3018032306","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80323","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NICOTINE AND METABOLITES URINE - ARUP","code_information":[{"code":"3018032309","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80323","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NICOTINE AND METABOLITES PLASMA - ARUP","code_information":[{"code":"3018032310","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80323","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NICOTINE AND METABOLITES - DRUG DETECTION PANEL AND THC MECONIUM - ARUP","code_information":[{"code":"3018032311","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80323","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG ID ALKALOIDS NOT OTHERWISE SPECIFIED - ALKALOIDS NOS SCREEN URINE","code_information":[{"code":"3018032312","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80323","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALKALOIDS - DRUG DETECTION PANEL QUALITATIVE MECONIUM - ARUP","code_information":[{"code":"3018032313","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80323","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALKALOIDS DEFINITIVE - DRUG DETECT PNL MECONIUM QUAL - ARUP","code_information":[{"code":"3018032314","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80323","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREEN QUANT AMPHETAMINES 1 OR 2 - AMPHETAMINE, BLOOD, QUANT","code_information":[{"code":"3018032401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80324","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG DEFINITIVE EVAL - AMPHETAMINES QUANTITATION URINE","code_information":[{"code":"3018032403","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80324","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMPHETAMINE BLOOD QUANT - ARUP","code_information":[{"code":"3018032404","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80324","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMPHETAMINES DEFINITIVE - DRUG DETECT PNL MECONIUM QUAL - ARUP","code_information":[{"code":"3018032503","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80325","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREEN QUANT AMPHETAMINES 5 OR MORE - BUNDLED CHARGE","code_information":[{"code":"3018032601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80326","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMPHETAMINES - DRUG DETECTION PANEL & THC METABOLITE MECONIUM QUAL- ARUP","code_information":[{"code":"3018032603","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80326","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMPHETAMINES - DRUG DETECTION PANEL QUALITATIVE MECONIUM - ARUP","code_information":[{"code":"3018032604","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80326","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2 - FLUOXETINE/PROZAC","code_information":[{"code":"3018033201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80332","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.66,"discounted_cash":124.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTIDEPRESSANTS SEROTONERGIC CLASS 6 OR MORE - BUNDLED CHARGE","code_information":[{"code":"3018033401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80334","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2 - AMITRIPTYLINE LVL","code_information":[{"code":"3018033502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80335","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2 - DESIPRAMINE LVL","code_information":[{"code":"3018033503","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80335","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2 - DOXEPIN&NORDOX","code_information":[{"code":"3018033504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80335","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2 - IMIPRAMINE LEVEL","code_information":[{"code":"3018033505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80335","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2 - NORTRIPTYLINE LVL","code_information":[{"code":"3018033506","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80335","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTIDEPRESSANTS TRICYCLIC/CYCLICALS 1-2 DESIPRAMINE LVL","code_information":[{"code":"3018033509","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80335","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2 - CLOMIPRAMINE/ANAFRANIL LVL","code_information":[{"code":"3018033513","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80335","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG DEFINITIVE EVAL - DESIPRAMINE LEVEL","code_information":[{"code":"3018033514","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80335","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG DEFINITIVE EVAL - DOXEPIN LEVEL","code_information":[{"code":"3018033515","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80335","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG DEFINITIVE EVAL - IMIPRAMINE LEVEL","code_information":[{"code":"3018033516","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80335","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG DEFINITIVE EVAL - NORTRIPTYLINE LEVEL","code_information":[{"code":"3018033517","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80335","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMITRIPTYLINE AND NORTRIPTYLINE SP LEVEL - ARUP","code_information":[{"code":"3018033518","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80335","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NORTRIPTYLINE LEVEL - ARUP","code_information":[{"code":"3018033519","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80335","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTIDEP TRICYCLIC/CYCLICALS 6+ TRICYCLIC ANTIDEP - BUNDLED CHARGE","code_information":[{"code":"3018033701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80337","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTIDEP TRICYCLIC UNLISTED - TRAZODONE/DESYREL BUNDLED CHARGE","code_information":[{"code":"3018033802","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80338","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRAZODONE DESYREL LEVEL - ARUP","code_information":[{"code":"3018033803","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80338","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ADDITIONAL ANTIDEPRESSANTS - ANTIDEPRESSANT PANEL QUANT URINE - ARUP","code_information":[{"code":"3018033804","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80338","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTIPSYCHOTICS NOS 1-3  - BUNDLED CHARGE","code_information":[{"code":"3018034215","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80342","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTIPSYCHOTICS NOS 1-3 QUETIAPINE / SEROQUEL - BUNDLED CHARGE","code_information":[{"code":"3018034216","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80342","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG DEFINITIVE EVAL - OLANZAPINE LEVEL","code_information":[{"code":"3018034220","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80342","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC QUETIAPINE (SEROQUEL) LEVEL - ARUP","code_information":[{"code":"3018034222","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80342","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREENING BARBITURATES - PENTOBARBITAL URINE QUANT","code_information":[{"code":"3018034504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80345","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG DEFINITIVE EVAL - BARBITURATES QUANTITATION","code_information":[{"code":"3018034505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80345","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BARBITURATE URINE CONFIRMATION - ARUP","code_information":[{"code":"3018034506","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80345","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BARBITURATES BLOOD QUANT - ARUP","code_information":[{"code":"3018034507","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80345","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PENTOBARBITAL LEVEL SERUM OR PLASMA - ARUP","code_information":[{"code":"3018034508","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80345","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BARBITURATES DEFINITIVE - DRUG DETECT PNL MECONIUM QUAL - ARUP","code_information":[{"code":"3018034510","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80345","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREENING BENZODIAZEPINES 1-12 BENZODIAZEPINE - BUNDLED CHARGE","code_information":[{"code":"3018034604","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80346","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREENING BENZODIAZEPINES 1-12 - CLONAZEPAM / KLONOPIN QUANT","code_information":[{"code":"3018034610","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80346","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREENING BENZODIAZEPINES 1-12 - LORAZEPAM / ATIVAN QUANT","code_information":[{"code":"3018034611","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80346","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BENZODIAZEPINE LEVEL URINE QUANT - ARUP","code_information":[{"code":"3018034615","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80346","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLONAZEPAM LEVEL - ARUP","code_information":[{"code":"3018034616","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80346","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALPRAZOLAM (XANAX) LEVEL - ARUP","code_information":[{"code":"3018034617","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80346","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BENZODIAZEPINE LEVEL QUANT SERUM OR PLASMA - ARUP","code_information":[{"code":"3018034618","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80346","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BENZODIAZEPINES DEFINITIVE - DRUG DETECT PNL MECONIUM QUAL - ARUP","code_information":[{"code":"3018034621","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80346","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BENZODIAZEPINES DEFINITIVE - DRUG DETECT PNL CORDTISS QUAL-ARUP","code_information":[{"code":"3018034622","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80346","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREENING BENZODIAZEPINES 13+ BENZODIAZEPINE - BUNDLED CHARGE","code_information":[{"code":"3018034701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80347","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BENZODIAZEPINES-DRUG DETECTION PANEL & THC METABOLITE MECONIUM QUAL-ARUP","code_information":[{"code":"3018034705","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80347","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BENZODIAZEPINES - DRUG DETECTION PANEL QUALITATIVE MECONIUM - ARUP","code_information":[{"code":"3018034706","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80347","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREENING BUPRENORPHINE","code_information":[{"code":"3018034801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80348","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BUPRENORPHINE LEVEL URINE","code_information":[{"code":"3018034803","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80348","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BUPRENORPHINE & METABOLITES QUANT URINE - ARUP","code_information":[{"code":"3018034804","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80348","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BUPRENORPHINE LEVEL & METABOLITES QUANT SERUM OR PLASMA - ARUP","code_information":[{"code":"3018034805","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80348","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BUPRENORPHINE DEFINITIVE - DRUG DETECT PNL MECONIUM QUAL - ARUP","code_information":[{"code":"3018034806","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80348","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BUPRENORPHINE DEFINITIVE - DRUG DETECT PNL CORDTISS QUAL-ARUP","code_information":[{"code":"3018034807","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80348","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREENING CANNABINOIDS NATURAL - CANNABINOID CONFIRMATION UR","code_information":[{"code":"3018034901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80349","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":78.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREENING CANNABINOIDS NATURAL - CANNABINOID CONFIRMATION","code_information":[{"code":"3018034902","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80349","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG DEFINITIVE EVAL - THC CONFIRMATION MECONIUM","code_information":[{"code":"3018034903","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80349","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":78.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THC (CANNABINOID) METABOLITE QUANT URINE - ARUP","code_information":[{"code":"3018034906","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80349","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":78.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THC (CANNABINOID) CONFIRMATION SERUM OR PLASMA - ARUP","code_information":[{"code":"3018034907","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80349","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":78.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THC MARIJUANA METABOLITE DEFINITIVE, MECONIUM, QUAL - ARUP","code_information":[{"code":"3018034909","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80349","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":78.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THC - DRUG DETECTION PANEL & THC METABOLITE MECONIUM QUAL - ARUP","code_information":[{"code":"3018034910","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80349","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":78.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MARIJUANA CONFIRMATION MEC - ARUP","code_information":[{"code":"3018034911","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80349","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREENING COCAINE - COCAINE URINE CONF","code_information":[{"code":"3018035301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80353","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREENING COCAINE - COCAINE, BLOOD, QUANTITATIVE","code_information":[{"code":"3018035302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80353","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREENING COCAINE - COCAINE MECONIUM CONF","code_information":[{"code":"3018035303","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80353","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COCAINE BLOOD QUANT - ARUP","code_information":[{"code":"3018035304","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80353","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COCAINE DEFINITIVE - DRUG DETECT PNL MECONIUM QUAL-ARUP","code_information":[{"code":"3018035305","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80353","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COCAINE DEFINITIVE - DRUG DETECT PNL CORDTISS QUAL-ARUP","code_information":[{"code":"3018035306","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80353","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREENING FENTANYL - FENTANYL URINE","code_information":[{"code":"3018035401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80354","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREENING FENTANYL - FENTANYL","code_information":[{"code":"3018035402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80354","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FENTANYL AND METABOLITE URINE QUANT - ARUP","code_information":[{"code":"3018035403","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80354","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FENTANYL DEFINITIVE - DRUG DETECT PNL MECONIUM QUAL-ARUP","code_information":[{"code":"3018035405","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80354","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FENTANYL DEFINITIVE - DRUG DETECT PNL CORDTISS QUAL-ARUP","code_information":[{"code":"3018035406","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80354","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEFINITIVE DRUG ASSAY - GABAPENTIN NON-BLOOD","code_information":[{"code":"3018035501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80355","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GABAPENTIN - DRUG DETECTION PANEL & THC METABOLITE MECONIUM QUAL - ARUP","code_information":[{"code":"3018035503","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80355","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GABAPENTIN - DRUG DETECTION PANEL QUALITATIVE MECONIUM - ARUP","code_information":[{"code":"3018035504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80355","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GABAPENTIN NON-BLOOD DEFINITIVE - DRUG DETECT PNL MECONIUM QUAL-ARUP","code_information":[{"code":"3018035505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80355","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GABAPENTIN NON-BLOOD DEFINITIVE - DRUG DETECT PNL CORDTISS QUAL-ARUP","code_information":[{"code":"3018035506","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80355","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEROIN - HEROIN METABOLITES, FREE, CONFIRMATION, SERUM/PLASMA - ARUP","code_information":[{"code":"3018035601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80356","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG DEFINITIVE EVAL - HEROIN CONFIRMATION URINE","code_information":[{"code":"3018035602","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80356","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEROIN METABOLITE DEFINITIVE - DRUG DETECT PNL MECONIUM QUAL - ARUP","code_information":[{"code":"3018035603","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80356","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEROIN METABOLITE DEFINITIVE - DRUG DETECT PNL CORDTISS QUAL-ARUP","code_information":[{"code":"3018035604","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80356","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG DEFINITIVE EVAL - KETAMINE LEVEL","code_information":[{"code":"3018035701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80357","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREENING METHADONE - METHADONE & METABOLITE LEVEL","code_information":[{"code":"3018035801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80358","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG DEFINITIVE EVAL - METHADONE QUANTITATION URINE","code_information":[{"code":"3018035803","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80358","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC METHADONE LEVEL SERUM/PLASMA - ARUP","code_information":[{"code":"3018035804","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80358","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC METHADONE & METABOLITES LEVEL URINE CONFIRMATION - ARUP","code_information":[{"code":"3018035806","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80358","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC METHADONE DEFINITIVE - DRUG DETECT PNL MECONIUM QUAL - ARUP","code_information":[{"code":"3018035807","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80358","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC METHADONE DEFINITIVE - DRUG DETECT PNL CORDTISS QUAL-ARUP","code_information":[{"code":"3018035808","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80358","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MDMA (ECSTACY) URINE","code_information":[{"code":"3018035901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80359","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREENING METHYLENEDIOXYAMPHETAMINES","code_information":[{"code":"3018035902","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80359","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC METHAMPHETAMINE QUANT - AMPHETAMINE URINE CONFIRMATION - ARUP","code_information":[{"code":"3018035903","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80359","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MDMA/ECSTASY DEFINITIVE - DRUG DETECT PNL MECONIUM QUAL - ARUP","code_information":[{"code":"3018035904","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80359","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MDMA/ECSTASY DEFINITIVE - DRUG DETECT PNL CORDTISS QUAL-ARUP","code_information":[{"code":"3018035905","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80359","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC METHYLPHENIDATE AND METABOLITE LEVEL","code_information":[{"code":"3018036001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80360","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG DEFINITIVE EVAL - METHYLPHENIDATE LEVEL","code_information":[{"code":"3018036002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80360","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC METHYLPHENIDATE AND METABOLITE LEVEL URINE - ARUP","code_information":[{"code":"3018036003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80360","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC METHYLPHENIDATE DEFINITIVE - DRUG DETECT PNL MECONIUM QUAL - ARUP","code_information":[{"code":"3018036004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80360","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREENING OPIATES 1 OR MORE - OPIATE,QUANTITATIVE,UR CONF","code_information":[{"code":"3018036101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREENING OPIATES 1 OR MORE - BUNDLED CHARGE","code_information":[{"code":"3018036102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OPIATE LEVEL QUANT URINE CONFIRMATION - ARUP","code_information":[{"code":"3018036104","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OPIATES - HEROIN METABOLITES, FREE, CONFIRMATION, SERUM/PLASMA - ARUP","code_information":[{"code":"3018036106","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OPIATES DEFINITIVE - DRUG DETECT PNL MECONIUM QUAL - ARUP","code_information":[{"code":"3018036107","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OPIATES DEFINITIVE - DRUG DETECT PNL CORDTISS QUAL-ARUP","code_information":[{"code":"3018036108","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MEPERIDINE (DEMEROL) LEVEL","code_information":[{"code":"3018036201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80362","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OPIOIDS, OPIATE ANALOGS DEFINITIVE - DRUG DETECT PNL MECONIUM QUAL -  ARUP","code_information":[{"code":"3018036203","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80362","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OPIOIDS, OPIATE ANALOGS DEFINITIVE - DRUG DETECT PNL CORDTISS QUAL  ARUP","code_information":[{"code":"3018036204","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80362","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OPIATE 5+ MECONIUM CONFIRMATION","code_information":[{"code":"3018036401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80364","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OPIATE 5+ CONFIRMATION","code_information":[{"code":"3018036402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80364","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OPIATE - DRUG DETECTION PANEL & THC METABOLITE MECONIUM QUAL - ARUP","code_information":[{"code":"3018036404","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80364","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OPIATES - DRUG DETECTION PANEL QUALITATIVE MECONIUM - ARUP","code_information":[{"code":"3018036405","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80364","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREENING OXYCODONE - CONFIRMATION","code_information":[{"code":"3018036501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80365","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OXYCODONE DEFINITIVE - DRUG DETECT PNL MECONIUM QUAL - ARUP","code_information":[{"code":"3018036502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80365","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OXYCODONE DEFINITIVE - DRUG DETECT PNL CORDTISS QUAL-ARUP","code_information":[{"code":"3018036503","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80365","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREENING PREGABALIN - CONFIRMATION","code_information":[{"code":"3018036601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80366","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PREGABALIN LEVEL URINE - ARUP","code_information":[{"code":"3018036602","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80366","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG DEFINITIVE EVAL - PROPOXYPHENE LEVEL","code_information":[{"code":"3018036704","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80367","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROPOXYPHENE DEFINITIVE - DRUG DETECT PNL CORDTISS QUAL-ARUP","code_information":[{"code":"3018036705","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80367","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SEDATIVE HYPNOTICS DEFINITIVE - DRUG DETECT PNL MECONIUM QUAL - ARUP","code_information":[{"code":"3018036807","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80368","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SEDATIVE HYPNOTICS DEFINITIVE - DRUG DETECT PNL CORDTISS QUAL-ARUP","code_information":[{"code":"3018036808","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80368","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREENING SKELETAL MUSCLE RELAXANTS 1 OR 2 - BUNDLED CHARGE","code_information":[{"code":"3018036902","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80369","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG SCREENING TAPENTADOL - BUNDLED CHARGE","code_information":[{"code":"3018037201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80372","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TAPENTADOL DEFINITIVE - DRUG DETECT PNL MECONIUM QUAL - ARUP","code_information":[{"code":"3018037203","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80372","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TAPENTADOL DEFINITIVE - DRUG DETECT PNL CORDTISS QUAL-ARUP","code_information":[{"code":"3018037204","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80372","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRAMADOL & METABOLITE LEVEL URINE QUANT - ARUP","code_information":[{"code":"3018037302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80373","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRAMADOL DEFINITIVE - DRUG DETECT PNL MECONIUM QUAL - ARUP","code_information":[{"code":"3018037303","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80373","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRAMADOL DEFINITIVE - DRUG DETECT PNL CORDTISS QUAL-ARUP","code_information":[{"code":"3018037304","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80373","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 1-3 - BUNDLED CHARGE","code_information":[{"code":"3018037506","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80375","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.66,"discounted_cash":124.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARBIDOPA & LEVODOPA (SINEMET) LEVEL QUANT - ARUP","code_information":[{"code":"3018037508","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80375","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.66,"discounted_cash":124.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 7+ - DIURETICS BUNDLED CHARGE","code_information":[{"code":"3018037703","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80377","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HYPOGLYCEMIA PANEL (SULFONYLUREAS), SERUM OR PLASMA - ARUP","code_information":[{"code":"3018037705","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80377","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIURETIC SCREEN URINE - ARUP","code_information":[{"code":"3018037706","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80377","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SULFONYLUREA HYPOGLYCEMIA PANEL URINE - ARUP","code_information":[{"code":"3018037707","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80377","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URINE VOLUME MEASUREMENT TIMED SPECIMEN","code_information":[{"code":"3018105001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"81050","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.09,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALPHA GLOBIN HBA2 SEQUENCING AND DELETION","code_information":[{"code":"3018126901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"81269","type":"HCPCS"}],"standard_charges":[{"gross_charge":708.4,"discounted_cash":708.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALPHA GLOBIN HBA2 SEQUENCING AND DELETION - ARUP","code_information":[{"code":"3018126902","type":"CDM"},{"code":"0301","type":"RC"},{"code":"81269","type":"HCPCS"}],"standard_charges":[{"gross_charge":708.4,"discounted_cash":708.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BACTERIAL VAGINOSIS RNA MARKERS QUALITATIVE","code_information":[{"code":"3018151301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"81513","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.21,"discounted_cash":499.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BACTERIAL VAGINOSIS - SURESWAB BACTERIAL VAGINOSIS (BV) TMA 10016 - QDID","code_information":[{"code":"3018151302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"81513","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.21,"discounted_cash":499.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC KETONE BODIES SERUM QUALITATIVE - ACETONE","code_information":[{"code":"3018200901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82009","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.05,"discounted_cash":30.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC KETONE BODIES SERUM QUANTITATIVE - BETA HYDROXYBUTYRATE","code_information":[{"code":"3018201002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82010","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.54,"discounted_cash":54.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACETONE, SERUM/PLASMA, QUANT - ARUP","code_information":[{"code":"3018201004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82010","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.32,"discounted_cash":60.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACYLCARNITINES,QUANT,EACH SPEC - ACYLCARNITINES, PLASMA, QUANT","code_information":[{"code":"3018201701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82017","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.8,"discounted_cash":504.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACYLCARNITINES QUANT PLASMA - ARUP","code_information":[{"code":"3018201703","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82017","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.8,"discounted_cash":504.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACYLCARNITINES QUANT - CARNITINE PANEL - ARUP","code_information":[{"code":"3018201704","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82017","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.8,"discounted_cash":504.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ACTH - ACTH","code_information":[{"code":"3018202401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82024","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.59,"discounted_cash":285.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACTH LEVEL","code_information":[{"code":"3018202402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82024","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.22,"discounted_cash":258.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACTH LEVEL - ARUP","code_information":[{"code":"3018202403","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82024","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.59,"discounted_cash":285.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALBUMIN LEVEL","code_information":[{"code":"3018204001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.93,"discounted_cash":36.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALBUMIN LEVEL SERUM -  IMMUNOGLOBULIN G (IGG) CSF INDEX - ARUP","code_information":[{"code":"3018204003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.93,"discounted_cash":36.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALBUMIN LEVEL ARUP OLIGOCLONAL BAND","code_information":[{"code":"3018204004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.93,"discounted_cash":36.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALBUMIN LEVEL SERUM - OLIGOCLONAL BAND PROFILE - ARUP","code_information":[{"code":"3018204005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.93,"discounted_cash":36.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF URINE ALBUMIN - ALBUMIN BODY FLUID","code_information":[{"code":"3018204201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.85,"discounted_cash":57.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALBUMIN CSF IGG SYNTH -ARUP","code_information":[{"code":"3018204203","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.85,"discounted_cash":57.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALBUMIN CSF IGG OLIGOCLONAL BAND PROFILE - ARUP","code_information":[{"code":"3018204204","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.85,"discounted_cash":57.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALBUMIN CSF - ARUP","code_information":[{"code":"3018204205","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.31,"discounted_cash":52.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALBUMIN BODY FLUID","code_information":[{"code":"3018204208","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.85,"discounted_cash":57.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALBUMIN LEVEL CSF - OLIGOCLONAL BAND PROFILE - ARUP","code_information":[{"code":"3018204210","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.85,"discounted_cash":57.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALBUMIN LEVEL CSF - IMMUNOGLOBULIN G (IGG) CSF INDEX - ARUP","code_information":[{"code":"3018204211","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.85,"discounted_cash":57.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROALBUMIN, QUANTITATIVE - MICROALBUMIN 24HR URINE","code_information":[{"code":"3018204301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.96,"discounted_cash":38.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROALBUMIN, QUANTITATIVE - MICROALBUMIN RANDOM URINE","code_information":[{"code":"3018204302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.09,"discounted_cash":43.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROALBUMIN, QUANTITATIVE - MICROALBUMIN / CREATININE URINE RATIO","code_information":[{"code":"3018204303","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.09,"discounted_cash":43.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROALBUMIN 24 HOUR URINE MG/L","code_information":[{"code":"3018204304","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.09,"discounted_cash":43.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALBUMIN LEVEL - ALBUMIN / CREATININE RATIO URINE - ARUP","code_information":[{"code":"3018204305","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.09,"discounted_cash":43.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROALBUMIN LEVEL -  MICROALBUMIN/CREATININE RATIO RANDOME URINE MG/DL","code_information":[{"code":"3018204306","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.09,"discounted_cash":43.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROALBUMIN LEVEL - MICROALBUMIN/CREATININE RATIO RANDOM URINE MG/L","code_information":[{"code":"3018204307","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.09,"discounted_cash":43.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ETHANOL LEVEL","code_information":[{"code":"3018207701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82077","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.02,"discounted_cash":128.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ALDOLASE - ALDOLASE","code_information":[{"code":"3018208501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82085","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.39,"discounted_cash":71.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALDOLASE LEVEL - ARUP","code_information":[{"code":"3018208502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82085","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.55,"discounted_cash":64.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ALDOSTERONE - ALDOSTERONE,24HR URINE","code_information":[{"code":"3018208801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.6,"discounted_cash":301.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALDOSTERONE LEVEL - ARUP","code_information":[{"code":"3018208802","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.6,"discounted_cash":301.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALDOSTERONE LEVEL - ALDOSTERONE/RENIN ACTIVITY RATIO - ARUP","code_information":[{"code":"3018208803","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.6,"discounted_cash":301.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALDOSTERONE 24 HOUR URINE - ARUP","code_information":[{"code":"3018208804","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":272.69,"discounted_cash":272.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALDOSTERONE INTERNAL SAMPLING - ARUP","code_information":[{"code":"3018208805","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.6,"discounted_cash":301.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALPHA-1-ANTITRYPSIN TOTAL","code_information":[{"code":"3018210301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.71,"discounted_cash":99.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALPHA 1 ANTITRYPSIN STOOL - ARUP","code_information":[{"code":"3018210302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.71,"discounted_cash":99.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC A1A GENOTYPE WITH REFLEX TO PHENOTYPE - ARUP","code_information":[{"code":"3018210304","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.71,"discounted_cash":99.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALPHA 1 ANTITRYPSIN PHENOTYPE - ARUP","code_information":[{"code":"3018210306","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.71,"discounted_cash":99.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALPHA-1-ANTITRYPSIN TOTAL - A1A PHENOTYPE - ARUP","code_information":[{"code":"3018210307","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.71,"discounted_cash":99.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALPHA-1-ANTITRYPSIN TOTAL - AIA GENOTYPE - ARUP","code_information":[{"code":"3018210308","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.71,"discounted_cash":99.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALPHA 1 ANTITRYPSIN PHENOTYPE - ARUP","code_information":[{"code":"3018210402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82104","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.09,"discounted_cash":107.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALPHA 1 ANTITRYPSIN PHENOTYPE - A1A PHENOTYPE - ARUP","code_information":[{"code":"3018210403","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82104","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.83,"discounted_cash":96.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALPHA FETOPROTEIN (AFP) TUMOR MARKER","code_information":[{"code":"3018210501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.33,"discounted_cash":124.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALPHA FETOPROTEIN MATERNAL SERUM - ARUP","code_information":[{"code":"3018210502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.33,"discounted_cash":124.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MATERNAL QUAD SCREEN - AFP","code_information":[{"code":"3018210505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.33,"discounted_cash":124.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALPHA-FETOPROTEIN L3 - ALPHA FETOPROTEIN, L3 PERCENT","code_information":[{"code":"3018210701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82107","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALPHA FETOPROTEIN (AFP) TOTAL AND L3 PERCENT - ARUP","code_information":[{"code":"3018210702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82107","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AFP TOTAL & L3 PERCENT-HEPATOCELLULAR CARCINOMA TUMOR MARKER PANEL-ARUP","code_information":[{"code":"3018210703","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82107","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ALUMINUM - ALUMINUM LEVEL","code_information":[{"code":"3018210801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82108","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.29,"discounted_cash":170.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALUMINUM LEVEL - ARUP","code_information":[{"code":"3018210802","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82108","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.29,"discounted_cash":170.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMINO ACIDS, SINGLE QUANTITATION - CYSTINE URINE QUANTITATIVE","code_information":[{"code":"3018213101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82131","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.59,"discounted_cash":153.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY, AMINOLEVULINIC ACID - AMINOLEVULINIC ACID 24HR","code_information":[{"code":"3018213501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82135","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.64,"discounted_cash":64.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMINOLEVULINIC ACID URINE 24 HOUR - ARUP","code_information":[{"code":"3018213502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82135","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.64,"discounted_cash":64.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMINO ACIDS, 6+ QUANT - AMINO ACID QUANT,URINE","code_information":[{"code":"3018213901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82139","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.33,"discounted_cash":124.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMINO ACIDS, 6+ QUANT - AMINO ACIDS, PLASMA","code_information":[{"code":"3018213902","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82139","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.41,"discounted_cash":112.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMINO ACIDS 6+ QUANT - AMINO ACIDS CSF","code_information":[{"code":"3018213903","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82139","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.33,"discounted_cash":124.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMINO ACID QUANT URINE - ARUP","code_information":[{"code":"3018213904","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82139","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.41,"discounted_cash":112.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMINO ACIDS CSF - ARUP","code_information":[{"code":"3018213905","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82139","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.33,"discounted_cash":124.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMINO ACIDS, 6+ QUANT PLASMA - ARUP","code_information":[{"code":"3018213906","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82139","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.33,"discounted_cash":124.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMMONIA LEVEL","code_information":[{"code":"3018214001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82140","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.09,"discounted_cash":107.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF AMYLASE - AMYLASE BODY FLUID","code_information":[{"code":"3018215001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.01,"discounted_cash":48.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF AMYLASE - AMYLASE,RANDOM","code_information":[{"code":"3018215002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.01,"discounted_cash":48.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF AMYLASE - AMYLASE,TIMED URINE","code_information":[{"code":"3018215004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.01,"discounted_cash":48.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMYLASE LEVEL","code_information":[{"code":"3018215005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.01,"discounted_cash":48.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF AMYLASE - POCT AMYLASE","code_information":[{"code":"3018215006","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.01,"discounted_cash":48.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SALIVARY AMYLASE ISOENZYME - AMYLASE ISOENZYMES - ARUP","code_information":[{"code":"3018215007","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.01,"discounted_cash":48.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SALIVARY AMYLASE ISOENZYME - AMYLASE ISOENZYMES - ARUP","code_information":[{"code":"3018215008","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.41,"discounted_cash":43.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMYLASE URINE RANDOM","code_information":[{"code":"3018215009","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.01,"discounted_cash":48.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PANCREATIC AMYLASE ISOENZYME - AMYLASE ISOENZYMES - ARUP","code_information":[{"code":"3018215010","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.01,"discounted_cash":48.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ANDROSTENEDIONE - ANDROSTENEDIONE","code_information":[{"code":"3018215701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82157","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.89,"discounted_cash":195.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANDROSTENEDIONE LEVEL - ARUP","code_information":[{"code":"3018215702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82157","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.89,"discounted_cash":195.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANGIOTENSIN I ENZYME TEST - ANGIOTENSIN CONVERTING ENZYME","code_information":[{"code":"3018216401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.32,"discounted_cash":108.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANGIOTENSIN I ENZYME TEST - ANGIOTENSIN CONVERT ENZYME CSF","code_information":[{"code":"3018216402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.94,"discounted_cash":97.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANGIOTENSIN CONVERT ENZYME CSF - ARUP","code_information":[{"code":"3018216403","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.94,"discounted_cash":97.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTI-MULLERIAN HORMONE (AMH) ASSAY","code_information":[{"code":"3018216601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82166","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.64,"discounted_cash":104.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF APOLIPOPROTEIN - LIPOPROTEIN A (LPA)","code_information":[{"code":"3018217201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.35,"discounted_cash":141.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APOLIPOPROTEIN B100","code_information":[{"code":"3018217202","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.35,"discounted_cash":141.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF APOLIPOPROTEIN - EACH","code_information":[{"code":"3018217204","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.35,"discounted_cash":141.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APOLIPOPROTEIN A1 - ARUP","code_information":[{"code":"3018217205","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.35,"discounted_cash":141.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APOLIPOPROTEIN B 100 - ARUP","code_information":[{"code":"3018217206","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.35,"discounted_cash":141.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIPOPROTEIN A - CARDIO IQ - QWDL","code_information":[{"code":"3018217207","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.35,"discounted_cash":141.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APOLIPOPROTEIN E - B-AMYLOID RATIO, APOE ISOFORM, CSF - QUEST","code_information":[{"code":"3018217208","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.35,"discounted_cash":141.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ARSENIC - ARSENIC,FRACTIONATION,UR","code_information":[{"code":"3018217502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.33,"discounted_cash":140.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ARSENIC - ARSENIC RANDOM URINE","code_information":[{"code":"3018217503","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.88,"discounted_cash":126.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARSENIC URINE HEAVY METALS PANEL 3- ARUP","code_information":[{"code":"3018217504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.33,"discounted_cash":140.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARSENIC LEVEL","code_information":[{"code":"3018217505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.33,"discounted_cash":140.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARSENIC FRACTIONATIONED URINE - ARUP","code_information":[{"code":"3018217508","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.33,"discounted_cash":140.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARSENIC LEVEL BLOOD - ARUP","code_information":[{"code":"3018217509","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.88,"discounted_cash":126.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARSENIC URINE - HEAVY METALS PANEL 3 - ARUP","code_information":[{"code":"3018217510","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.33,"discounted_cash":140.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARSENIC FRACTIONATION URINE REFLEX - ARUP","code_information":[{"code":"3018217511","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.33,"discounted_cash":140.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ASCORBIC ACID - VITAMIN C","code_information":[{"code":"3018218001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82180","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.67,"discounted_cash":65.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VITAMIN C (ASCORBIC ACID) LEVEL - ARUP","code_information":[{"code":"3018218002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82180","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.67,"discounted_cash":65.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BETA-2 PROTEIN - BETA 2 MICROGLOBULIN CSF","code_information":[{"code":"3018223201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82232","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.4,"discounted_cash":119.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BETA-2 PROTEIN - BETA 2 MICROGLOBULIN","code_information":[{"code":"3018223202","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82232","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.4,"discounted_cash":119.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BETA 2 MICROGLOBULIN URINE","code_information":[{"code":"3018223203","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82232","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.4,"discounted_cash":119.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BETA 2 MICROGLOBULIN SERUM - ARUP","code_information":[{"code":"3018223205","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82232","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.4,"discounted_cash":119.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ABETA42 - ALZHEMIER'S DISEASE MARKERS, CSF - ARUP","code_information":[{"code":"3018223402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82234","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.0,"discounted_cash":500.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BILE ACIDS, TOTAL - BILE ACIDS, TOTAL","code_information":[{"code":"3018223901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82239","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.2,"discounted_cash":37.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BILIRUBIN TOTAL - BILIRUBIN BODY FLUID","code_information":[{"code":"3018224702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.39,"discounted_cash":33.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BILIRUBIN TOTAL","code_information":[{"code":"3018224703","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.93,"discounted_cash":36.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BILIRUBIN TOTAL - BILIRUBIN NEONATAL","code_information":[{"code":"3018224704","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.93,"discounted_cash":36.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BILIRUBIN TOTAL BODY FLUID - ARUP","code_information":[{"code":"3018224708","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.93,"discounted_cash":36.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BILIRUBIN DIRECT","code_information":[{"code":"3018224801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82248","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.93,"discounted_cash":36.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BIOTINIDASE LEVEL - ARUP","code_information":[{"code":"3018226102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82261","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.05,"discounted_cash":59.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD OCCULT,BY PEROXID,FECES,SINGLE, COLORECTAL SCREEN - OCCULT BLD","code_information":[{"code":"3018227001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82270","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.01,"discounted_cash":32.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OCCULT BLOOD GASTRIC / DUODENUM","code_information":[{"code":"3018227101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82271","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.4,"discounted_cash":39.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OCCULT BLOOD - OCCULT BLOOD STOOL","code_information":[{"code":"3018227201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82272","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.78,"discounted_cash":30.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC POC FECAL OCCULT BLOOD STOOL","code_information":[{"code":"3018227202","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82272","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.78,"discounted_cash":30.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OCCULT BLOOD - 1 TO 3 SIMULTANEOUS TESTS POC","code_information":[{"code":"3018227401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82274","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.85,"discounted_cash":106.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OCCULT BLOOD FECES SCREENING SPECIMEN #1","code_information":[{"code":"3018227402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82274","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.2,"discounted_cash":120.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OCCULT BLOOD FECES DIAGNOSTIC SPECIMEN #1","code_information":[{"code":"3018227403","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82274","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.85,"discounted_cash":106.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OCCULT BLOOD BY IMMUNOASSAY, FECES","code_information":[{"code":"3018227404","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82274","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.85,"discounted_cash":106.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OCCULT BLOOD BY IMMUNOASSAY, FECES - ARUP","code_information":[{"code":"3018227405","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82274","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.85,"discounted_cash":106.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF CADMIUM - CADMIUM 24 HR URINE","code_information":[{"code":"3018230001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82300","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.05,"discounted_cash":158.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CADMIUM LEVEL BLOOD - ARUP","code_information":[{"code":"3018230002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82300","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.05,"discounted_cash":158.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CADMIUM LEVEL -  PANEL 4 BLOOD ARUP","code_information":[{"code":"3018230003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82300","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.05,"discounted_cash":158.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CADMIUM LEVEL, RANDOM URINE - ARUP","code_information":[{"code":"3018230004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82300","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.05,"discounted_cash":158.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VITAMIN D 25-HYDROXY LEVEL DEFICIENCY","code_information":[{"code":"3018230601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82306","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.11,"discounted_cash":219.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VITAMIN D2 AND D3 25 HYDROXY LEVEL - ARUP","code_information":[{"code":"3018230602","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82306","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.11,"discounted_cash":219.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF CALCITONIN - CALCITONIN","code_information":[{"code":"3018230801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82308","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":107.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CALCITONIN - ARUP","code_information":[{"code":"3018230802","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82308","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":107.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CALCIUM TOTAL LEVEL","code_information":[{"code":"3018231001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF CALCIUM, TOTAL - POCT CALCIUM, TOTAL","code_information":[{"code":"3018231002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF CALCIUM, TOTAL - ADDITIONAL CHARGE","code_information":[{"code":"3018231004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.5,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CALCIUM LEVEL TOTAL -  PTH INTACT WITH CALCIUM - ARUP","code_information":[{"code":"3018231006","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF CALCIUM, IONIZED - CALCIUM IONIZED","code_information":[{"code":"3018233001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":100.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CALCIUM RANDOM URINE","code_information":[{"code":"3018234001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.07,"discounted_cash":40.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CALCIUM TIMED URINE","code_information":[{"code":"3018234002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.07,"discounted_cash":40.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CALCIUM 24 HR URINE CALCULI RISK - ARUP","code_information":[{"code":"3018234003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.07,"discounted_cash":40.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CALCIUM - KIDNEY STONE RISK PANEL URINE - ARUP","code_information":[{"code":"3018234008","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.07,"discounted_cash":40.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CALCULUS ANALYSIS - KIDNEY STONE ANALYSIS QUANT","code_information":[{"code":"3018236001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82360","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CALCULUS ASSAY,INFRARED SPECTR - KIDNEY STONE ANALYSIS","code_information":[{"code":"3018236501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82365","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":94.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY CALCULUS INFRARED SPECTR - KIDNEY STONE ANALYSIS QUANT","code_information":[{"code":"3018236502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82365","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":94.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY CARBOHYDRATE DEF TRANSFERRIN - CARBOHYDRATE DEFICIENT TRANS","code_information":[{"code":"3018237301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82373","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.21,"discounted_cash":63.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARBOHYDRATE DEFICIENT TRANSFERRIN FOR ALCOHOL USE - ARUP","code_information":[{"code":"3018237302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82373","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.21,"discounted_cash":63.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CO2 TOTAL BLOOD","code_information":[{"code":"3018237401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82374","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.28,"discounted_cash":32.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY URINE CARBON DIOXIDE - CO2 TOTAL","code_information":[{"code":"3018237402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82374","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.28,"discounted_cash":32.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY BLOOD CARBON MONOXIDE - CARBOXYHEMOGLOBIN","code_information":[{"code":"3018237501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82375","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.09,"discounted_cash":91.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARBOXYHEMOGLOBIN QUANT, CO-OX, WHOLE BLOOD - ARUP","code_information":[{"code":"3018237502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82375","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.09,"discounted_cash":91.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARCINOEMBRYONIC ANTIGEN (CEA)","code_information":[{"code":"3018237801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.33,"discounted_cash":140.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARCINOEMBRYONIC ANTIGEN FLUID","code_information":[{"code":"3018237802","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.33,"discounted_cash":140.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARCINOEMBRYONIC ANTIGEN (CEA) FLUID - ARUP","code_information":[{"code":"3018237805","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.33,"discounted_cash":140.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF CARNITINE - CARNITINE","code_information":[{"code":"3018237901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82379","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.41,"discounted_cash":112.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARNITINE TOTAL AND FREE - ARUP","code_information":[{"code":"3018237903","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82379","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.41,"discounted_cash":112.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF CAROTENE - CAROTENE, SERUM","code_information":[{"code":"3018238001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82380","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.22,"discounted_cash":61.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY, THREE CATECHOLAMINES - CATECHOLAMINE 24 HR URINE","code_information":[{"code":"3018238401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82384","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.18,"discounted_cash":169.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY, THREE CATECHOLAMINES - CATECHOLAMINES FRACTIONATED PL","code_information":[{"code":"3018238402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82384","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.18,"discounted_cash":169.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CATECHOLAMINES, FRACTIONATED, BY LC-MS/MS - ARUP","code_information":[{"code":"3018238403","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82384","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.18,"discounted_cash":169.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CATECHOLAMINES, FRACTIONATED, PLASMA - ARUP","code_information":[{"code":"3018238405","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82384","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.18,"discounted_cash":169.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF CERULOPLASMIN - CERULOPLASMIN","code_information":[{"code":"3018239001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82390","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.78,"discounted_cash":78.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CERULOPLASMIN LEVEL","code_information":[{"code":"3018239002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82390","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.78,"discounted_cash":78.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHEMILUMINESCENT ASSAY - INTERLEUKIN-6","code_information":[{"code":"3018239701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.61,"discounted_cash":94.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHEMILUMINESCENT ASSAY - IGF BINDING PROTEIN 3","code_information":[{"code":"3018239702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.61,"discounted_cash":94.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHEMILUMINESCENT ASSAY - PITUITARY GLYCOPROTEIN","code_information":[{"code":"3018239703","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.61,"discounted_cash":94.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHEMILUMINESCENT ASSAY - MISCELLANEOUS","code_information":[{"code":"3018239704","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.64,"discounted_cash":104.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IGF BINDING PROTEIN 3 - ARUP","code_information":[{"code":"3018239707","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.61,"discounted_cash":94.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHEMILUMINESCENT ASSAY - ANTIBODIES TO INFLIXIMAB QUANT - ARUP","code_information":[{"code":"3018239708","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.61,"discounted_cash":94.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHEMILUMINESCENT ASSAY - ANTIBODIES TO ADALIMUMAB QUANT - ARUP","code_information":[{"code":"3018239709","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.61,"discounted_cash":94.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HMGCR 3-HYDROXY-3-METHYLGLUTARYL COENZYME A REDUCTASE IGG Çô ARUP","code_information":[{"code":"3018239710","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":185.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HMGCR IGG - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"3018239711","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":185.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHLORIDE BLOOD","code_information":[{"code":"3018243501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82435","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.16,"discounted_cash":31.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHLORIDE BLOOD POC","code_information":[{"code":"3018243502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82435","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.16,"discounted_cash":31.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHLORIDE URINE TIMED","code_information":[{"code":"3018243601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.09,"discounted_cash":43.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHLORIDE URINE CALCULI RISK ASSESSMENT - ARUP","code_information":[{"code":"3018243605","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.09,"discounted_cash":43.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHLORIDE URINE RANDOM","code_information":[{"code":"3018243606","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.09,"discounted_cash":43.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHLORIDE URINE 24 HOUR TIMED","code_information":[{"code":"3018243607","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.09,"discounted_cash":43.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OTHER FLUID CHLORIDES - CHLORIDE BODY FLUID","code_information":[{"code":"3018243801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82438","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.39,"discounted_cash":33.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OTHER FLUID CHLORIDES - ADDITIONAL CHARGE","code_information":[{"code":"3018243804","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82438","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.39,"discounted_cash":33.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TEST FOR CHLOROHYDROCARBONS - POLYCHLORINATED BIPHENYLS","code_information":[{"code":"3018244101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82441","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.04,"discounted_cash":21.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC POLYCHLORINATED BIPHENYLS - ARUP","code_information":[{"code":"3018244102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82441","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.04,"discounted_cash":21.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY, BLD/SERUM CHOLESTEROL - CHOLESTEROL FLUID","code_information":[{"code":"3018246501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82465","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.01,"discounted_cash":32.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY, BLD/SERUM CHOLESTEROL - CHOLESTEROL TOTAL","code_information":[{"code":"3018246502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82465","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.94,"discounted_cash":28.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY, SERUM CHOLINESTERASE - PSEUDOCHOLINESTERASE PHENOTYPE","code_information":[{"code":"3018248002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82480","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.31,"discounted_cash":52.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY, SERUM CHOLINESTERASE - CHOLINESTERASE","code_information":[{"code":"3018248003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82480","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.31,"discounted_cash":52.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY, RBC CHOLINESTERASE - CHOLINESTERASE, RBC","code_information":[{"code":"3018248201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82482","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.34,"discounted_cash":34.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF CHROMIUM - CHROMIUM LEVEL","code_information":[{"code":"3018249501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.18,"discounted_cash":150.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHROMIUM LEVEL - ARUP","code_information":[{"code":"3018249502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.18,"discounted_cash":150.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF CITRATE - CITRATE 24 HOUR URINE","code_information":[{"code":"3018250701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82507","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.87,"discounted_cash":185.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CITRATE - STONE RISK PANEL - ARUP","code_information":[{"code":"3018250702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82507","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.87,"discounted_cash":185.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CITRATE URINE CALCULI RISK ASSESSMENT - ARUP","code_information":[{"code":"3018250703","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82507","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.87,"discounted_cash":185.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF CITRATE - CITRATE BLOOD","code_information":[{"code":"3018250704","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82507","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.87,"discounted_cash":185.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CITRATE 24 HOUR URINE - ARUP","code_information":[{"code":"3018250705","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82507","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.87,"discounted_cash":185.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CITRIC ACID - KIDNEY STONE RISK PANEL URINE - ARUP","code_information":[{"code":"3018250706","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82507","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.87,"discounted_cash":185.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY FOR COLLAGEN CROSS LINKS - COLLAGEN TYPE I CROSSLINK","code_information":[{"code":"3018252301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.66,"discounted_cash":124.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY FOR COLLAGEN CROSS LINKS - N-TELOPEPTIDE, URINE","code_information":[{"code":"3018252302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.66,"discounted_cash":124.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C-TELOPEPTIDE, BETA-CROSS -LINKED, SERUM - ARUP","code_information":[{"code":"3018252305","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.66,"discounted_cash":124.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC N-TELOPEPTIDE, CROSS-LINKED, SERUM - ARUP","code_information":[{"code":"3018252306","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.66,"discounted_cash":124.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC N TELOPEPTIDE URINE - ARUP","code_information":[{"code":"3018252307","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.66,"discounted_cash":124.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF COPPER - COPPER RANDOM URINE","code_information":[{"code":"3018252503","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82525","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.36,"discounted_cash":82.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF COPPER - COPPER, SERUM","code_information":[{"code":"3018252504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82525","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.09,"discounted_cash":91.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CORTISOL, FREE - CORTISOL, FREE","code_information":[{"code":"3018253002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82530","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.3,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CORTISOL, FREE - CORTISOL, URINE, FREE","code_information":[{"code":"3018253003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82530","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.3,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CORTISOL FREE - ARUP","code_information":[{"code":"3018253004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82530","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.3,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CORTISOL FREE URINE - ARUP","code_information":[{"code":"3018253005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82530","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.3,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CORTISOL TOTAL","code_information":[{"code":"3018253301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.63,"discounted_cash":120.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOTAL CORTISOL - ACTH STIMULATION BASELINE","code_information":[{"code":"3018253302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.07,"discounted_cash":109.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOTAL CORTISOL - ACTH STIMULATION 30 MINUTES","code_information":[{"code":"3018253303","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.63,"discounted_cash":120.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOTAL CORTISOL - ACTH STIMULATION 1 HOUR","code_information":[{"code":"3018253304","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.63,"discounted_cash":120.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOTAL CORTISOL AM - QWDL","code_information":[{"code":"3018253305","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.07,"discounted_cash":109.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOTAL CORTISOL - CORTISOL PM","code_information":[{"code":"3018253306","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.07,"discounted_cash":109.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOTAL CORTISOL - ACTH STIMULATION 90 MINUTES","code_information":[{"code":"3018253307","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.63,"discounted_cash":120.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CORTISOL SALIVA","code_information":[{"code":"3018253308","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.63,"discounted_cash":120.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CORTISOL SALIVARY - ARUP","code_information":[{"code":"3018253309","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.63,"discounted_cash":120.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CORTISOL TOTAL - QWDL","code_information":[{"code":"3018253310","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.63,"discounted_cash":120.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CORTISOL TOTAL - ARUP","code_information":[{"code":"3018253311","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.63,"discounted_cash":120.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CORTISOL INTERNAL SAMPLING - ARUP","code_information":[{"code":"3018253312","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.63,"discounted_cash":120.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF CREATINE - CREATINE","code_information":[{"code":"3018254001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82540","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.16,"discounted_cash":31.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATINE LEVEL URINE","code_information":[{"code":"3018254002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82540","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.16,"discounted_cash":31.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATINE LEVEL -  ARUP","code_information":[{"code":"3018254003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82540","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.16,"discounted_cash":31.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATINE LEVEL URINE - ARUP","code_information":[{"code":"3018254004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82540","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.16,"discounted_cash":31.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC COENZYME Q10","code_information":[{"code":"3018254204","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.39,"discounted_cash":161.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC","code_information":[{"code":"3018254206","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.39,"discounted_cash":161.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC PARATHYROID HORMONE RELATED PEPTIDE","code_information":[{"code":"3018254207","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.39,"discounted_cash":161.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC PORPHYRINS PLASMA FRACTIONATED","code_information":[{"code":"3018254208","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.39,"discounted_cash":161.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COENZYME Q10 TOTAL - ARUP","code_information":[{"code":"3018254212","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.39,"discounted_cash":161.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC N-METHYLHISTAMINE URINE 24 HOUR - ARUP","code_information":[{"code":"3018254213","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.39,"discounted_cash":161.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PTH-RELATED PEPTIDE - ARUP","code_information":[{"code":"3018254215","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.39,"discounted_cash":161.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FATTY ACIDS PROFILE, ESSENTIAL - ARUP","code_information":[{"code":"3018254216","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.39,"discounted_cash":161.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APOLIPOPROTEIN E (APOE) ISOFORM, CSF - QUEST","code_information":[{"code":"3018254217","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.39,"discounted_cash":161.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BETA-AMYLOID 42 - B-AMYLOID RATIO, APOE ISOFORM, CSF - QUEST","code_information":[{"code":"3018254218","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.39,"discounted_cash":161.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BETA-AMYLOID 40 - B-AMYLOID RATIO, APOE ISOFORM, CSF - QUEST","code_information":[{"code":"3018254219","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.39,"discounted_cash":161.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CK (CPK) TOTAL","code_information":[{"code":"3018255001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.01,"discounted_cash":48.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CK (CPK) TOTAL - ARUP","code_information":[{"code":"3018255002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.01,"discounted_cash":48.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATINE KINASE (CPK) TOTAL W/ REFLEX CKMB","code_information":[{"code":"3018255004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.01,"discounted_cash":48.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATINE KINASE (CK) TOTAL","code_information":[{"code":"3018255006","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.01,"discounted_cash":48.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATINE KINASE (CPK) TOTAL - CK ISOENZYMES - ARUP","code_information":[{"code":"3018255008","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.01,"discounted_cash":48.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CPK ISOENZYMES","code_information":[{"code":"3018255201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82552","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.48,"discounted_cash":98.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATINE KINASE ISOENZYMES - CK ISOENZYMES - ARUP","code_information":[{"code":"3018255202","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82552","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.48,"discounted_cash":98.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATINE, MB FRACTION - CK TOTAL AND CKMB","code_information":[{"code":"3018255301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82553","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.94,"discounted_cash":84.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATINE, MB FRACTION - CKMB","code_information":[{"code":"3018255302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82553","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.94,"discounted_cash":84.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATINE, MB FRACTION - CKMB - ARUP","code_information":[{"code":"3018255303","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82553","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.94,"discounted_cash":84.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATININE LEVEL","code_information":[{"code":"3018256501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82565","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATININE, EGFR - CYSTATIN, CREATININE, EGFR - ARUP","code_information":[{"code":"3018256504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82565","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATININE LEVEL RANDOM URINE","code_information":[{"code":"3018257001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.24,"discounted_cash":19.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATININE TIMED URINE","code_information":[{"code":"3018257002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.24,"discounted_cash":19.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF URINE CREATININE - POCT CREATININE","code_information":[{"code":"3018257003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.24,"discounted_cash":19.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF URINE CREATININE - CREATININE, URINE, 24 HOUR","code_information":[{"code":"3018257004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.55,"discounted_cash":32.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATININE LEVEL BODY FLUID","code_information":[{"code":"3018257005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.5,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATININE LEVEL - ALBUMIN / CREATININE RATIO URINE - ARUP","code_information":[{"code":"3018257011","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.24,"discounted_cash":19.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATININE LEVEL - MICROALBUMIN/CREATININE RATIO RANDOME URINE MG/DL","code_information":[{"code":"3018257012","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.24,"discounted_cash":19.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATININE LEVEL - MICROALBUMIN/CREATININE RATIO RANDOM URINE MG/L","code_information":[{"code":"3018257013","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.24,"discounted_cash":19.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATININE LEVEL URINE 24 HOUR","code_information":[{"code":"3018257017","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.24,"discounted_cash":19.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATININE LEVEL - PROTEIN/CREATININE RATIO URINE","code_information":[{"code":"3018257018","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.24,"discounted_cash":19.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREATININE CLEARANCE URINE 24 HOUR","code_information":[{"code":"3018257501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82575","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.16,"discounted_cash":70.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CRYOFIBRINOGEN LEVEL - ARUP","code_information":[{"code":"3018258502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82585","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.49,"discounted_cash":49.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF CRYOGLOBULIN - CRYOGLOBULIN","code_information":[{"code":"3018259501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82595","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.01,"discounted_cash":48.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF CYANIDE - CYANIDE LEVEL","code_information":[{"code":"3018260001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82600","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.9,"discounted_cash":67.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYANIDE LEVEL - ARUP","code_information":[{"code":"3018260002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82600","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.9,"discounted_cash":67.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VITAMIN B12 LEVEL","code_information":[{"code":"3018260701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82607","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VITAMIN B12 - QWDL","code_information":[{"code":"3018260702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82607","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC B-12 BINDING CAPACITY - B-12 BINDING CAPACITY","code_information":[{"code":"3018260801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82608","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.72,"discounted_cash":95.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYSTATIN C","code_information":[{"code":"3018261001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82610","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.54,"discounted_cash":123.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYSTATIN - CYSTATIN, CREATININE, EGFR - ARUP","code_information":[{"code":"3018261003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82610","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.54,"discounted_cash":123.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEHYDROEPIANDROSTERONE - DHEA","code_information":[{"code":"3018262601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82626","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.11,"discounted_cash":187.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEHYDROEPIANDROSTERONE (DHEA) - ARUP","code_information":[{"code":"3018262602","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82626","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.11,"discounted_cash":187.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEHYDROEPIANDROSTERONE-SULFATE - DHEA-SULFATE","code_information":[{"code":"3018262701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82627","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.72,"discounted_cash":163.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEHYDROEPIANDROSTERONE SULFATE (DHEA) SULFATE - ARUP","code_information":[{"code":"3018262703","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82627","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.03,"discounted_cash":148.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DESOXYCORTICOSTERONE - DEOXYCORTICOSTERONE","code_information":[{"code":"3018263301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82633","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.43,"discounted_cash":108.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC 11 DEOXYCORTISOL - ARUP","code_information":[{"code":"3018263403","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82634","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.48,"discounted_cash":102.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHOLINESTERASE AND DIBUCAINE NUMBER","code_information":[{"code":"3018263802","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82638","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.88,"discounted_cash":42.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIHYDROTESTOSTERONE","code_information":[{"code":"3018264201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82642","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.65,"discounted_cash":216.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC 5 A DIHYDROTESTOSTERONE - ARUP","code_information":[{"code":"3018264202","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82642","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.89,"discounted_cash":195.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY, DIHYDROXYVITAMIN D W/FRACTIONS, IF PERFORMED - VITAMIN D 1","code_information":[{"code":"3018265201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82652","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.35,"discounted_cash":284.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VITAMIN D 1,25 DIHYDROXY - ARUP","code_information":[{"code":"3018265202","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82652","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.35,"discounted_cash":284.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PANCREATIC ELASTASE, FECAL, QUANT","code_information":[{"code":"3018265301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82653","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PANCREATIC ELASTASE STOOL QUANT - ARUP","code_information":[{"code":"3018265302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82653","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENZYME ACTIVITY NOS","code_information":[{"code":"3018265701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.03,"discounted_cash":148.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENZYME ACTIVITY NOS ALPHA GALACTOSIDASE","code_information":[{"code":"3018265702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.03,"discounted_cash":148.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENZYME ACTIVITY NOS THIOPURINE METHYLTRANSFERASE","code_information":[{"code":"3018265705","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.72,"discounted_cash":163.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PORPHOBILINOGEN DEAMINASE RBC - ARUP","code_information":[{"code":"3018265709","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.03,"discounted_cash":148.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALPHA GALACTOSIDASE - ARUP","code_information":[{"code":"3018265710","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.03,"discounted_cash":148.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHYLOMICRONS FLUID","code_information":[{"code":"3018266404","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82664","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.7,"discounted_cash":410.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ERYTHROPOIETIN - ERYTHROPOIETIN","code_information":[{"code":"3018266801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82668","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.1,"discounted_cash":139.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ERYTHROPOIETIN LEVEL - ARUP","code_information":[{"code":"3018266802","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82668","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.1,"discounted_cash":139.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ESTRADIOL - ESTRADIOL","code_information":[{"code":"3018267001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.8,"discounted_cash":206.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ESTRADIOL LEVEL PEDIATRICS","code_information":[{"code":"3018267002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.8,"discounted_cash":206.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ESTRADIOL MALE, CHILD, POST-MENOPAUSE FEMALE BY MASS SPEC - ARUP","code_information":[{"code":"3018267004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.8,"discounted_cash":206.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ESTROGENS - ESTROGENS, FRACTIONATED","code_information":[{"code":"3018267101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82671","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.81,"discounted_cash":238.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ESTROGENS FRACTIONATED - ARUP","code_information":[{"code":"3018267102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82671","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.81,"discounted_cash":238.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ESTROGEN - ESTROGENS TOTAL","code_information":[{"code":"3018267201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82672","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.03,"discounted_cash":160.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ESTRIOL - ADDITIONAL CHARGE","code_information":[{"code":"3018267701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82677","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.39,"discounted_cash":161.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ESTRIOL LEVEL - ARUP","code_information":[{"code":"3018267703","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82677","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.39,"discounted_cash":161.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ESTRONE - ESTRONE","code_information":[{"code":"3018267902","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82679","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.65,"discounted_cash":184.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ESTRONE LEVEL - ARUP","code_information":[{"code":"3018267903","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82679","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.65,"discounted_cash":184.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY DIRECT MEASURE FREE - ESTRADIOL","code_information":[{"code":"3018268101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82681","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.98,"discounted_cash":186.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ETHYLENE GLYCOL - ETHYLENE GLYCOL","code_information":[{"code":"3018269301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82693","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.06,"discounted_cash":99.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FECAL FAT QUAL","code_information":[{"code":"3018270501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82705","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":20.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FATS/LIPIDS, FECES, QUANTITATIVE - FECAL FAT QUANTITATIVE","code_information":[{"code":"3018271001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82710","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.41,"discounted_cash":112.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FATTY ACIDS FREE - ARUP","code_information":[{"code":"3018272502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82725","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.7,"discounted_cash":65.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FERRITIN LEVEL","code_information":[{"code":"3018272801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82728","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":100.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NON-ALCOHOLIC FATTY LIVER DISEASE PANEL - FERRITIN","code_information":[{"code":"3018272802","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82728","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":100.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FERRITIN LEVEL - QWDL","code_information":[{"code":"3018272803","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82728","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":100.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FERRITIN - LIVER FIBROSIS FIBROMETER NAFLD - ARUP","code_information":[{"code":"3018272805","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82728","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":100.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FETAL FIBRONECTIN","code_information":[{"code":"3018273101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82731","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.16,"discounted_cash":475.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FOLATE LEVEL SERUM","code_information":[{"code":"3018274601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82746","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.32,"discounted_cash":108.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FOLATE LEVEL SERUM - QWDL","code_information":[{"code":"3018274602","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82746","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.32,"discounted_cash":108.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FOLATE RBC LEVEL","code_information":[{"code":"3018274701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82747","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.49,"discounted_cash":130.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY GALACTOSE TRANSFERASE - GALACTOSE-1-PHOSPHATE TRANSFERASE","code_information":[{"code":"3018277501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82775","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.24,"discounted_cash":140.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IMMUNOGLOBULINS","code_information":[{"code":"3018278401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":68.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGG","code_information":[{"code":"3018278402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":68.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGM","code_information":[{"code":"3018278403","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":68.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGA","code_information":[{"code":"3018278404","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":68.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - CELIAC REFLEX PNL","code_information":[{"code":"3018278407","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":68.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IGG LEVEL SERUM/CSF IGG SYNTH - ARUP","code_information":[{"code":"3018278408","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":68.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN D","code_information":[{"code":"3018278409","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.8,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN G CSF","code_information":[{"code":"3018278410","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":68.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN M CSF","code_information":[{"code":"3018278411","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":68.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN A CSF","code_information":[{"code":"3018278412","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":68.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN G - IGG","code_information":[{"code":"3018278413","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":68.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN M - IGM","code_information":[{"code":"3018278414","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":68.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN A - IGA","code_information":[{"code":"3018278415","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":68.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IGG LEVEL SERUM/CSF OLIGOCLONAL BAND PROFILE - ARUP","code_information":[{"code":"3018278416","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":68.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GAMMAGLOBULIN G (IGG) - MONOCLONAL PROTEIN STUDY EXTENDED SERUM - ARUP","code_information":[{"code":"3018278417","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":68.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GAMMAGLOBULIN A (IGA) - MONOCLONAL PROTEIN STUDY EXTENDED SERUM - ARUP","code_information":[{"code":"3018278418","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":68.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GAMMAGLOBULIN M (IGM) - MONOCLONAL PROTEIN STUDY EXTENDED SERUM - ARUP","code_information":[{"code":"3018278419","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":68.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN G (IGG) CSF","code_information":[{"code":"3018278420","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":68.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN A (IGA) CSF - ARUP","code_information":[{"code":"3018278425","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":68.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN M (IGM) CSF - ARUP","code_information":[{"code":"3018278426","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":68.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN A (IGA) - CELIAC DISEASE REFLEX CASCADE - ARUP","code_information":[{"code":"3018278430","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":68.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN D SERUM - ARUP","code_information":[{"code":"3018278431","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":68.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN G(IGG)-IMMUNOGLOBULINS CRYOPRECIPITINS REFLEX SERUM- ARUP","code_information":[{"code":"3018278432","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":68.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN M(IGM)-IMMUNOGLOBULINS CRYOPRECIPITINS REFLEX SERUM- ARUP","code_information":[{"code":"3018278433","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":68.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN A(IGA)-IMMUNOGLOBULINS CRYOPRECIPITINS REFLEX SERUM- ARUP","code_information":[{"code":"3018278434","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":68.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN G (IGG) - ARUP","code_information":[{"code":"3018278436","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":68.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN G (IGG)","code_information":[{"code":"3018278437","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":68.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN M (IGM) - ARUP","code_information":[{"code":"3018278439","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":68.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN A (IGA)","code_information":[{"code":"3018278441","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":68.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN A (IGA) - ARUP","code_information":[{"code":"3018278443","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":68.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN G (IGG) CSF - OLIGOCLONAL BAND PROFILE - ARUP","code_information":[{"code":"3018278444","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":68.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN G (IGG) - OLIGOCLONAL BAND PROFILE CSF - ARUP","code_information":[{"code":"3018278445","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":68.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN G (IGG) - OLIGOCLONAL BAND PROFILE SERUM - ARUP","code_information":[{"code":"3018278446","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":68.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOTAL IMMUNOGLOBULIN A WITH SUBCLASSES 1 - 2 (ARUP)","code_information":[{"code":"3018278447","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.33,"discounted_cash":62.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IGG - IMMUNOGLOBULIN G (IGG) CSF INDEX - ARUP","code_information":[{"code":"3018278448","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":68.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN E - IGE","code_information":[{"code":"3018278501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.87,"discounted_cash":121.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IGG1, 2, 3 OR 4, EACH - IGG 1","code_information":[{"code":"3018278701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.42,"discounted_cash":53.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IGG1, 2, 3 OR 4, EACH - IGG 2","code_information":[{"code":"3018278702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.42,"discounted_cash":53.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IGG1, 2, 3 OR 4, EACH - IGG 3","code_information":[{"code":"3018278703","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.42,"discounted_cash":53.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IGG1, 2, 3 OR 4, EACH - IGG 4","code_information":[{"code":"3018278704","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.08,"discounted_cash":59.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IGG SUBCLASSES 1-4","code_information":[{"code":"3018278705","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.42,"discounted_cash":53.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN A SUBCLASSES","code_information":[{"code":"3018278706","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.42,"discounted_cash":53.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY IGA1, 2, 3 OR 4, EACH - IGA 1","code_information":[{"code":"3018278707","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.42,"discounted_cash":53.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN G SUBCLASS 4 (IGG4)","code_information":[{"code":"3018278713","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.42,"discounted_cash":53.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN G SUBCLASSES 1 - 4","code_information":[{"code":"3018278714","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.42,"discounted_cash":53.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN A SUBCLASSES 1 - 2 WITH TOTAL IGA (ARUP)","code_information":[{"code":"3018278716","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.08,"discounted_cash":59.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD PH - PH VENOUS","code_information":[{"code":"3018280001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82800","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.46,"discounted_cash":73.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD PH - PH RT","code_information":[{"code":"3018280003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82800","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.46,"discounted_cash":73.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PH ARTERIAL","code_information":[{"code":"3018280005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82800","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.46,"discounted_cash":73.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC POC CORD ARTERIAL PH","code_information":[{"code":"3018280007","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82800","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.46,"discounted_cash":73.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC POC CORD VENOUS PH","code_information":[{"code":"3018280008","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82800","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.46,"discounted_cash":73.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC POC ARTERIAL PH","code_information":[{"code":"3018280009","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82800","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.46,"discounted_cash":73.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC POC VENOUS PH","code_information":[{"code":"3018280010","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82800","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.46,"discounted_cash":73.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD GASES: PH, PO2 & PCO2 - BLOOD GAS ARTERIAL","code_information":[{"code":"3018280301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.03,"discounted_cash":192.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD GASES: PH, PO2 & PCO2 - BLOOD GAS CORD VENOUS","code_information":[{"code":"3018280302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.03,"discounted_cash":192.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD GASES: PH, PO2 & PCO2 - BLOOD GAS VENOUS","code_information":[{"code":"3018280304","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.03,"discounted_cash":192.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD GASES: PH, PO2 & PCO2 - BLOOD GAS CORD ARTERIAL","code_information":[{"code":"3018280305","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.03,"discounted_cash":192.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD GASES: PH, PO2 & PCO2 - BLOOD GAS ARTERIAL RT","code_information":[{"code":"3018280309","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.03,"discounted_cash":192.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD GAS ARTERIAL W/ CO-OX","code_information":[{"code":"3018280314","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.63,"discounted_cash":173.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD GAS CORD VENOUS","code_information":[{"code":"3018280324","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.03,"discounted_cash":192.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD GAS VENOUS","code_information":[{"code":"3018280325","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.03,"discounted_cash":192.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC POC BLOOD GAS ANALYSIS","code_information":[{"code":"3018280327","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.03,"discounted_cash":192.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC POC CG4+","code_information":[{"code":"3018280328","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.03,"discounted_cash":192.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD GAS - CG8+ POC","code_information":[{"code":"3018280331","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.03,"discounted_cash":192.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD GASES, O2 SAT ONLY - OXYGEN SATURATION, ARTERIAL","code_information":[{"code":"3018281001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82810","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.67,"discounted_cash":65.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD GASES, O2 SAT ONLY - OXYGEN SATURATION, ARTERIAL RT","code_information":[{"code":"3018281003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82810","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.67,"discounted_cash":65.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF GASTRIN - GASTRIN","code_information":[{"code":"3018294101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82941","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.49,"discounted_cash":130.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GASTRIN LEVEL - ARUP","code_information":[{"code":"3018294102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82941","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.49,"discounted_cash":130.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF GLUCAGON - GLUCAGON","code_information":[{"code":"3018294301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82943","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.02,"discounted_cash":50.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUCAGON LEVEL - ARUP","code_information":[{"code":"3018294302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82943","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.02,"discounted_cash":50.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY GLUCOSE, BODY FLUID - GLUCOSE CSF","code_information":[{"code":"3018294501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.54,"discounted_cash":29.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUCOSE BODY FLUID","code_information":[{"code":"3018294502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.71,"discounted_cash":26.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY GLUCOSE, BODY FLUID - GLUCOSE URINE RANDOM","code_information":[{"code":"3018294504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.54,"discounted_cash":29.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUCOSE BODY FLUID - ARUP","code_information":[{"code":"3018294506","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.54,"discounted_cash":29.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY QUANTITATIVE,BLOOD GLUCOSE - POCT GLUCOMETER","code_information":[{"code":"3018294701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.54,"discounted_cash":29.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUCOSE LEVEL FASTING","code_information":[{"code":"3018294703","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.54,"discounted_cash":29.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUCOSE LEVEL","code_information":[{"code":"3018294704","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.54,"discounted_cash":29.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY QUANTITATIVE,BLOOD GLUCOSE - GLUCOSE","code_information":[{"code":"3018294706","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.71,"discounted_cash":26.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FIBROSURE ASH - GLUCOSE","code_information":[{"code":"3018294707","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.54,"discounted_cash":29.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NON ALCOHOLIC FATTY LIVER DISEASE PANEL - GLUCOSE","code_information":[{"code":"3018294708","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.54,"discounted_cash":29.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUCOSE LEVEL - LIVER FIBROSIS FIBROMETER NAFLD - ARUP","code_information":[{"code":"3018294709","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.54,"discounted_cash":29.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUCOSE TOLERANCE TEST (GTT) 1 HOUR SPECIMEN","code_information":[{"code":"3018295001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82950","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.7,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUCOSE TEST - LTT FASTING","code_information":[{"code":"3018295002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82950","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.7,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUCOSE TEST - LTT 2 HR","code_information":[{"code":"3018295004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82950","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.7,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUCOSE TEST - POST GLUCOSE DOSE","code_information":[{"code":"3018295007","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82950","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.7,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUCOSE TOLERANCE TEST (GTT) FIRST 3 SPECIMENS, 2 HOUR GTT","code_information":[{"code":"3018295101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82951","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":94.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUCOSE TOLERANCE TEST (GTT) FIRST 3 SPECIMENS","code_information":[{"code":"3018295102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82951","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LACTOSE TOLERANCE TEST (LTT) FIRST 3 SPECIMENS, 3 HOUR LTT","code_information":[{"code":"3018295109","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82951","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":94.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUCOSE TOLERANCE TEST (GTT) 3 HOUR SPECIMEN","code_information":[{"code":"3018295201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82952","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.54,"discounted_cash":29.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUCOSE TOLERANCE TEST (GTT) EACH ADDITIONAL SPECIMEN","code_information":[{"code":"3018295204","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82952","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.54,"discounted_cash":29.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF G6PD ENZYME - GLUCOSE 6 PHOSPHATE DEHYDROGENASE","code_information":[{"code":"3018295501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82955","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.39,"discounted_cash":71.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUCOSE 6 PHOSPHATE DEHYDROGENASE - ARUP","code_information":[{"code":"3018295502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82955","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.39,"discounted_cash":71.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUCOSE BLOOD TEST WITH DEVICE - POCT GLUCOSE","code_information":[{"code":"3018296201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82962","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.62,"discounted_cash":24.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GAMMA GT LEVEL","code_information":[{"code":"3018297701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82977","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.93,"discounted_cash":52.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIVER FIBROSIS PANEL - GGT","code_information":[{"code":"3018297703","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82977","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.93,"discounted_cash":52.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GAMMA GT - ARUP","code_information":[{"code":"3018297704","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82977","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.93,"discounted_cash":52.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GGT - LIVER FIBROSIS CHRONIC VIRAL HEPATITIS FIBROMETER PANEL - ARUP","code_information":[{"code":"3018297705","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82977","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.93,"discounted_cash":52.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUTATHIONE","code_information":[{"code":"3018297801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82978","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.51,"discounted_cash":103.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUTATHIONE TOTAL - ARUP","code_information":[{"code":"3018297802","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82978","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.51,"discounted_cash":103.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLYCATED PROTEIN - FRUCTOSAMINE","code_information":[{"code":"3018298504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82985","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.41,"discounted_cash":112.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FRUCTOSAMINE LEVEL - ARUP","code_information":[{"code":"3018298505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82985","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.41,"discounted_cash":112.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GONADOTROPIN (FSH) - FSH","code_information":[{"code":"3018300101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83001","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.64,"discounted_cash":136.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LUTEINIZING HORMONE LEVEL","code_information":[{"code":"3018300201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83002","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.64,"discounted_cash":136.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LUTEINIZING HORMONE LEVEL PEDIATRIC - ARUP","code_information":[{"code":"3018300203","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83002","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.64,"discounted_cash":136.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LUTEINIZING HORMONE LEVEL - ARUP","code_information":[{"code":"3018300206","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83002","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.64,"discounted_cash":136.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY GROWTH HORMONE (HGH) - GROWTH HORMONE","code_information":[{"code":"3018300301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83003","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.1,"discounted_cash":123.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HAPTOGLOBIN LEVEL","code_information":[{"code":"3018301001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83010","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.33,"discounted_cash":92.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC H. PYLORI;BREATH TEST, NON-ISOTOPE - H PYLORI BREATH TEST","code_information":[{"code":"3018301301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83013","type":"HCPCS"}],"standard_charges":[{"gross_charge":449.65,"discounted_cash":449.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC H PYLORI C-13 BREATH TEST","code_information":[{"code":"3018301303","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83013","type":"HCPCS"}],"standard_charges":[{"gross_charge":449.65,"discounted_cash":449.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC H PYLORI BREATH TEST - ARUP","code_information":[{"code":"3018301304","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83013","type":"HCPCS"}],"standard_charges":[{"gross_charge":449.65,"discounted_cash":449.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC H PYLORI DRUG ADMIN FOR C-13 BREATH TEST","code_information":[{"code":"3018301401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83014","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":94.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC QUANTITATIVE SCREEN, METALS - COBALT","code_information":[{"code":"3018301801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.92,"discounted_cash":146.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC QUANTITATIVE SCREEN, METALS - THALLIUM, SERUM","code_information":[{"code":"3018301806","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.92,"discounted_cash":146.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC QUANTITATIVE SCREEN, METALS - OTHER","code_information":[{"code":"3018301810","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.92,"discounted_cash":146.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC QUANTITATIVE SCREEN, METALS - IODINE","code_information":[{"code":"3018301811","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.92,"discounted_cash":146.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COBALT LEVEL WHOLE BLOOD","code_information":[{"code":"3018301812","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.92,"discounted_cash":146.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COBALT LEVEL SERUM/PLASMA - ARUP","code_information":[{"code":"3018301815","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.92,"discounted_cash":146.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THALLIUM LEVEL, QUANTITATIVE, WHOLE BLOOD - ARUP","code_information":[{"code":"3018301818","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.92,"discounted_cash":146.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IODINE LEVEL QUANT RANDOM OR 24HR URINE - ARUP","code_information":[{"code":"3018301821","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.92,"discounted_cash":146.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COBALT LEVEL WHOLE BLOOD - ARUP","code_information":[{"code":"3018301822","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.92,"discounted_cash":146.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IODINE LEVEL, QUANTITATIVE, SERUM - ARUP","code_information":[{"code":"3018301824","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.92,"discounted_cash":146.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEMOGLOBIN ELECTROPHORESIS","code_information":[{"code":"3018302001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83020","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEMOGLOBIN ELECTROPHORESIS","code_information":[{"code":"3018302002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83020","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEMOGLOBIN S QUANTITATION","code_information":[{"code":"3018302003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83020","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CAPILLARY HEMOGLOBIN ELECTROPHORESIS - ARUP","code_information":[{"code":"3018302005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83020","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEMOGLOBIN F EVALUATION BY HPLC W/REFLEX - ARUP","code_information":[{"code":"3018302101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEMOGLOBIN CHROMOTOGRAPHY - HEMOGLOBIN,FETAL","code_information":[{"code":"3018302102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEMOGLOBIN A2 AND F BY COLUMN CHROMATOGRAPHY W/REFLEX - ARUP","code_information":[{"code":"3018302103","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEMOGLOBIN S EVALUATION BY HPLC W/REFLEX - ARUP","code_information":[{"code":"3018302104","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEMOGLOBIN FRACTIONATION & QUANTITATION BY HPLC WITH REFLEX - ARUP","code_information":[{"code":"3018302105","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLYCOSYLATED HEMOGLOBIN TEST - HEMOGLOBIN A1C","code_information":[{"code":"3018303601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83036","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.39,"discounted_cash":71.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLYCOSYLATED HEMOGLOBIN TEST - GLYCATED HEMOGLOBIN REFERRED","code_information":[{"code":"3018303603","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83036","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.39,"discounted_cash":71.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLYCOSYLATED HEMOGLOBIN, HOME DEVICE - POCT GLYCOSYLATED HEMOGLOBIN","code_information":[{"code":"3018303701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83037","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.99,"discounted_cash":33.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD METHEMOGLOBIN, QUANT - METHEMOGLOBIN","code_information":[{"code":"3018305001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83050","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.32,"discounted_cash":60.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF PLASMA HEMOGLOBIN - HEMOGLOBIN PLASMA","code_information":[{"code":"3018305101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83051","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.97,"discounted_cash":48.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF URINE HEMOGLOBIN - HEMOGLOBIN (BODY FLUID)","code_information":[{"code":"3018306901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83069","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.71,"discounted_cash":26.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEMOGLOBIN URINE - ARUP","code_information":[{"code":"3018306902","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83069","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.71,"discounted_cash":26.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEMOSIDERIN LEVEL QUALITATIVE URINE","code_information":[{"code":"3018307001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83070","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.28,"discounted_cash":32.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF HISTAMINE - HISTAMINE","code_information":[{"code":"3018308801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83088","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":197.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF HOMOCYSTINE - HOMOCYSTEINE TOTAL","code_information":[{"code":"3018309001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83090","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HOMOCYSTEINE LEVEL","code_information":[{"code":"3018309002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83090","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF HOMOCYSTINE - HOMOCYSTEINE TOTAL URINE","code_information":[{"code":"3018309003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83090","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HOMOCYSTEINE LEVEL - ARUP","code_information":[{"code":"3018309004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83090","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HOMOCYSTEINE LEVEL - QWDL","code_information":[{"code":"3018309005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83090","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF FOR HVA - HOMOVANILLIC ACID URINE","code_information":[{"code":"3018315001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83150","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.14,"discounted_cash":149.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HOMOVANILLIC ACID (HVA) URINE - ARUP","code_information":[{"code":"3018315002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83150","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.14,"discounted_cash":149.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF 5-HIAA - 5 HIAA QUANT,24HR URINE","code_information":[{"code":"3018349701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83497","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC 5 HIAA QUANT URINE RANDOM - ARUP","code_information":[{"code":"3018349702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83497","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA","code_information":[{"code":"3018349703","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83497","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF PROGESTERONE 17-D - 17-HYDROXYPROGESTERONE","code_information":[{"code":"3018349801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83498","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.65,"discounted_cash":200.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC 17 HYDROXYPROGESTERONE - ARUP","code_information":[{"code":"3018349803","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83498","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.65,"discounted_cash":200.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY NONANTIBODY - GLIADIN ANTIBODY IGA","code_information":[{"code":"3018351601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.8,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY NONANTIBODY - GLIADIN ANTIBODY IGG","code_information":[{"code":"3018351602","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.8,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY NONANTIBODY - ANTI-SMOOTH MUSCLE ANTIBODY, IGG","code_information":[{"code":"3018351604","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY NONANTIBODY - ANTIMULLERIAN HORMONE (AMH)","code_information":[{"code":"3018351607","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY NONANTIBODY - MITOCHONDRIAL ANTIBODIES, M2","code_information":[{"code":"3018351608","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY NONANTIBODY - CELIAC DISEASE - TISSUE TRANSGLUTAMINASE, EACH","code_information":[{"code":"3018351609","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.94,"discounted_cash":84.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY NONANTIBODY - CELIAC DISEASE - DEAMINATED GLIADIN PEPTIDE, EACH","code_information":[{"code":"3018351610","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.8,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY NONINFECTIOUS ANALYTE","code_information":[{"code":"3018351611","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SERINE PROTEASE 3 ANTIBODY IGG","code_information":[{"code":"3018351612","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.8,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY NONINFECTIOUS ANALYTE - HISTONE ANTIBODY","code_information":[{"code":"3018351613","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.8,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY NONINFECTIOUS ANALYTE - ACETYLCHOLINE RECEPTOR ANTIBODY","code_information":[{"code":"3018351614","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY NONINFECTIOUS ANALYTE - GLUTAMIC ACID DECARBOXYLASE ANTIBODY","code_information":[{"code":"3018351615","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.8,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY NONINFECTIOUS ANALYTE - AQUAPORIN 4 RECEPTOR ANTIBODY","code_information":[{"code":"3018351617","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY NONINFECTIOUS ANALYTE - CENTROMERE ANTIBODY IGG","code_information":[{"code":"3018351618","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY NONINFECTIOUS ANALYTE - CHROMATIN ANTIBODY IGG","code_information":[{"code":"3018351619","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY NONINFECTIOUS ANALYTE - GLOMERULAR BASEMENT MEMBRANE ANTIBODY IGG","code_information":[{"code":"3018351620","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYELOPEROXIDASE ANTIBODY IGG","code_information":[{"code":"3018351621","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY NONINFECTIOUS ANALYTE - GM1 GANGLIOSIDE ANTIBODY","code_information":[{"code":"3018351622","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SENSORIMOTOR NEUROPATHY PANEL","code_information":[{"code":"3018351626","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACETYLCHOLINE MODULATING ANTIBODY","code_information":[{"code":"3018351631","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY ANALYTE - 21 HYDROXYLASE","code_information":[{"code":"3018351632","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY - ARUP","code_information":[{"code":"3018351642","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY ANALYTE - RIBOSOMAL P ABY","code_information":[{"code":"3018351643","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.8,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY ANALYTE - NEURONAL NUC ABY IGG","code_information":[{"code":"3018351644","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY ANALYTE - ANTI-SMOOTH MUSCLE ANTIBODY, IGG W/TITER","code_information":[{"code":"3018351646","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.8,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANCA SERINE PROTEASE 3 ANTIBODY (PRE) - (ARUP)","code_information":[{"code":"3018351649","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANCA MYELOPEROXIDASE ANTIBODY (MPO) - (ARUP)","code_information":[{"code":"3018351650","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYELOPEROXIDASE (MPO) IGG","code_information":[{"code":"3018351653","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYELOPEROXIDASE (MPO) IGG - ARUP","code_information":[{"code":"3018351654","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SERINE PROTEASE 3 (PR3) IGG - ARUP","code_information":[{"code":"3018351655","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHOSPHATIDYLSERINE & PROTHROMBIN IGG - NON-CRITERIA APS - ARUP","code_information":[{"code":"3018351656","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHOSPHATIDYLSERINE & PROTHROMBIN IGM - NON-CRITERIA APS - ARUP","code_information":[{"code":"3018351657","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SERINE PROTEASE 3 (PR3) IGG - ANCA ASSOCIATED VASCULITIS PROFILE - ARUP","code_information":[{"code":"3018351658","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYELOPEROXIDASE (MPO) IGG - ANCA ASSOCIATED VASCULITIS PROFILE - ARUP","code_information":[{"code":"3018351659","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC 21 HYDROXYLASE AUTOANTIBODY - ARUP","code_information":[{"code":"3018351666","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACHR BLOCKING ANTIBODY - ACETYLCHOLINE RECEPTOR AB RFLX PANEL - ARUP","code_information":[{"code":"3018351667","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BULLOUS PEMPHIGOID ANTIGENS IGG - ARUP","code_information":[{"code":"3018351668","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CENTROMERE IGG - ARUP","code_information":[{"code":"3018351670","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHROMATIN IGG","code_information":[{"code":"3018351671","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC 3-HYDROXY-3-METHYLGLUTARYL COENZYME A REDUCTASE (HMGCR) IGG- ARUP","code_information":[{"code":"3018351672","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GM1 IGG - GANGLIOSIDE GM1 ANTIBODIES IGG/IGM - ARUP","code_information":[{"code":"3018351675","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GM1 IGM - GANGLIOSIDE GM1 ANTIBODIES IGG/IGM - ARUP","code_information":[{"code":"3018351676","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GM1 IGG - GANGLIOSIDE GM1/GD1B/GQ1B IGG/IGM ANTIBODIES - ARUP","code_information":[{"code":"3018351677","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GM1 IGM - GANGLIOSIDE GM1/GD1B/GQ1B IGG/IGM ANTIBODIES - ARUP","code_information":[{"code":"3018351678","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GD1B IGG - GANGLIOSIDE GM1/GD1B/GQ1B IGG/IGM ANTIBODIES - ARUP","code_information":[{"code":"3018351679","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GD1B IGM- GANGLIOSIDE GM1/GD1B/GQ1B IGG/IGM ANTIBODIES - ARUP","code_information":[{"code":"3018351680","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GQ1 IGG - GANGLIOSIDE GM1/GD1B/GQ1B IGG/IGM ANTIBODIES - ARUP","code_information":[{"code":"3018351681","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GQ1 IGM - GANGLIOSIDE GM1/GD1B/GQ1B IGG/IGM ANTIBODIES - ARUP","code_information":[{"code":"3018351682","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EJ (GLYCYL TRNA SYNTHETASE) - DERMATOMYOSITIS POLYMYOSITIS PANEL-ARUP","code_information":[{"code":"3018351683","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MI2 (NUCLEAR HELICASE PROTEIN) - DERMATOMYOSITIS POLYMYOSITIS PANEL-ARUP","code_information":[{"code":"3018351684","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OJ (ISOLEUCYL TRNA SYNTHETASE) - DERMATOMYOSITIS POLYMYOSITIS PANEL-ARUP","code_information":[{"code":"3018351685","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC P155/140 - DERMATOMYOSITIS POLYMYOSITIS PANEL-ARUP","code_information":[{"code":"3018351686","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PL12 (ALANYL TRNA SYNTHETASE) - DERMATOMYOSITIS POLYMYOSITIS PANEL-ARUP","code_information":[{"code":"3018351687","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PL7 (THREONYL TRNA SYNTHETASE) DERMATOMYOSITIS POLYMYOSITIS PANEL-ARUP","code_information":[{"code":"3018351688","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SRP(SIGNAL RECOGNITION PARTICLE)-DERMATOMYOSITIS POLYMYOSITIS PANEL-ARUP","code_information":[{"code":"3018351689","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HISTONE IGG - ARUP","code_information":[{"code":"3018351690","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DESMOGLIEN 1 - DESMOGLIEN 1 & 3 IGG - ARUP","code_information":[{"code":"3018351691","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DESMOGLIEN 3 - DESMOGLIEN 1 & 3 IGG - ARUP","code_information":[{"code":"3018351692","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYELIN ASSOCIATED GLYCOPROTEIN IGM - ARUP","code_information":[{"code":"3018351693","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACETYLCHOLINE BINDING ANTIBODY - MYASTHENIA GRAVIS PANEL - ARUP","code_information":[{"code":"3018351694","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY- MYASTHENIA GRAVIS PANEL - ARUP","code_information":[{"code":"3018351695","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SERINE PROTEASE 3 (PR3) IGG - MYELOPEROXIDASE / PROTEASE 3 AB - ARUP","code_information":[{"code":"3018351696","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYELOPEROXIDASE (MPO) IGG - MYELOPEROXIDASE / PROTEASE 3 AB - ARUP","code_information":[{"code":"3018351697","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EJ (GLYCYL TRNA SYNTHETASE) - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"3018351698","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC KU ANTIBODY - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"3018351699","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MI2 (NUCLEAR HELICASE PROTEIN) - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"30183516A1","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OJ (ISOLEUCYL TRNA SYNTHETASE) - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"30183516A2","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC P155/140 ANTIBODY - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"30183516A3","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PL12 (ALANYL TRNA SYNTHETASE) - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"30183516A4","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PL7 (THREONYL TRNA SYNTHETASE) - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"30183516A5","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SRP (SIGNAL RECOGNITION PARTICLE) - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"30183516A6","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SERINE PROTEASE 3 (PR3) IGG - MPO AND PR3 ANTIBODIES W/ RFLX ANCA- ARUP","code_information":[{"code":"30183516A7","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYELOPEROXIDASE (MPO) IGG - MPO AND PR3 ANTIBODIES W/ RFLX ANCA - ARUP","code_information":[{"code":"30183516A8","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GASTRIC PARIETAL IGG - ARUP","code_information":[{"code":"30183516A9","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.8,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RF IGG - RHEUMATOID FACTOR (RF) IGA IGG IGM - ARUP","code_information":[{"code":"30183516B3","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RNA POLYMERASE III IGG - ARUP","code_information":[{"code":"30183516B4","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.8,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MAG IGM ELISA - SENSORY NEUROPATHY PANEL - ARUP","code_information":[{"code":"30183516B5","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SGPG IGM - SENSORY NEUROPATHY PANEL - ARUP","code_information":[{"code":"30183516B6","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SOLUBLE LIVER ANTIGEN IGG - ARUP","code_information":[{"code":"30183516B7","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.8,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARBAMYLATED PROTEIN IGG - RHEUMATOID ARTHRITIS PANEL - ARUP","code_information":[{"code":"30183516B8","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CENTROMERE IGG -CONNECTIVE TISSUE DISEASES PROFILE - ARUP","code_information":[{"code":"30183516C1","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RIBOSOMAL P ANTIBODY - CONNECTIVE TISSUE DISEASES PROFILE - ARUP","code_information":[{"code":"30183516C2","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TISSUE TRANSGLUTAMINASE IGG - QWDL","code_information":[{"code":"30183516C3","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.8,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLOMERULAR BASEMENT MEMBRANE (GBM) IGG","code_information":[{"code":"30183516C5","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.8,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLOMERULAR BASEMENT MEMBRANE (GBM) IGG BY MULTIPLEX BEAD ASSAY - ARUP","code_information":[{"code":"30183516C6","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RF IGA - RHEUMATOID FACTOR (RF) IGA IGG IGM - ARUP","code_information":[{"code":"30183516C9","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RF IGM - RHEUMATOID FACTOR (RF) IGA IGG IGM - ARUP","code_information":[{"code":"30183516D1","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TIF1 GAMMA (155 KDA) - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"30183516D8","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NXP2 NUCLEAR MATRIC PROTEIN 2 - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"30183516D9","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MDA5 CADM 140 - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"30183516E1","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SAE1 SUMO ACTIVATING ENZYME - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"30183516E2","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RIA IMMUNOASSAY NONINFECTIOUS ANALYTE","code_information":[{"code":"3018351904","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSULIN LIKE GROWTH FACTOR BINDING PROTEIN 1","code_information":[{"code":"3018351907","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.43,"discounted_cash":122.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACETYLCHOLINE RECEPTOR BINDING AB - ARUP","code_information":[{"code":"3018351908","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PANCREATIC POLYPEPTIDE","code_information":[{"code":"3018351909","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.43,"discounted_cash":122.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VOLTAGE GATED POTASSIUM CHANNEL ANTIBODY","code_information":[{"code":"3018351910","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VOLTAGE GATED CALCIUM CHANNEL ANTIBODY","code_information":[{"code":"3018351911","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.43,"discounted_cash":122.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRYPSIN LEVEL","code_information":[{"code":"3018351913","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.43,"discounted_cash":122.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RIA IMMUNOASSAY ACETYLCHOLINE RECEPTOR BLOCKING ABY","code_information":[{"code":"3018351914","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RIA IMMUNOASSAY ACETYLCHOLINE RECEPTOR MODULATING ABY","code_information":[{"code":"3018351915","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RIA IMMUNOASSAY MISCELLANEOUS","code_information":[{"code":"3018351921","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.43,"discounted_cash":122.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACHR BINDING ANTIBODY - ACETYLCHOLINE RECEPTOR AB RFLX PANEL - ARUP","code_information":[{"code":"3018351931","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VOLTAGE GATED POTASSIUM CHNL AB-AUTOIMMUNE ENCEPHALITIS EXTND PNL-ARUP","code_information":[{"code":"3018351933","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IGF BINDING PROTEIN 1 - ARUP","code_information":[{"code":"3018351935","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IGF BINDING PROTEIN 2 - ARUP","code_information":[{"code":"3018351936","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC STRIATED MUSCLE IGG - MYASTHENIA GRAVIS PANEL - ARUP","code_information":[{"code":"3018351938","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROCOLLAGEN TYPE 1 PROPEPTIDE - ARUP","code_information":[{"code":"3018351940","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VOLTAGE GATED POTASSIUM CHANNEL REFLEX - ARUP","code_information":[{"code":"3018351942","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VOLTAGE GATED POTASSIUM CHANNEL ANTIBODY - ARUP","code_information":[{"code":"3018351943","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VOLTAGE GATED POTASSIUM CHNL AB-AUTOIMMUNE NEURO DISEASE RFLX PNL-ARUP","code_information":[{"code":"3018351944","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VOLTAGE GATE POTASSIUM CHANNEL-AUTOIMMUNE ENCEPHALITIS RFLX PNL CSF-ARUP","code_information":[{"code":"3018351945","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY NONINFECTIOUS ANALYTE QUANT","code_information":[{"code":"3018352005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY QUANT NOS NONAB - OTHER","code_information":[{"code":"3018352008","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY QUANT NOS NONAB - INTERLEUKIN 6","code_information":[{"code":"3018352010","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY QUANT NOS NONAB - TSH RECPT","code_information":[{"code":"3018352012","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.02,"discounted_cash":128.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTOKINE PANEL","code_information":[{"code":"3018352016","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTERFERON ALPHA LEVEL","code_information":[{"code":"3018352019","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ADIPONECTIN - ARUP","code_information":[{"code":"3018352022","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MAG ANTIBODY","code_information":[{"code":"3018352023","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MAG-SGPG ANTIBODY IGM","code_information":[{"code":"3018352024","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INHIBIN B","code_information":[{"code":"3018352025","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTERLEUKIN 2 LEVEL","code_information":[{"code":"3018352026","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.75,"discounted_cash":243.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRYPTASE","code_information":[{"code":"3018352027","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.02,"discounted_cash":128.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT - INHIBIN B","code_information":[{"code":"3018352029","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTERFERON GAMMA - ARUP","code_information":[{"code":"3018352031","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ADAMTS13 ANTIBODY - ARUP","code_information":[{"code":"3018352032","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC 14-3-3 ETA PROTEIN - QST","code_information":[{"code":"3018352033","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.02,"discounted_cash":128.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTERFERON GAMMA - CYTOKINE PANEL, SERUM - ARUP","code_information":[{"code":"3018352034","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTERLEUKIN 1 BETA - CYTOKINE PANEL, SERUM - ARUP","code_information":[{"code":"3018352035","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT - PANCREATIC ELASTASE FECAL","code_information":[{"code":"3018352036","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTERLEUKIN 10 - CYTOKINE PANEL, SERUM - ARUP","code_information":[{"code":"3018352037","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTERLEUKIN 12 - CYTOKINE PANEL, SERUM - ARUP","code_information":[{"code":"3018352039","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTERLEUKIN 13 - CYTOKINE PANEL, SERUM - ARUP","code_information":[{"code":"3018352040","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTERLEUKIN 17 - CYTOKINE PANEL, SERUM - ARUP","code_information":[{"code":"3018352041","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTERLEUKIN 2 - CYTOKINE PANEL, SERUM - ARUP","code_information":[{"code":"3018352042","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTERLEUKIN 2 RECEPTOR, SOLUBLE - CYTOKINE PANEL, SERUM - ARUP","code_information":[{"code":"3018352043","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTERLEUKIN 4 - CYTOKINE PANEL, SERUM - ARUP","code_information":[{"code":"3018352044","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTERLEUKIN 5 - CYTOKINE PANEL, SERUM - ARUP","code_information":[{"code":"3018352045","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTERLEUKIN 8 - CYTOKINE PANEL, SERUM - ARUP","code_information":[{"code":"3018352046","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TUMOR NECROSIS FACTOR ALPHA - CYTOKINE PANEL, SERUM - ARUP","code_information":[{"code":"3018352047","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT - PANCA IGG","code_information":[{"code":"3018352049","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSULIN-LIKE GROWTH FACTOR 2 - ARUP","code_information":[{"code":"3018352050","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTERLEUKIN 2 - ARUP","code_information":[{"code":"3018352054","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEPTIN LEVEL QUANT - ARUP","code_information":[{"code":"3018352055","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VON WILLEBRAND FACTOR COLLAGEN BINDING - ARUP","code_information":[{"code":"3018352057","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRANSFORMING GROWTH FACTOR BETA, SERUM - ARUP","code_information":[{"code":"3018352058","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TUMOR NECROSIS FACTOR ALPHA SERUM - ARUP","code_information":[{"code":"3018352061","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTERFERON GAMMA - CYTOKINE PANEL 13, CSF - ARUP","code_information":[{"code":"3018352064","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTERLEUKIN 1 BETA - CYTOKINE PANEL 13, CSF - ARUP","code_information":[{"code":"3018352065","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTERLEUKIN 10 - CYTOKINE PANEL 13, CSF - ARUP","code_information":[{"code":"3018352066","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTERLEUKIN 12 - CYTOKINE PANEL 13, CSF - ARUP","code_information":[{"code":"3018352067","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTERLEUKIN 13 - CYTOKINE PANEL 13, CSF - ARUP","code_information":[{"code":"3018352068","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTERLEUKIN 17 - CYTOKINE PANEL 13, CSF - ARUP","code_information":[{"code":"3018352069","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTERLEUKIN 2 - CYTOKINE PANEL 13, CSF - ARUP","code_information":[{"code":"3018352070","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTERLEUKIN 2 RECEPTOR, SOLUBLE - CYTOKINE PANEL 13, CSF - ARUP","code_information":[{"code":"3018352071","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTERLEUKIN 4 - CYTOKINE PANEL 13, CSF - ARUP","code_information":[{"code":"3018352072","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTERLEUKIN 5 - CYTOKINE PANEL 13, CSF - ARUP","code_information":[{"code":"3018352073","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTERLEUKIN 8 - CYTOKINE PANEL 13, CSF - ARUP","code_information":[{"code":"3018352074","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TUMOR NECROSIS FACTOR ALPHA - CYTOKINE PANEL 13, CSF - ARUP","code_information":[{"code":"3018352075","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALPHA SUBUNIT OF PITUITARY GLYCOPROTEIN - ARUP","code_information":[{"code":"3018352076","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INHIBIN B - ARUP","code_information":[{"code":"3018352077","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTERLEUKIN 2 RECEPTOR BY MAFD - ARUP","code_information":[{"code":"3018352078","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYELIN ASSOCIATED GLYCOPROTEIN (MAG) - SGPG, IGM - QDID","code_information":[{"code":"3018352079","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.02,"discounted_cash":128.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TSH RECEPTOR ANTIBODY - ARUP","code_information":[{"code":"3018352081","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRYPTASE LEVEL - ARUP","code_information":[{"code":"3018352082","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MUTATED CITRULLINATED VIMENTIN ANTIBODY - ARUP","code_information":[{"code":"3018352083","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHOSPHO TAU - ADMARK P-TAU/T-TAU/ABETA42, SYMPTOMATIC, CSF - QUEST","code_information":[{"code":"3018352088","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOTAL TAU - ADMARK P-TAU/T-TAU/ABETA42, SYMPTOMATIC, CSF - QUEST","code_information":[{"code":"3018352089","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AB42 PEPTIDE - ADMARK P-TAU/T-TAU/ABETA42, SYMPTOMATIC, CSF - QUEST","code_information":[{"code":"3018352090","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC 14-3-3 ETA PROTEIN BY ELISA - ARUP","code_information":[{"code":"3018352091","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MUTATED CITRULLINATED VIMENTIN (MCV) ANTIBODY - QST","code_information":[{"code":"3018352092","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.75,"discounted_cash":115.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SFLT-1 - PREECLAMPSIA RISK ASSESSMENT (SFLT-1/PIGF RATIO) - ARUP","code_information":[{"code":"3018352093","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.75,"discounted_cash":243.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PIGF - PREECLAMPSIA RISK ASSESSMENT (SFLT-1/PIGF RATIO) - ARUP","code_information":[{"code":"3018352094","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.75,"discounted_cash":243.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH","code_information":[{"code":"3018352101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":100.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC KAPPA LIGHT CHAINS - MONOCLONAL PROTEIN STUDY EXTENDED SERUM -  ARUP  [3018352101]","code_information":[{"code":"3018352102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":100.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAMBDA LIGHT CHAINS - MONOCLONAL PROTEIN STUDY EXTENDED SERUM -  ARUP","code_information":[{"code":"3018352103","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":100.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC KAPPA/LAMBDA IMMUNOGLOBULIN LIGHT CHAINS - IMMUNOFIXATION WITH FLC, URINE - ARUP","code_information":[{"code":"3018352104","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":100.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC KAPPA LIGHT CHAINS - KAPPA LAMBDA QUANTITATIVE","code_information":[{"code":"3018352105","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":100.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAMBDA LIGHT CHAINS - KAPPA LAMBDA QUANTITATIVE","code_information":[{"code":"3018352106","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":100.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC KAPPA LIGHT CHAINS - IMMUNOFIXATION WITH FREE LIGHT CHAINS URINE - ARUP","code_information":[{"code":"3018352107","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":100.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSULIN LEVEL TOTAL FASTING","code_information":[{"code":"3018352501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83525","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.94,"discounted_cash":84.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSULIN LEVEL TOTAL","code_information":[{"code":"3018352502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83525","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.94,"discounted_cash":84.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSULIN LEVEL TOTAL - INSULIN LEVEL FREE AND TOTAL - ARUP","code_information":[{"code":"3018352505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83525","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.94,"discounted_cash":84.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSULIN LEVEL TOTAL - QWDL","code_information":[{"code":"3018352506","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83525","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.94,"discounted_cash":84.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF INSULIN,FREE - INSULIN, FREE","code_information":[{"code":"3018352701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83527","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.81,"discounted_cash":86.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSULIN LEVEL FREE - INSULIN LEVEL FREE AND TOTAL - ARUP","code_information":[{"code":"3018352702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83527","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.81,"discounted_cash":86.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTERLEUKIN-6 (IL-6)","code_information":[{"code":"3018352901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83529","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.02,"discounted_cash":128.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTERLEUKIN 6 - ARUP","code_information":[{"code":"3018352902","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83529","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.02,"discounted_cash":128.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTERLEUKIN 6 - CYTOKINE PANEL, SERUM - ARUP","code_information":[{"code":"3018352903","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83529","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.02,"discounted_cash":128.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTERLEUKIN 6 - CYTOKINE PANEL 13, CSF - ARUP","code_information":[{"code":"3018352904","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83529","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.02,"discounted_cash":128.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF IRON - IRON,LIVER TISSUE","code_information":[{"code":"3018354001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.01,"discounted_cash":48.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IRON LEVEL","code_information":[{"code":"3018354002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.01,"discounted_cash":48.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IRON LEVEL","code_information":[{"code":"3018354007","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.01,"discounted_cash":48.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOTAL IRON BINDING CAPACITY","code_information":[{"code":"3018355001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83550","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.02,"discounted_cash":64.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF LACTIC ACID - LACTATE CSF","code_information":[{"code":"3018360501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.94,"discounted_cash":84.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LACTIC ACID LEVEL","code_information":[{"code":"3018360502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.94,"discounted_cash":84.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF LACTIC ACID - POCT LACTIC ACID (LACTATE)","code_information":[{"code":"3018360503","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.94,"discounted_cash":84.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LACTIC ACID LEVEL REFLEX","code_information":[{"code":"3018360510","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.94,"discounted_cash":84.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC POC LACTATE LEVEL ARTERIAL","code_information":[{"code":"3018360519","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.94,"discounted_cash":84.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC POC LACTATE LEVEL VENOUS","code_information":[{"code":"3018360520","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.94,"discounted_cash":84.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LACTIC ACID LEVEL CSF","code_information":[{"code":"3018360521","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.94,"discounted_cash":84.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LACTATE DEHYDROGENASE (LDH) FLUID","code_information":[{"code":"3018361501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.32,"discounted_cash":44.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LD (LDH) TOTAL","code_information":[{"code":"3018361502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.07,"discounted_cash":40.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LACTATE (LD) (LDH) ENZYME - LACTATE DEHYDROGENASE, CSF","code_information":[{"code":"3018361503","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.32,"discounted_cash":44.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LD (LDH) TOTAL  - ARUP","code_information":[{"code":"3018361504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.32,"discounted_cash":44.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LD (LDH) TOTAL BODY FLUID - ARUP","code_information":[{"code":"3018361505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.32,"discounted_cash":44.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LDH PLEURAL FLUID/SERUM RATION","code_information":[{"code":"3018361506","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.07,"discounted_cash":40.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LACTATE DEHYDROGENASE TOTAL","code_information":[{"code":"3018361508","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.07,"discounted_cash":40.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LD TOTAL - LACTATE DEHYDROGENASE ISOENZYMES - ARUP","code_information":[{"code":"3018361509","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.32,"discounted_cash":44.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LD 1 - LACTATE DEHYDROGENASE ISOENZYMES - ARUP","code_information":[{"code":"3018361510","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.32,"discounted_cash":44.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF LDH ISOENZYMES - LACTATE DEHYDROGENASE ISOENZMS","code_information":[{"code":"3018362501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83625","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LD (LDH) ISOENZYMES, LDH ISOENZYMES - ARUP","code_information":[{"code":"3018362502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83625","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LD ISOENZYMES - LACTATE DEHYDROGENASE ISOENZYMES - ARUP","code_information":[{"code":"3018362503","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83625","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LACTOFERRIN FECAL","code_information":[{"code":"3018363001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83630","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.68,"discounted_cash":164.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEAD URINE HEAVY METALS PANEL 3- ARUP","code_information":[{"code":"3018365501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":81.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEAD BLOOD  HEAVY METALS PANEL 3- ARUP","code_information":[{"code":"3018365503","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.86,"discounted_cash":89.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEAD CAPILLARY - ARUP","code_information":[{"code":"3018365504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.86,"discounted_cash":89.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEAD BLOOD HEAVY METALS PANEL 4 - ARUP","code_information":[{"code":"3018365505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.86,"discounted_cash":89.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEAD VENOUS - ARUP","code_information":[{"code":"3018365506","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.86,"discounted_cash":89.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEAD INDUSTRIAL EXPOSURE - ARUP","code_information":[{"code":"3018365507","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":81.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEAD - QWDL","code_information":[{"code":"3018365508","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":81.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEAD URINE - HEAVY METALS PANEL 3 - ARUP","code_information":[{"code":"3018365510","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.86,"discounted_cash":89.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIPASE LEVEL","code_information":[{"code":"3018369001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83690","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.47,"discounted_cash":50.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF LIPASE - LIPASE BODY FLUID","code_information":[{"code":"3018369002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83690","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.63,"discounted_cash":45.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIPOPROTEIN SMALL A","code_information":[{"code":"3018369501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83695","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.87,"discounted_cash":105.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIPOPROTEIN SMALL A PANEL COMPONENT","code_information":[{"code":"3018369502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83695","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.87,"discounted_cash":105.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIPOPROTEIN SMALL A - CARDIO IQ - QWDL","code_information":[{"code":"3018369503","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83695","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.87,"discounted_cash":105.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY LIPOPROTEIN PLA2 - LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2","code_information":[{"code":"3018369801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83698","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.41,"discounted_cash":309.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIPOPROTEIN-PLA2 (PLAC) ACTIVITY - ARUP","code_information":[{"code":"3018369802","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83698","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.41,"discounted_cash":309.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIPOPRO BLOOD, ELECTROPHOR/ QUANT - LIPOPROTEIN ELECTROPHORESIS","code_information":[{"code":"3018370001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83700","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.41,"discounted_cash":39.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIPOPROTEIN ELECTROPHORESIS - ARUP","code_information":[{"code":"3018370002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83700","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.41,"discounted_cash":39.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIPOPROTEIN, BLOOD, BY NMR SPECT - LIPOPROTEIN NMR","code_information":[{"code":"3018370401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83704","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.36,"discounted_cash":252.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIPOPROTEIN  BLOOD  BY NMR SPECT - LIPOPROTEIN","code_information":[{"code":"3018370402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83704","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.68,"discounted_cash":75.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIPOPROTEIN - NMR LIPOMED PROFILE - ARUP","code_information":[{"code":"3018370403","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83704","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.36,"discounted_cash":252.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIPOPROTEIN BY NMR SPECT - CARDIO IQ - QWDL","code_information":[{"code":"3018370404","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83704","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.36,"discounted_cash":252.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF BLOOD LIPOPROTEIN,HDL CHOLEST - HDL CHOLESTEROL","code_information":[{"code":"3018371801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83718","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.54,"discounted_cash":54.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF BLOOD LIPOPROTEIN,LDL CHOLEST - LDL CHOLESTEROL DIRECT","code_information":[{"code":"3018372101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83721","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.55,"discounted_cash":77.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MAGNESIUM LEVEL","code_information":[{"code":"3018373501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.24,"discounted_cash":49.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MAGNESIUM URINE RANDOM","code_information":[{"code":"3018373502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.52,"discounted_cash":44.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF MAGNESIUM - MAGNESIUM RBC","code_information":[{"code":"3018373504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.52,"discounted_cash":44.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CVICU IONIZED MAGNESIUM POC","code_information":[{"code":"3018373505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.24,"discounted_cash":49.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF MAGNESIUM - MAGNESIUM IONIZED","code_information":[{"code":"3018373506","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.24,"discounted_cash":49.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MAGNESIUM SUPERSATURATION PROFILE, URINE - ARUP","code_information":[{"code":"3018373507","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.24,"discounted_cash":49.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MAGNESIUM, URINE - ARUP","code_information":[{"code":"3018373508","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.24,"discounted_cash":49.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MAGNESIUM TIMED URINE","code_information":[{"code":"3018373509","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.52,"discounted_cash":44.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MAGNESIUM URINE CALCULI RISK ASSESSMENT - ARUP","code_information":[{"code":"3018373510","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.24,"discounted_cash":49.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MAGNESIUM RBC - ARUP","code_information":[{"code":"3018373512","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.24,"discounted_cash":49.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF MANGANESE - MANGANESE","code_information":[{"code":"3018378501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83785","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.52,"discounted_cash":148.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF MANGANESE - MANGANESE, WHOLE BLOOD","code_information":[{"code":"3018378502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83785","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.52,"discounted_cash":148.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MANGANESE LEVEL SERUM - ARUP","code_information":[{"code":"3018378504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83785","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.52,"discounted_cash":148.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MANGANESE LEVEL WHOLE BLOOD - ARUP","code_information":[{"code":"3018378505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83785","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.52,"discounted_cash":148.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MASS SPECTROMETRY NONDRUG ANALYTE","code_information":[{"code":"3018378901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.39,"discounted_cash":161.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY MASS SPECTROMETRY NONDRUG ANALYTE - IODINE URINE","code_information":[{"code":"3018378903","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.39,"discounted_cash":161.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BILE ACIDS FRACTIONATED AND TOTAL - ARUP","code_information":[{"code":"3018378904","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.39,"discounted_cash":161.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BACTERIAL ID BY MALDI-TOF MS - ARUP","code_information":[{"code":"3018378905","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.39,"discounted_cash":161.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FUNGAL ID BY MALDI-TOF MS - ARUP","code_information":[{"code":"3018378906","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.39,"discounted_cash":161.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AFB ID BY MALDI-TOF MS - ARUP","code_information":[{"code":"3018378907","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.39,"discounted_cash":161.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MERCURY URINE HEAVY METALS PANEL 3- ARUP","code_information":[{"code":"3018382501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.07,"discounted_cash":109.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MERCURY BLOOD HEAVY METALS PANEL 3 - ARUP","code_information":[{"code":"3018382503","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.63,"discounted_cash":120.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MERCURY BLOOD - ARUP","code_information":[{"code":"3018382504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.63,"discounted_cash":120.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MERCURY BLOOD HEAVY METALS PANEL 4 BLOOD - ARUP","code_information":[{"code":"3018382505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.63,"discounted_cash":120.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MERCURY URINE - HEAVY METALS PANEL 3 - ARUP","code_information":[{"code":"3018382506","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.63,"discounted_cash":120.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF METANEPHRINES - METANEPHRINES 24HR URINE","code_information":[{"code":"3018383501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.56,"discounted_cash":125.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF METANEPHRINES - METANEPHRINE PLASMA","code_information":[{"code":"3018383502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.56,"discounted_cash":125.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF METANEPHRINES - METANEPHRINES 24HR URINE FRACTIONATED","code_information":[{"code":"3018383504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.56,"discounted_cash":125.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC METANEPHRINES URINE 24 HOUR - ARUP","code_information":[{"code":"3018383505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.56,"discounted_cash":125.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYELIN BASIC PROTEIN,CSF - MYELIN BASIC PROTEIN CSF","code_information":[{"code":"3018387301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83873","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.79,"discounted_cash":126.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYELIN BASIC PROTEIN CSF - ARUP","code_information":[{"code":"3018387302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83873","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.64,"discounted_cash":114.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF MYOGLOBIN - MYOGLOBIN SERUM","code_information":[{"code":"3018387401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83874","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.81,"discounted_cash":86.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF MYOGLOBIN - MYOGLOBIN URINE QUANTITATIVE","code_information":[{"code":"3018387402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83874","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.81,"discounted_cash":86.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYOGLOBIN URINE SCREEN","code_information":[{"code":"3018387403","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83874","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.81,"discounted_cash":86.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYOGLOBIN URINE QUANT - ARUP","code_information":[{"code":"3018387404","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83874","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.81,"discounted_cash":86.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC N-TERMINAL PRO-BNP","code_information":[{"code":"3018388001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.51,"discounted_cash":290.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC B-TYPE NATRIUETIC PEPTIDE (BNP)","code_information":[{"code":"3018388004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.51,"discounted_cash":290.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC B-TYPE NATIURETIC PEPTIDE (BNP) - POCT ASSAY","code_information":[{"code":"3018388005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.67,"discounted_cash":262.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC B-TYPE NATRIUETIC PEPTIDE (BNP) - ARUP","code_information":[{"code":"3018388006","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.51,"discounted_cash":290.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEPHELOMETRY ALPHA 2 MACROGLOBULIN","code_information":[{"code":"3018388303","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":100.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEPHELOMETRY, NOT SPECIFIED - KAPPA / LAMBDA LIGHT CHAINS QUANT","code_information":[{"code":"3018388305","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":100.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY NEPHELOMETRY, NOT SPECIFIED - EACH","code_information":[{"code":"3018388308","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":100.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC A2 MACROGLOBULIN-LIVER FIBROSIS CHRONIC VIRAL HEP FIBROMETER PNL-ARUP","code_information":[{"code":"3018388309","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":100.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NUCLEOTIDASE 5","code_information":[{"code":"3018391501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83915","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.03,"discounted_cash":39.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NUCLEOTIDASE 5 - ARUP","code_information":[{"code":"3018391502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83915","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.03,"discounted_cash":39.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OLIGOCLONAL BANDS IN CSF AND SERUM - ARUP","code_information":[{"code":"3018391601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83916","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.88,"discounted_cash":201.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OLIGOCLONAL BANDS CSF & SERUM - ARUP","code_information":[{"code":"3018391602","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83916","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.88,"discounted_cash":201.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OLIGOCLONAL BABDS IN CSF AND SERUM - ARUP","code_information":[{"code":"3018391603","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83916","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.53,"discounted_cash":182.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OLIGOCLONAL BANDS NUMBER CSF - OLIGOCLONAL BAND PROFILE - ARUP","code_information":[{"code":"3018391604","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83916","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.88,"discounted_cash":201.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY ORGANIC ACIDS QUANTITATIVE - ORGANIC ACIDS URINE","code_information":[{"code":"3018391801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83918","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.92,"discounted_cash":475.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ORGANIC ACIDS URINE QUANT - ARUP","code_information":[{"code":"3018391802","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83918","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.92,"discounted_cash":475.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY ORGANIC ACIDS QUANTITATIVE - GAMMA HYDROXYBUTYRATE BLOOD SCREEN","code_information":[{"code":"3018391803","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83918","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.92,"discounted_cash":475.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY SNGL ORGANIC ACID, QUANTITATIVE - METHYLMALONIC ACID, SERUM","code_information":[{"code":"3018392101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83921","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.33,"discounted_cash":156.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY SNGL ORGANIC ACID QUANTITATIVE - METHYLMALONIC ACID URINE","code_information":[{"code":"3018392102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83921","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.35,"discounted_cash":141.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC METHYLMALONIC ACID LEVEL SERUM - ARUP","code_information":[{"code":"3018392104","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83921","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.33,"discounted_cash":156.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OSMOLALITY SERUM/PLASMA","code_information":[{"code":"3018393001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83930","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.24,"discounted_cash":49.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OSMOLALITY SERUM - QWDL","code_information":[{"code":"3018393003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83930","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.52,"discounted_cash":44.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OSMOLALITY URINE","code_information":[{"code":"3018393501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83935","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.47,"discounted_cash":50.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF OSTEOCALCIN - OSTEOCALCIN","code_information":[{"code":"3018393701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83937","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.23,"discounted_cash":199.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OSTEOCALCIN - ARUP","code_information":[{"code":"3018393702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83937","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.23,"discounted_cash":199.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF OXALATE - OXALATE 24HR URINE","code_information":[{"code":"3018394501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83945","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.83,"discounted_cash":96.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OXALATE SUPERSATURATION PROFILE, URINE - ARUP","code_information":[{"code":"3018394502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83945","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.83,"discounted_cash":96.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OXALATE CALCULI RISK ASSESSMENT, 24HR URINE - ARUP","code_information":[{"code":"3018394503","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83945","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.83,"discounted_cash":96.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OXALATE URINE 24 HOUR - ARUP","code_information":[{"code":"3018394505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83945","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.83,"discounted_cash":96.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OXALIC ACID - KIDNEY STONE RISK PANEL URINE - ARUP","code_information":[{"code":"3018394506","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83945","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.83,"discounted_cash":96.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DES GAMMA CARBOXY PROTHROMBIN","code_information":[{"code":"3018395101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83951","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.44,"discounted_cash":225.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DCP PROTHROMBIN - HEPATOCELLULAR CARCINOMA TUMOR MARKER PANEL - ARUP","code_information":[{"code":"3018395102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83951","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.44,"discounted_cash":225.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PTH INTACT","code_information":[{"code":"3018397001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83970","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.28,"discounted_cash":305.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PTH INTRAOPERATIVE","code_information":[{"code":"3018397002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83970","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.28,"discounted_cash":305.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PTH INTACT - PTH INTACT WITH CALCIUM - ARUP","code_information":[{"code":"3018397005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83970","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.28,"discounted_cash":305.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PH BODY FLUID","code_information":[{"code":"3018398601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.37,"discounted_cash":23.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PH BODY FLUID NOS - PH STOOL","code_information":[{"code":"3018398603","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.37,"discounted_cash":23.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PH - CALCULI RISK ASSESSMENT, 24HR URINE - ARUP","code_information":[{"code":"3018398608","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.37,"discounted_cash":23.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY FOR PHENCYCLIDINE - PHENCYCLIDINE LEVEL","code_information":[{"code":"3018399202","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83992","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHENCYCLIDINE CONFIRMATION SERUM","code_information":[{"code":"3018399204","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83992","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHENCYCLIDINE PCP DEFINITIVE - DRUG DETECT PNL MECONIUM QUAL - ARUP","code_information":[{"code":"3018399208","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83992","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHENCYCLIDINE PCP DEFINITIVE - DRUG DETECT PNL CORDTISS QUAL-ARUP","code_information":[{"code":"3018399209","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83992","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CALPROTECTIN FECAL - ARUP","code_information":[{"code":"3018399301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83993","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.25,"discounted_cash":145.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CALPROTECTIN","code_information":[{"code":"3018399302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83993","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.33,"discounted_cash":131.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CALPROTECTIN FECAL","code_information":[{"code":"3018399303","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83993","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.25,"discounted_cash":145.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF BLOOD PKU - PHENYLALANINE","code_information":[{"code":"3018403001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84030","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.25,"discounted_cash":19.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY PHOSPHATASE ACID PROSTATIC - PROSTATIC ACID PHOSPHATASE","code_information":[{"code":"3018406601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84066","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.55,"discounted_cash":64.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROSTATIC ACID PHOSPHATASE - ARUP","code_information":[{"code":"3018406602","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84066","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.55,"discounted_cash":64.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALKALINE PHOSPHATASE LEVEL","code_information":[{"code":"3018407501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALKALINE PHOSPHATASE - ARUP","code_information":[{"code":"3018407503","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.5,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALKALINE PHOSPHATASE ISOENZYMES ARUP","code_information":[{"code":"3018408001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84080","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.56,"discounted_cash":109.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY ALKAL PHOSPHATASE,ISOENZYMES - ALKALINE PHOSPHATASE,ISOENZYMES BONE","code_information":[{"code":"3018408002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84080","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.56,"discounted_cash":109.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALKALINE PHOSPHOTASE BONE SPECIFIC - ARUP","code_information":[{"code":"3018408003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84080","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.06,"discounted_cash":99.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHOSPHOHEXOSE ISOMERASE","code_information":[{"code":"3018408701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84087","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.23,"discounted_cash":71.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHOSPHORUS","code_information":[{"code":"3018410004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84100","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.46,"discounted_cash":34.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF URINE PHOSPHORUS - PHOSPHORUS RANDOM URINE","code_information":[{"code":"3018410501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.96,"discounted_cash":38.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHOSPHORUS URINE CALCULI RISK ASSESSMENT - ARUP","code_information":[{"code":"3018410504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.96,"discounted_cash":38.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHOSPHORUS URINE 24 HOUR","code_information":[{"code":"3018410505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.96,"discounted_cash":38.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PORPHOBILINOGEN URINE","code_information":[{"code":"3018411001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84110","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.76,"discounted_cash":56.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY PORPHOBILINOGEN TIMED URINE","code_information":[{"code":"3018411002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84110","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.76,"discounted_cash":56.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PORPHOBILINOGEN URINE - ARUP","code_information":[{"code":"3018411003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84110","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.76,"discounted_cash":56.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CERVICOVAGINAL FLUID EXAM - AFP QUAL","code_information":[{"code":"3018411201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84112","type":"HCPCS"}],"standard_charges":[{"gross_charge":725.05,"discounted_cash":725.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FRACTIONATED PORPHYRINS URINE","code_information":[{"code":"3018412001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84120","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.94,"discounted_cash":97.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY FRACTIONATED PORPHYRINS TIMED URINE","code_information":[{"code":"3018412002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84120","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.94,"discounted_cash":97.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FRACTIONATED PORPHYRINS URINE - ARUP","code_information":[{"code":"3018412003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84120","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.94,"discounted_cash":97.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FRACTIONATED PORPHYRINS FECAL","code_information":[{"code":"3018412601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84126","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.89,"discounted_cash":136.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC POTASSIUM LEVEL","code_information":[{"code":"3018413201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84132","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.7,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF URINE POTASSIUM - POTASSIUM DIALYSATE","code_information":[{"code":"3018413302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.46,"discounted_cash":34.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC POTASSIUM RANDOM URINE","code_information":[{"code":"3018413303","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.46,"discounted_cash":34.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC POTASSIUM TIMED URINE","code_information":[{"code":"3018413304","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.16,"discounted_cash":31.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC POTASSIUM URINE 24 HOUR","code_information":[{"code":"3018413307","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.46,"discounted_cash":34.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC POTASSIUM - CALCULI RISK ASSESSMENT, 24HR URINE - ARUP","code_information":[{"code":"3018413309","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.46,"discounted_cash":34.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PREALBUMIN","code_information":[{"code":"3018413401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84134","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.32,"discounted_cash":108.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PREALBUMIN - ARUP","code_information":[{"code":"3018413402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84134","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.32,"discounted_cash":108.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF PREGNENOLONE - PREGNENOLONE","code_information":[{"code":"3018414001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84140","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.64,"discounted_cash":152.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PREGNENOLONE LEVEL - ARUP","code_information":[{"code":"3018414003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84140","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.64,"discounted_cash":152.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF 17-HYDROXYPREGNENOLONE - 17-HYDROXYPREGNENOLONE","code_information":[{"code":"3018414301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84143","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.48,"discounted_cash":152.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC 17-HYDROXYPREGNENOLONE - ARUP","code_information":[{"code":"3018414303","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84143","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.48,"discounted_cash":152.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF PROGESTERONE - PROGESTERONE","code_information":[{"code":"3018414401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84144","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.88,"discounted_cash":153.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROGESTERONE LEVEL","code_information":[{"code":"3018414402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84144","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.88,"discounted_cash":153.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROCALCITONIN LEVEL","code_information":[{"code":"3018414501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84145","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.42,"discounted_cash":181.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROCALCITONIN LEVEL - ARUP","code_information":[{"code":"3018414502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84145","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.42,"discounted_cash":181.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROLACTIN","code_information":[{"code":"3018414601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84146","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.8,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROLACTIN - ARUP","code_information":[{"code":"3018414602","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84146","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.8,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROLACTIN - QWDL","code_information":[{"code":"3018414603","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84146","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.8,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MACROPROLACTIN - ARUP","code_information":[{"code":"3018414604","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84146","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.8,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF PROSTAGLANDIN - PROSTAGLANDIN E2, PLASMA","code_information":[{"code":"3018415001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84150","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.2,"discounted_cash":146.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROSTATE SPECIFIC ANTIGEN (PSA) TOTAL","code_information":[{"code":"3018415301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROSTATE SPECIFIC ANTIGEN,TOTAL - PSA TOTAL AND FREE","code_information":[{"code":"3018415302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROSTATE SPECIFIC ANTIGEN,TOTAL - PSA, ULTRASENSITIVE","code_information":[{"code":"3018415303","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PSA SCREEN","code_information":[{"code":"3018415304","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.8,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY PROSTATE SPECIFIC ANTIGEN,TOTAL - PSA ULTRA SENSITIVE","code_information":[{"code":"3018415305","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PSA TOTAL - ARUP","code_information":[{"code":"3018415306","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PSA TOTAL DIAGNOSTIC","code_information":[{"code":"3018415308","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PSA TOTAL SCREENING","code_information":[{"code":"3018415310","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PSA ULTRASENSITIVE - ARUP","code_information":[{"code":"3018415311","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PSA FREE","code_information":[{"code":"3018415401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84154","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PSA FREE  - ARUP","code_information":[{"code":"3018415402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84154","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROSTATE SPECIFIC ANTIGEN, FREE - PSA TOTAL AND FREE","code_information":[{"code":"3018415403","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84154","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":130.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN TOTAL","code_information":[{"code":"3018415501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.09,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN TOTAL - MONOCLONAL PROTEIN STUDY SERUM - ARUP","code_information":[{"code":"3018415503","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.09,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN TOTAL - MONOCLONAL PROTEIN STUDY EXTENDED SERUM - ARUP","code_information":[{"code":"3018415504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.09,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN TOTAL - PROTEIN ELECTROPHORESIS REFLEX IFE/IG - ARUP","code_information":[{"code":"3018415505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.09,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN TOTAL - PROTEIN ELECTROPHORESIS, SERUM - ARUP","code_information":[{"code":"3018415506","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.09,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN TOTAL - PROTEIN ELECTROPHORESIS REFLEX IFE - ARUP","code_information":[{"code":"3018415507","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.09,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN RANDOM URINE","code_information":[{"code":"3018415601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.09,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN TOT XCPT REFRACTOMETRY URINE - PROTEIN TIMED URINE","code_information":[{"code":"3018415602","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.49,"discounted_cash":24.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN RANDOM URINE - QWDL","code_information":[{"code":"3018415603","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.09,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN TOT XCPT REFRACTOMETRY URINE - BENCE JONES PROTOCOL","code_information":[{"code":"3018415605","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.09,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN TOTAL URINE IMMUNOFIXATION WITH FLC - ARUP","code_information":[{"code":"3018415606","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.09,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN URINE 24 HOUR","code_information":[{"code":"3018415609","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.09,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN LEVEL - PROTEIN/CREATININE RATIO URINE","code_information":[{"code":"3018415610","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.49,"discounted_cash":24.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN TOTAL - IMMUNOFIXATION WITH FREE LIGHT CHAINS URINE - ARUP","code_information":[{"code":"3018415611","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.09,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN TOTAL - IMMUNOFIXATION URINE - ARUP","code_information":[{"code":"3018415613","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.09,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOTAL PROTEIN - MONOCLONAL PROTEIN STUDY, URINE - ARUP","code_information":[{"code":"3018415614","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.09,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN TOT XCPT REFRACTOMETRY OTH SRC - PROTEIN CSF","code_information":[{"code":"3018415701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.71,"discounted_cash":26.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN TOTAL BODY FLUID","code_information":[{"code":"3018415702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.54,"discounted_cash":29.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOTAL PROTEIN CSF","code_information":[{"code":"3018415704","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.54,"discounted_cash":29.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOTAL PROTEIN - PROTEIN ELECTROPHORESIS CSF - ARUP","code_information":[{"code":"3018415705","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.54,"discounted_cash":29.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN ELECTROPHORESIS SERUM","code_information":[{"code":"3018416501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.78,"discounted_cash":78.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN ELECTROPHORESIS -MONOCLONAL PROTEIN STUDY SERUM - ARUP","code_information":[{"code":"3018416502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.78,"discounted_cash":78.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN ELECTROPHORESIS - MONOCLONAL PROTEIN STUDY EXTENDED SERUM - ARUP","code_information":[{"code":"3018416504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.78,"discounted_cash":78.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN ELECTROPHORESIS REFLEX IFE/IG - ARUP","code_information":[{"code":"3018416505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.78,"discounted_cash":78.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN ELECTROPHORESIS, SERUM - ARUP","code_information":[{"code":"3018416506","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.78,"discounted_cash":78.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN E-PHORESIS/URINE/CSF - PROTEIN ELECTROPHORESIS URINE","code_information":[{"code":"3018416601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.09,"discounted_cash":119.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PE CSF - PROTEIN ELECTROPHORESIS CSF - ARUP","code_information":[{"code":"3018416602","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.09,"discounted_cash":119.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN ELECTROPHORESIS, URINE, 24 HOUR","code_information":[{"code":"3018416603","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.71,"discounted_cash":131.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN ELECTROPHORESIS, URINE RANDOM","code_information":[{"code":"3018416604","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.09,"discounted_cash":119.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN ELECTROPHORESIS - MONOCLONAL PROTEIN STUDY, URINE - ARUP","code_information":[{"code":"3018416605","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.71,"discounted_cash":131.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY PROTEIN, WESTERN BLOT TEST - MISCELLANEOUS","code_information":[{"code":"3018418103","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84181","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.53,"discounted_cash":113.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN, WESTERN BLOT TEST, W BAND ID - HEAT SHOCK PROTEIN 70, IGG","code_information":[{"code":"3018418202","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.43,"discounted_cash":215.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN, WESTERN BLOT TEST, W BAND ID","code_information":[{"code":"3018418203","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.43,"discounted_cash":215.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN  WESTERN BLOT TEST  W BAND ID AMPHIPHYSIN AB IGG","code_information":[{"code":"3018418208","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.43,"discounted_cash":215.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY PROTEIN, WESTERN BLOT TEST, W BAND ID - IMMUNOLOGICAL PROBE","code_information":[{"code":"3018418209","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.43,"discounted_cash":215.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN WESTERN BLOT AMPHIPHYSIN AB IGG","code_information":[{"code":"3018418210","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.43,"discounted_cash":215.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PRION PROTEIN RT QUIC - 14 3 3 PROTEIN CSF - ARUP","code_information":[{"code":"3018418211","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.43,"discounted_cash":215.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMPHIPHYSIN ANTIBODY IGG -ARUP","code_information":[{"code":"3018418213","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.43,"discounted_cash":215.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MDA5 (CADM 140) - DERMATOMYOSITIS POLYMYOSITIS PANEL","code_information":[{"code":"3018418218","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.43,"discounted_cash":215.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NXP2 (NUCLEAR MATRIC PROTEIN 2) - DERMATOMYOSITIS POLYMYOSITIS PANEL","code_information":[{"code":"3018418219","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.43,"discounted_cash":215.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SAE1 (SUMO ACTIVATING ENZYME) - DERMATOMYOSITIS POLYMYOSITIS PANEL","code_information":[{"code":"3018418220","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.43,"discounted_cash":215.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TIF1 GAMMA (155 KDA) - DERMATOMYOSITIS POLYMYOSITIS PANEL","code_information":[{"code":"3018418221","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.43,"discounted_cash":215.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIVER CYTOSOLIC TYPE 1 IGG - ARUP","code_information":[{"code":"3018418222","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.43,"discounted_cash":215.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HU IGG - NEURONAL NUCLEAR ANTIBODIES IGG IMMUNOBLOT BLOT - ARUP","code_information":[{"code":"3018418227","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.43,"discounted_cash":215.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RI IGG - NEURONAL NUCLEAR ANTIBODIES IGG IMMUNOBLOT BLOT - ARUP","code_information":[{"code":"3018418228","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.43,"discounted_cash":215.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TR/DNER IGG - NEURONAL NUCLEAR ANTIBODIES IGG IMMUNOBLOT BLOT - ARUP","code_information":[{"code":"3018418229","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.43,"discounted_cash":215.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC YO IGG - NEURONAL NUCLEAR ANTIBODIES IGG IMMUNOBLOT BLOT - ARUP","code_information":[{"code":"3018418230","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.43,"discounted_cash":215.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEURONAL ANTIBODY (AMPHIPHYSIN) -PARANEOPLASTIC REFLEX PANEL - ARUP","code_information":[{"code":"3018418231","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.43,"discounted_cash":215.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SOX1 IGG IMMUNOBLOT - PARANEOPLASTIC REFLEX PANEL - ARUP","code_information":[{"code":"3018418232","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.43,"discounted_cash":215.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HU IGG - CSF NEURONAL NUCLEAR ANTIBODIES IGG IB CSF - ARUP","code_information":[{"code":"3018418233","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.43,"discounted_cash":215.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RI IGG CSF - NEURONAL NUCLEAR ANTIBODIES IGG IB CSF - ARUP","code_information":[{"code":"3018418234","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.43,"discounted_cash":215.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TR/DNER IGG CSF - NEURONAL NUCLEAR ANTIBODIES IGG IB - ARUP","code_information":[{"code":"3018418235","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.43,"discounted_cash":215.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC YO IGG CSF - NEURONAL NUCLEAR ANTIBODIES IGG IB CSF - ARUP","code_information":[{"code":"3018418236","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.43,"discounted_cash":215.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SOX1 IGG IB CSF - AUTOIMMUNE NEUROLOGIC DISEASE REFLEX PANEL - ARUP","code_information":[{"code":"3018418237","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.43,"discounted_cash":215.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMPHIPHYSIN IGG CSF - AUTOIMMUNE NEUROLOGIC DISEASE REFLEX PANEL - ARUP","code_information":[{"code":"3018418238","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.43,"discounted_cash":215.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMPHIPHYSIN ANTIBODY-AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PANEL CSF - ARUP","code_information":[{"code":"3018418239","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.43,"discounted_cash":215.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SOX1 IGG IB - AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PANEL CSF","code_information":[{"code":"3018418240","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.43,"discounted_cash":215.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMPHIPHYSIN AB - AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PNL, SERUM - ARUP","code_information":[{"code":"3018418241","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.43,"discounted_cash":215.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SOX1 AB - AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PNL , SERUM - ARUP","code_information":[{"code":"3018418242","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.43,"discounted_cash":215.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MA2/TA AB - AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PNL, SERUM - ARUP","code_information":[{"code":"3018418243","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.43,"discounted_cash":215.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ZO PHENYLALANYL - TRNA SYNTHETASE-EXTENDED MYOSITIS PANEL-ARUP","code_information":[{"code":"3018418247","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.43,"discounted_cash":215.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC KS ASPARAGINYL - TRNA SYNTHETASE-EXTENDED MYOSITIS PANEL-ARUP","code_information":[{"code":"3018418248","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.43,"discounted_cash":215.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HA TYROSYL - TRNA SYNTHETASE-EXTENDED MYOSITIS PANEL-ARUP","code_information":[{"code":"3018418249","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.43,"discounted_cash":215.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY RBC PROTOPORPHYRIN - ZINC PROTOPORPHYRIN","code_information":[{"code":"3018420202","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84202","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.23,"discounted_cash":50.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ERYTHROCYTE PORPHYRIN FREE","code_information":[{"code":"3018420203","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84202","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.23,"discounted_cash":50.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RBC PHOTOPORPHYRIN INDUSTRIAL EXPOSURE - ARUP","code_information":[{"code":"3018420204","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84202","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.23,"discounted_cash":50.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ERYTHROCYTE PORPHYRIN FREE - ARUP","code_information":[{"code":"3018420205","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84202","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.23,"discounted_cash":50.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ZINC PROTOPORPHYRIN (ZPP), WHOLE BLOOD - ARUP","code_information":[{"code":"3018420206","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84202","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.23,"discounted_cash":50.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF PROINSULIN - PROINSULIN","code_information":[{"code":"3018420601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84206","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.08,"discounted_cash":178.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROINSULIN - ARUP","code_information":[{"code":"3018420602","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84206","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.08,"discounted_cash":178.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF VITAMIN B-6 - VITAMIN B6","code_information":[{"code":"3018420701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84207","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.04,"discounted_cash":208.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VITAMIN B6 - ARUP","code_information":[{"code":"3018420702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84207","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.04,"discounted_cash":208.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PYRUVATE LEVEL - ARUP","code_information":[{"code":"3018421003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84210","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.68,"discounted_cash":50.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF PYRUVATE KINASE - PYRUVATE KINASE","code_information":[{"code":"3018422001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84220","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.44,"discounted_cash":63.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PYRUVATE KINASE - ARUP","code_information":[{"code":"3018422002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84220","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.44,"discounted_cash":63.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY NON-ENDOCRINE RECEPTOR - SOLUBLE TRANSFERRIN","code_information":[{"code":"3018423804","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84238","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.75,"discounted_cash":243.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY, NON-ENDOCRINE RECEPTOR - OTHER","code_information":[{"code":"3018423805","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84238","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.75,"discounted_cash":243.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SOLUBLE TRANSFERRIN RECEPTOR - ARUP","code_information":[{"code":"3018423806","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84238","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.75,"discounted_cash":243.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RENIN DIRECT LEVEL  - ARUP","code_information":[{"code":"3018424401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84244","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.49,"discounted_cash":162.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RENIN LEVEL","code_information":[{"code":"3018424402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84244","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.49,"discounted_cash":162.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RENIN DIRECT LEVEL","code_information":[{"code":"3018424403","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84244","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.49,"discounted_cash":162.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RENIN ACTIVITY  - ARUP","code_information":[{"code":"3018424404","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84244","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.49,"discounted_cash":162.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RENIN ACTIVITY - ALDOSTERONE/RENIN ACTIVITY RATIO - ARUP","code_information":[{"code":"3018424405","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84244","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.49,"discounted_cash":162.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF VITAMIN B-2 - VITAMIN B2","code_information":[{"code":"3018425201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84252","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.67,"discounted_cash":134.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VITAMIN B2 - ARUP","code_information":[{"code":"3018425202","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84252","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.67,"discounted_cash":134.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF SELENIUM - SELENIUM SERUM","code_information":[{"code":"3018425501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84255","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.29,"discounted_cash":170.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SELENIUM SERUM - ARUP","code_information":[{"code":"3018425503","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84255","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.29,"discounted_cash":170.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF SEROTONIN - SEROTONIN SERUM","code_information":[{"code":"3018426001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84260","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.96,"discounted_cash":228.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF SEX HORMONE BINDING GLOBULIN - SEX HORMONE BINDING GLOBULIN","code_information":[{"code":"3018427001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.03,"discounted_cash":160.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SEX HORMONE BINDING GLOBULIN - TESTOSTERONE FREE AND TOTAL ADULT MALE","code_information":[{"code":"3018427003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.03,"discounted_cash":160.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SEX HORMONE BINDING GLOBULIN - TESTOSTERONE FREE & TOTAL MALE ADULT-ARUP","code_information":[{"code":"3018427004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.03,"discounted_cash":160.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SEX HORMONE BINDING GLOBULIN-TESTOSTERONE BIOAVAILABLE & SHBG ADULT MALE","code_information":[{"code":"3018427005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.03,"discounted_cash":160.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SEX HORMONE BINDING GLOBULIN","code_information":[{"code":"3018427008","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.03,"discounted_cash":160.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SEX HORMONE BINDING GLOBULIN - ARUP","code_information":[{"code":"3018427009","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.03,"discounted_cash":160.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SEX HORMONE BINDING GLOBULIN-TESTOSTERONE BIOAVAILABLE FEMALE/CHILD-ARUP","code_information":[{"code":"3018427010","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.03,"discounted_cash":160.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SEX HORMONE BINDING GLOBULIN-TESTOSTERONE FREE & TOTAL FEMALE/CHILD-ARUP","code_information":[{"code":"3018427011","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.03,"discounted_cash":160.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SODIUM LEVEL","code_information":[{"code":"3018429501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84295","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.7,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SODIUM LEVEL URINE RANDOM","code_information":[{"code":"3018430001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.93,"discounted_cash":36.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SODIUM TIMED URINE","code_information":[{"code":"3018430002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.93,"discounted_cash":36.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF URINE SODIUM - SODIUM 24 HOUR URINE","code_information":[{"code":"3018430003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.93,"discounted_cash":36.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF URINE SODIUM - ADDITIONAL CHARGE","code_information":[{"code":"3018430004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.39,"discounted_cash":33.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SODIUM URINE - ARUP","code_information":[{"code":"3018430006","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.93,"discounted_cash":36.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SODIUM - CALCULI RISK ASSESSMENT, 24HR URINE - ARUP","code_information":[{"code":"3018430007","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.93,"discounted_cash":36.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SODIUM BODY FLUID","code_information":[{"code":"3018430201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84302","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.28,"discounted_cash":32.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SODIUM RANDOM URINE","code_information":[{"code":"3018430202","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84302","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.28,"discounted_cash":32.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SODIUM BODY FLUID - ARUP","code_information":[{"code":"3018430204","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84302","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.28,"discounted_cash":32.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SODIUM STOOL - ARUP","code_information":[{"code":"3018430205","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84302","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.28,"discounted_cash":32.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF SOMATOMEDIN - INSULIN-LIKE GROWTH FACTOR","code_information":[{"code":"3018430501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84305","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.56,"discounted_cash":157.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSULIN LIKE GROWTH FACTOR (IGF) 1 - ARUP","code_information":[{"code":"3018430502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84305","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.56,"discounted_cash":157.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF SOMATOSTATIN - SOMATOSTATIN","code_information":[{"code":"3018430701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84307","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.43,"discounted_cash":122.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SOMATOSTATIN - ARUP","code_information":[{"code":"3018430702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84307","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.43,"discounted_cash":122.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SPECTROPHOTOMETRY - PORPHYRIN TOTAL","code_information":[{"code":"3018431101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.32,"discounted_cash":60.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SPECTROPHOTOMETRY ANALYTE","code_information":[{"code":"3018431102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.32,"discounted_cash":60.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SPECTROPHOTOMETRY - CHOLESTEROL TOTAL BODY FLUID","code_information":[{"code":"3018431103","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.32,"discounted_cash":60.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ADENOSINE DEAMINASE PLEURAL FLUID","code_information":[{"code":"3018431105","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.54,"discounted_cash":54.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHYMOTRYPSIN FECES","code_information":[{"code":"3018431106","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.54,"discounted_cash":54.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PORPHYRIN TOTAL - ARUP","code_information":[{"code":"3018431107","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.54,"discounted_cash":54.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHOLESTEROL LEVEL BODY FLUID - ARUP","code_information":[{"code":"3018431108","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.54,"discounted_cash":54.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHYMOTRYPSIN STOOL - ARUP","code_information":[{"code":"3018431109","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.32,"discounted_cash":60.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ADENOSINE DEAMINASE, PERICARDIAL FLUID - ARUP","code_information":[{"code":"3018431112","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.32,"discounted_cash":60.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BODY FLUID SPECIFIC GRAVITY - SPECIFIC GRAVITY BODY FLUID","code_information":[{"code":"3018431501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84315","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.26,"discounted_cash":22.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REDUCING SUBSTANCES STOOL","code_information":[{"code":"3018437601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84376","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":22.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REDUCING SUBSTANCES STOOL - ARUP","code_information":[{"code":"3018437602","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84376","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":22.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY SUGARS SINGLE QUANTITATIVE, EACH SPECIMEN","code_information":[{"code":"3018437801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84378","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.8,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REDUCING SUBSTANCES SINGLE QUANT","code_information":[{"code":"3018437802","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84378","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.8,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC 15 ANHYDROGLUCITOL LEVEL","code_information":[{"code":"3018437803","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84378","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.8,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC 1,5 ANHYDROGLUCITOL QUANT","code_information":[{"code":"3018437804","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84378","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.8,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF URINE SULFATE - SULFATE, URINE","code_information":[{"code":"3018439201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84392","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.73,"discounted_cash":36.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF TESTOSTERONE - TESTOSTERONE TOTAL FREE","code_information":[{"code":"3018440201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.34,"discounted_cash":188.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF TOTAL TESTOSTERONE - TESTOSTERONE","code_information":[{"code":"3018440301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.81,"discounted_cash":190.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TESTOSTERONE LEVEL TOTAL - TESTOSTERONE FREE AND TOTAL MALE ADULT","code_information":[{"code":"3018440302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.81,"discounted_cash":190.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF TOTAL TESTOSTERONE - TESTOSTERONE FEMALE OR CHILD","code_information":[{"code":"3018440303","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.81,"discounted_cash":190.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TESTOSTERONE LEVEL TOTAL- TESTOSTERONE FREE & TOTAL MALE ADULT - ARUP","code_information":[{"code":"3018440304","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.81,"discounted_cash":190.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TESTOSTERONE TOTAL LEVEL- TESTOSTERONE, BIOAVAILABLE & SHBG ADULT MALE","code_information":[{"code":"3018440305","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.81,"discounted_cash":190.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TESTOSTERONE TOTAL LEVEL","code_information":[{"code":"3018440306","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.81,"discounted_cash":190.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TESTOSTERONE LEVEL ADULT MALE - ARUP","code_information":[{"code":"3018440309","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.52,"discounted_cash":172.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TESTOSTERONE LEVEL TOTAL- TESTOSTERONE BIOAVAILABLE FEMALE/CHILD - ARUP","code_information":[{"code":"3018440310","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.81,"discounted_cash":190.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TESTOSTERONE LEVEL TOTAL - TESTOSTERONE FREE & TOTAL FEMALE/CHILD - ARUP","code_information":[{"code":"3018440311","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.81,"discounted_cash":190.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TESTOSTERONE LEVEL TOTAL FEMALE/CHILD - ARUP","code_information":[{"code":"3018440312","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.81,"discounted_cash":190.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TESTOSTERONE BIOAVAILABLE","code_information":[{"code":"3018441001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84410","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.8,"discounted_cash":342.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF VITAMIN B-1 - VITAMIN B1","code_information":[{"code":"3018442501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84425","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.35,"discounted_cash":141.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF VITAMIN B-1 - VITAMIN B1, WHOLE BLOOD","code_information":[{"code":"3018442502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84425","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.33,"discounted_cash":156.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VITAMIN B1 - ARUP","code_information":[{"code":"3018442504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84425","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.33,"discounted_cash":156.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VITAMIN B1 WHOLE BLOOD - ARUP","code_information":[{"code":"3018442505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84425","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.33,"discounted_cash":156.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF THYROGLOBULIN - THYROGLOBULIN","code_information":[{"code":"3018443201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.85,"discounted_cash":106.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROGLOBULIN BY CIA","code_information":[{"code":"3018443203","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.85,"discounted_cash":106.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROGLOBULIN CIA - ARUP","code_information":[{"code":"3018443204","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.85,"discounted_cash":106.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROGLOBULIN LC - ARUP","code_information":[{"code":"3018443205","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.85,"discounted_cash":106.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROGLOBULIN LC-MS/MS, SERUM/PLASMA - ARUP","code_information":[{"code":"3018443206","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.85,"discounted_cash":106.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY THIOPURIN S-MTHYLTRNSFRS (TPMT)","code_information":[{"code":"3018443301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84433","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.72,"discounted_cash":163.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THIOPURIN S-METHYLTRANSFERASE (TPMT) RBC - ARUP","code_information":[{"code":"3018443302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84433","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.72,"discounted_cash":163.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROXINE T4 TOTAL","code_information":[{"code":"3018443601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.47,"discounted_cash":50.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF TOTAL THYROXINE - T4 (THYROID HORMONE) RIA","code_information":[{"code":"3018443602","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.63,"discounted_cash":45.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC T4 THYROID PANEL WITH FTI - ARUP","code_information":[{"code":"3018443603","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.47,"discounted_cash":50.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROID T4 - ARUP","code_information":[{"code":"3018443604","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.47,"discounted_cash":50.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC T4 FREE - THYROXINE FREE","code_information":[{"code":"3018443901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.47,"discounted_cash":66.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC T4 FREE BY DIALYSIS - ARUP","code_information":[{"code":"3018443902","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.47,"discounted_cash":66.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC T4 FREE","code_information":[{"code":"3018443904","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.1,"discounted_cash":60.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF THYROXINE BNDNG GLOBULIN - THYROXINE BINDING GLOBULIN","code_information":[{"code":"3018444201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84442","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.73,"discounted_cash":51.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROXINE BINDNG GLOBULIN - ARUP","code_information":[{"code":"3018444202","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84442","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.73,"discounted_cash":51.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROID STIMULATING HORMONE","code_information":[{"code":"3018444301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.33,"discounted_cash":124.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TSH LEVEL","code_information":[{"code":"3018444303","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.33,"discounted_cash":124.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TSH LEVEL - TSH CASCADE","code_information":[{"code":"3018444305","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.33,"discounted_cash":124.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TSH LEVEL - TSH REFLEX FREE T4","code_information":[{"code":"3018444306","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.41,"discounted_cash":112.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TSH LEVEL - ARUP","code_information":[{"code":"3018444310","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.33,"discounted_cash":124.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TSH LEVEL 3RD GENERATION","code_information":[{"code":"3018444311","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.33,"discounted_cash":124.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF THYROID STIM IMMUNOGLOBULINS (TSI) - THYROID STIMULATING IM","code_information":[{"code":"3018444501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84445","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.45,"discounted_cash":375.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROID STIMULATING IMMUNOGLOBULINS (TSI) - ARUP","code_information":[{"code":"3018444502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84445","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.45,"discounted_cash":375.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF VITAMIN E - VITAMIN E (TOCOPHEROL)","code_information":[{"code":"3018444601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84446","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.64,"discounted_cash":104.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VITAMIN E (TOCOPHEROL) - ARUP","code_information":[{"code":"3018444602","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84446","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.64,"discounted_cash":104.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AST (SGOT) SERUM/PLASMA","code_information":[{"code":"3018445001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIVER FIBROSIS PANEL - AST","code_information":[{"code":"3018445004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NON ALCOHOLIC FATTY LIVER DISEASE PANEL - AST","code_information":[{"code":"3018445005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASPARTATE AMINOTRANSFERASE (AST)- LIVER FIBROSIS FIBROMETER NAFLD - ARUP","code_information":[{"code":"3018445006","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AST - LIVER FIBROSIS CHRONIC VIRAL HEPATITIS FIBROMETER PANEL - ARUP","code_information":[{"code":"3018445007","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALT (SPGT) SERUM/PLASMA","code_information":[{"code":"3018446001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.4,"discounted_cash":39.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIVER FIBROSIS PANEL - ALT","code_information":[{"code":"3018446004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.4,"discounted_cash":39.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NON ALCOHOLIC FATTY LIVER DISEASE PANEL - ALT","code_information":[{"code":"3018446005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.4,"discounted_cash":39.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALANINE AMINOTRANSFERASE (ALT) - LIVER FIBROSIS FIBROMETER NAFLD - ARUP","code_information":[{"code":"3018446006","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.4,"discounted_cash":39.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALT - LIVER FIBROSIS CHRONIC VIRAL HEPATITIS FIBROMETER PANEL - ARUP","code_information":[{"code":"3018446007","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.4,"discounted_cash":39.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRANSFERRIN LEVEL","code_information":[{"code":"3018446601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84466","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":94.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRIGLYCERIDES","code_information":[{"code":"3018447801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.85,"discounted_cash":41.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF TRIGLYCERIDES - TRIGLYCERIDES BODY FLUID","code_information":[{"code":"3018447802","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.84,"discounted_cash":37.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRIGLYCERIDES, BODY FLUID - ARUP","code_information":[{"code":"3018447804","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.85,"discounted_cash":41.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROID HORM UPTAKE/THYR HORM BINDING RATIO - T3 UPTAKE","code_information":[{"code":"3018447901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.01,"discounted_cash":48.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROID HORM UPTAKE/THYR HORM BINDING RATIO - T3 UPTAKE AND FTI","code_information":[{"code":"3018447902","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.01,"discounted_cash":48.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC T3 UPTAKE","code_information":[{"code":"3018447903","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.41,"discounted_cash":43.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC T3 UPTAKE - ARUP","code_information":[{"code":"3018447904","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.01,"discounted_cash":48.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC T3 UPTAKE - THYROID PANEL WITH FTI- ARUP","code_information":[{"code":"3018447905","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.01,"discounted_cash":48.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRIIODOTHYRONINE TOTAL ASSAY, TT-3 - T3 (THYROID HORMONE)","code_information":[{"code":"3018448001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84480","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.64,"discounted_cash":104.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC T3 FREE","code_information":[{"code":"3018448101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84481","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.56,"discounted_cash":125.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC T3, FREE - ARUP","code_information":[{"code":"3018448102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84481","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.56,"discounted_cash":125.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC T3 FREE - QWDL","code_information":[{"code":"3018448103","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84481","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.56,"discounted_cash":125.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRIIODOTHYRONINE T3 REVERSE - T3 REVERSE","code_information":[{"code":"3018448201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84482","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.95,"discounted_cash":116.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRIIODOTHYRONINE (T3) REVERSE - ARUP","code_information":[{"code":"3018448202","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84482","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.74,"discounted_cash":105.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TROPONIN T HIGH SENSITIVITY","code_information":[{"code":"3018448401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84484","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.33,"discounted_cash":92.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF TROPONIN, QUANT - TROPONIN I","code_information":[{"code":"3018448402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84484","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.33,"discounted_cash":92.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TROPONIN T QUANT HIGH SENSITIVITY","code_information":[{"code":"3018448404","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84484","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.33,"discounted_cash":92.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC POC TROPONIN I","code_information":[{"code":"3018448405","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84484","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.33,"discounted_cash":92.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD UREA NITROGEN - BUN","code_information":[{"code":"3018452001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.54,"discounted_cash":29.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY UREA NITROGEN, QUAN - POCT UREA (BUN)","code_information":[{"code":"3018452004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.71,"discounted_cash":26.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC UREA NITROGEN BODY FLUID","code_information":[{"code":"3018452005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.54,"discounted_cash":29.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BUN - LIVER FIBROSIS CHRONIC VIRAL HEPATITIS FIBROMETER PANEL - ARUP","code_information":[{"code":"3018452007","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.54,"discounted_cash":29.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC UREA NITROGEN URINE TIMED","code_information":[{"code":"3018454001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84540","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.73,"discounted_cash":36.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC UREA NITROGEN URINE RANDOM","code_information":[{"code":"3018454002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84540","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.73,"discounted_cash":36.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URIC ACID LEVEL","code_information":[{"code":"3018455001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84550","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.24,"discounted_cash":33.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URIC ACID LEVEL - ARUP","code_information":[{"code":"3018455002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84550","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.24,"discounted_cash":33.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF URIC ACID, BLOOD, OTHER SOURCE - URIC ACID BODY FLUID","code_information":[{"code":"3018456002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.39,"discounted_cash":33.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URIC ACID LEVEL URINE 24 HOUR","code_information":[{"code":"3018456003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.39,"discounted_cash":33.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URIC ACID LEVEL URINE 24 HOUR","code_information":[{"code":"3018456004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.39,"discounted_cash":33.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URIC ACID SUPERSATURATION PROFILE, URINE - ARUP","code_information":[{"code":"3018456005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.39,"discounted_cash":33.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URIC ACID URINE RANDOM","code_information":[{"code":"3018456007","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.39,"discounted_cash":33.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URIC ACID LEVEL BODY FLUID","code_information":[{"code":"3018456008","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.39,"discounted_cash":33.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URIC ACID - CALCULI RISK ASSESSMENT, 24HR URINE - ARUP","code_information":[{"code":"3018456010","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.39,"discounted_cash":33.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URIC ACID - KIDNEY STONE RISK PANEL URINE - ARUP","code_information":[{"code":"3018456011","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.39,"discounted_cash":33.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF URINE VMA - VMA TIMED URINE","code_information":[{"code":"3018458501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84585","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":62.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF URINE VMA - VMA, URINE","code_information":[{"code":"3018458502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84585","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.51,"discounted_cash":103.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VANILLYLMANDELIC ACID (VMA) URINE - ARUP","code_information":[{"code":"3018458503","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84585","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":62.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF VIP - VASOACTIVE INTESTINAL PEPTIDE (VIP)","code_information":[{"code":"3018458601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84586","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.96,"discounted_cash":235.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VASOACTIVE INTESTINAL PEPTIDE (VIP) - ARUP","code_information":[{"code":"3018458602","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84586","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.96,"discounted_cash":235.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF VASOPRESSIN - ARGININE VASOPRESSIN HORMONE","code_information":[{"code":"3018458801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84588","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.05,"discounted_cash":227.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARGININE VASOPRESSIN HORMONE - ARUP","code_information":[{"code":"3018458802","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84588","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.05,"discounted_cash":227.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF VITAMIN A - VITAMIN A","code_information":[{"code":"3018459001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84590","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.17,"discounted_cash":86.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VITAMIN A - ARUP","code_information":[{"code":"3018459002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84590","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.17,"discounted_cash":86.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF NOS VITAMIN - NIACIN (VITAMIN B3)","code_information":[{"code":"3018459101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84591","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.53,"discounted_cash":113.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF NOS VITAMIN - PANTOTHENIC ACID (VITAMIN B5)","code_information":[{"code":"3018459102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84591","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.53,"discounted_cash":113.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF NOS VITAMIN - BIOTIN (VITAMIN B7)","code_information":[{"code":"3018459103","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84591","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.53,"discounted_cash":113.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NIACIN (VITAMIN B3) - ARUP","code_information":[{"code":"3018459105","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84591","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.53,"discounted_cash":113.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VITAMIN B5 (PANTOTHENIC ACID) LEVEL - ARUP","code_information":[{"code":"3018459106","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84591","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.53,"discounted_cash":113.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VITAMIN B7 (BIOTIN) LEVEL - ARUP","code_information":[{"code":"3018459107","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84591","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.53,"discounted_cash":113.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF VITAMIN K - VITAMIN K","code_information":[{"code":"3018459701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84597","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":100.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VITAMIN K - ARUP","code_information":[{"code":"3018459702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84597","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":100.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF VOLATILES - VOLATILE COMPOUNDS","code_information":[{"code":"3018460001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84600","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.64,"discounted_cash":114.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROPYLENE GLYCOL - ARUP","code_information":[{"code":"3018460004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84600","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.64,"discounted_cash":114.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ZINC - ZINC","code_information":[{"code":"3018463001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.7,"discounted_cash":83.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ZINC - ZINC, WHOLE BLOOD","code_information":[{"code":"3018463002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.7,"discounted_cash":83.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF ZINC - ZINC RBC","code_information":[{"code":"3018463003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.7,"discounted_cash":83.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ZINC LEVEL RBC - ARUP","code_information":[{"code":"3018463005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.7,"discounted_cash":83.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ZINC WHOLE BLOOD - ARUP","code_information":[{"code":"3018463006","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.7,"discounted_cash":83.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY OF C-PEPTIDE - C-PEPTIDE","code_information":[{"code":"3018468101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84681","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.88,"discounted_cash":153.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C PEPTIDE LEVEL - QWDL","code_information":[{"code":"3018468103","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84681","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.88,"discounted_cash":153.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHORIONIC GONADOTROPIN, QUANT - HCG QUANTITATIVE BLOOD","code_information":[{"code":"3018470201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BETA HCG TUMOR MARKER CSF","code_information":[{"code":"3018470202","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHORIONIC GONADOTROPIN, QUANT - HCG TUMOR MARKER","code_information":[{"code":"3018470204","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HCG QUANT TUMOR MARKER CSF - ARUP","code_information":[{"code":"3018470206","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HCG QUANTITATIVE TUMOR MARKER BLOOD","code_information":[{"code":"3018470207","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MATERNAL QUAD SCREEN - HCG QUANTITATIVE","code_information":[{"code":"3018470208","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY CHORIONIC GONADOTROPIN, QUANT - HCG QUANTITATIVE BLOOD POC","code_information":[{"code":"3018470209","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HCG QUANTITATIVE TUMOR MARKER BLOOD - ARUP","code_information":[{"code":"3018470210","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HCG PREGNANCY URINE QUAL","code_information":[{"code":"3018470301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84703","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.4,"discounted_cash":55.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHORIONIC GONADOTROPIN, QUAL - HCG QUALITATIVE SERUM PLASMA","code_information":[{"code":"3018470302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84703","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.4,"discounted_cash":55.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PREGNANCY URINE POINT OF CARE","code_information":[{"code":"3018470303","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84703","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.4,"discounted_cash":55.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLINICAL CHEMISTRY TEST - OSMOLALITY STOOL","code_information":[{"code":"3018499901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84999","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.92,"discounted_cash":18.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLINICAL CHEMISTRY TEST - ADDITIONAL CHARGE","code_information":[{"code":"3018499903","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84999","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.92,"discounted_cash":18.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHEMISTRY NONSPECIFIED ANALYTE","code_information":[{"code":"3018499904","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84999","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.92,"discounted_cash":18.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC POTASSIUM STOOL ARUP","code_information":[{"code":"3018499908","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84999","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.92,"discounted_cash":18.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OSMOLALITY STOOL - ARUP","code_information":[{"code":"3018499909","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84999","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.92,"discounted_cash":18.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC POTASSIUM STOOL - ARUP","code_information":[{"code":"3018499910","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84999","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.92,"discounted_cash":18.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC POTASSIUM BODY FLUID - ARUP","code_information":[{"code":"3018499911","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84999","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.92,"discounted_cash":18.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNFIX E-PHORSIS URINE - IMMUNOFIXATION WITH FLC, URINE - ARUP","code_information":[{"code":"3018633502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.65,"discounted_cash":216.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNFIX EPHORESIS  BETA 2 TRANSFERRIN","code_information":[{"code":"3018633504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.65,"discounted_cash":216.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ZINC TRANSPORTERS 8 AB","code_information":[{"code":"3018634102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.72,"discounted_cash":249.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ZINC TRANSPROTER 8 ANTIBODY - ARUP","code_information":[{"code":"3018634103","type":"CDM"},{"code":"0301","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.72,"discounted_cash":249.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TISSUE TRANSGLUTAMINASE ANTIBODY, IGG","code_information":[{"code":"3018636401","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.24,"discounted_cash":21.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TISSUE TRANSGLUTAMINASE ANTIBODY, IGA","code_information":[{"code":"3018636402","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.24,"discounted_cash":21.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TISSUE TRANSGLUTAMINASE IGA - CELIAC CASCADE SCREEN","code_information":[{"code":"3018636403","type":"CDM"},{"code":"0301","type":"RC"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.24,"discounted_cash":21.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TISSUE TRANSGLUTAMINASE IGA WITH REFLEX TITER - ARUP","code_information":[{"code":"3018636406","type":"CDM"},{"code":"0301","type":"RC"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.24,"discounted_cash":21.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TISSUE TRANSGLUTAMINASE IGG","code_information":[{"code":"3018636407","type":"CDM"},{"code":"0301","type":"RC"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.24,"discounted_cash":21.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TISSUE TRANSGLUTAMINASE IGG - ARUP","code_information":[{"code":"3018636408","type":"CDM"},{"code":"0301","type":"RC"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.24,"discounted_cash":21.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TISSUE TRANSGLUTAMINASE IGA","code_information":[{"code":"3018636409","type":"CDM"},{"code":"0301","type":"RC"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.94,"discounted_cash":84.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TISSUE TRANSGLUTAMINASE IGA - ARUP","code_information":[{"code":"3018636410","type":"CDM"},{"code":"0301","type":"RC"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.24,"discounted_cash":21.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RHEUMATOID FACTOR - RHEUMATOID ARTHRITIS PANEL - ARUP","code_information":[{"code":"3018643102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.85,"discounted_cash":41.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VARICELLA ZOSTER IGG","code_information":[{"code":"3018678705","type":"CDM"},{"code":"0301","type":"RC"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":94.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MACROSCOPIC EXAM ARTHROPOD","code_information":[{"code":"3018716801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"87168","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.94,"discounted_cash":28.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BILIRUBIN TOTAL TRANSCUTANEOUS","code_information":[{"code":"3018872001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"88720","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.74,"discounted_cash":245.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BIOFIRE RESP PNL 22 TARGETS INCLUDING SARSCOV2","code_information":[{"code":"3020202U01","type":"CDM"},{"code":"0302","type":"RC"},{"code":"0202U","type":"HCPCS"}],"standard_charges":[{"gross_charge":1458.73,"discounted_cash":1458.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RESP PNL 21 TARGETS INCLUDING SARSCOV2","code_information":[{"code":"3020225U01","type":"CDM"},{"code":"0302","type":"RC"},{"code":"0225U","type":"HCPCS"}],"standard_charges":[{"gross_charge":1458.73,"discounted_cash":1458.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FIBRILLARIN (U3 RNP) IGG - SYSTEMIC SCLEROSIS PANEL - ARUP","code_information":[{"code":"3028351604","type":"CDM"},{"code":"0302","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TITIN AB - ACHR, TITIN, STM AB REFLEX PANEL - ARUP","code_information":[{"code":"3028351605","type":"CDM"},{"code":"0302","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTHROMBIN IGG - NON-CRITERIA APS - ARUP","code_information":[{"code":"3028351606","type":"CDM"},{"code":"0302","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FRANCISELLA TULARENIS ANTIBODY - ARUP","code_information":[{"code":"3028600002","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86000","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.75,"discounted_cash":46.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, BAKER'S YEAST IGG","code_information":[{"code":"3028600104","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.31,"discounted_cash":52.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, BARLEY IGG","code_information":[{"code":"3028600105","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.31,"discounted_cash":52.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, BEEF IGG","code_information":[{"code":"3028600106","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.31,"discounted_cash":52.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, CHICKEN IGG","code_information":[{"code":"3028600107","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.31,"discounted_cash":52.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, CHOCOLATE IGG","code_information":[{"code":"3028600108","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.31,"discounted_cash":52.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, CORN IGG","code_information":[{"code":"3028600110","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.31,"discounted_cash":52.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, EGG WHITE IGG","code_information":[{"code":"3028600111","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.31,"discounted_cash":52.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, LETTUCE IGG","code_information":[{"code":"3028600114","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.31,"discounted_cash":52.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, MALT IGG","code_information":[{"code":"3028600115","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.31,"discounted_cash":52.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, MILK (COW'S) IGG","code_information":[{"code":"3028600116","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.31,"discounted_cash":52.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, OAT IGG","code_information":[{"code":"3028600118","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.31,"discounted_cash":52.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, ORANGE IGG","code_information":[{"code":"3028600121","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.31,"discounted_cash":52.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, PEANUT IGG","code_information":[{"code":"3028600122","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.31,"discounted_cash":52.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, PORK IGG","code_information":[{"code":"3028600123","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.31,"discounted_cash":52.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, RYE IGG","code_information":[{"code":"3028600126","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.31,"discounted_cash":52.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, SOYBEAN IGG","code_information":[{"code":"3028600127","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.31,"discounted_cash":52.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH","code_information":[{"code":"3028600138","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.31,"discounted_cash":52.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - TOMATO","code_information":[{"code":"3028600139","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.31,"discounted_cash":52.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - WHEAT","code_information":[{"code":"3028600140","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.31,"discounted_cash":52.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - WHITE POTATO","code_information":[{"code":"3028600141","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.31,"discounted_cash":52.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - AUREOBASIDIUM PULLULANS","code_information":[{"code":"3028600143","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.31,"discounted_cash":52.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - FUSARIUM MONILIFORME","code_information":[{"code":"3028600145","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.31,"discounted_cash":52.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - PENICILLIUM NOTATUM","code_information":[{"code":"3028600146","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.31,"discounted_cash":52.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - PHOMA BETAE","code_information":[{"code":"3028600147","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.31,"discounted_cash":52.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CASEIN (COW'S MILK) IGG - ARUP","code_information":[{"code":"3028600149","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.31,"discounted_cash":52.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST FUSARIUM MONILIFORME IGG - ARUP","code_information":[{"code":"3028600154","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.31,"discounted_cash":52.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST ALMONDS IGE","code_information":[{"code":"3028600303","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST APPLE IGE","code_information":[{"code":"3028600305","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN APRICOT IGE","code_information":[{"code":"3028600306","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN ASH, WHITE IGE","code_information":[{"code":"3028600308","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST RABBIT EPITHELIUM IGE - ARUP","code_information":[{"code":"302860030D","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST COW MILK WITH REFLEX IGE","code_information":[{"code":"302860030G","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST DOG DANDER IGE - ARUP","code_information":[{"code":"302860030H","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CAT HAIR DANDER IGE - ARUP","code_information":[{"code":"302860030L","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CINNAMON IGE - ARUP","code_information":[{"code":"302860030O","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST MITES BLOMIA TROPICALIS IGE - ARUP","code_information":[{"code":"302860030R","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST DERMATOPHAGOIDES FARINAE (HOUSE DUST MITE) IGE - ARUP","code_information":[{"code":"302860030S","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST ASPERGILLUS NIGER IGE - ARUP","code_information":[{"code":"302860030W","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST ASPERGILLUS FUMAGATUS IGE","code_information":[{"code":"3028600310","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN ASPERGILLUS NIGER IGE","code_information":[{"code":"3028600311","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST BANANA IGE","code_information":[{"code":"3028600313","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN BARLEY IGE","code_information":[{"code":"3028600314","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN BEAN, GREEN IGE","code_information":[{"code":"3028600317","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST GERMAN COCKROACH IGE","code_information":[{"code":"302860031B","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN VENOM: EUROPEAN PAPER WASP","code_information":[{"code":"302860031G","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST MACADAMIA NUT IGE - ARUP","code_information":[{"code":"302860031M","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST WHITE BEAN IGE - ARUP","code_information":[{"code":"302860031N","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST BARLEY IGE- ARUP","code_information":[{"code":"302860031O","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST COFFEE IGE - ARUP","code_information":[{"code":"302860031R","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST LAMB IGE - ARUP","code_information":[{"code":"302860031T","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST FOOD RYE IGE - ARUP","code_information":[{"code":"302860031U","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST BEECH AMERICAN IGE","code_information":[{"code":"3028600320","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST BEEF IGE","code_information":[{"code":"3028600321","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST BERMUDA GRASS IGE","code_information":[{"code":"3028600323","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST BIRCH TREE IGE","code_information":[{"code":"3028600324","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST BIRCH TREE IGE - ARUP","code_information":[{"code":"3028600326","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN BLUEBERRY IGE","code_information":[{"code":"3028600327","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN BRAZIL NUT IGE","code_information":[{"code":"3028600329","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST BERMUDA GRASS IGE - ARUP","code_information":[{"code":"302860032B","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST OYSTER IGE - ARUP","code_information":[{"code":"302860032C","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST ASH, WHITE IGE - ARUP","code_information":[{"code":"302860032D","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CEDAR, MOUNTAIN IGE","code_information":[{"code":"302860032F","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST OAK, WHITE IGE - ARUP","code_information":[{"code":"302860032G","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST SYCAMORE, AMERICAN IGE - ARUP","code_information":[{"code":"302860032H","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST WILLOW, BLACK IGE - ARUP","code_information":[{"code":"302860032I","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST FESCUE, MEADOW IGE","code_information":[{"code":"302860032J","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN FOOD: RJUG R 1 WALNUT","code_information":[{"code":"302860032L","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST FUSARIUM MONILIFORME IGE - ARUP","code_information":[{"code":"302860032N","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CEDAR, RED IGE - ARUP","code_information":[{"code":"302860032Q","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST ELM TREE IGE - ARUP","code_information":[{"code":"302860032R","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST COCKLEBUR IGE - ARUP","code_information":[{"code":"302860032S","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST MUGWORT IGE - ARUP","code_information":[{"code":"302860032U","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST EUROPEAN PAPER WASP IGE - ARUP","code_information":[{"code":"302860032W","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST THISTLE, RUSSIAN IGE - ARUP","code_information":[{"code":"302860032X","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST COW HAIR/DANDER IGE - ARUP","code_information":[{"code":"302860032Y","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN BROCCOLI IGE","code_information":[{"code":"3028600330","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN BUCKWHEAT IGE","code_information":[{"code":"3028600333","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN CABBAGE IGE","code_information":[{"code":"3028600335","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CANDIDA ALBICANS IGE - ARUP","code_information":[{"code":"3028600336","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CANDIDA ALBICANS IGE","code_information":[{"code":"3028600337","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN CANTALOUPE IGE","code_information":[{"code":"3028600338","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CHICKEN FEATHERS IGE - ARUP","code_information":[{"code":"3028600339","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST GOOSE FEATHERS IGE - ARUP","code_information":[{"code":"302860033A","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST COCKROACH, AMERICAN IGE - ARUP","code_information":[{"code":"302860033B","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST FIRE ANT (INVICTA) IGE - ARUP","code_information":[{"code":"302860033C","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST HONEYBEE IGE - ARUP","code_information":[{"code":"302860033D","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST MOUSE EPIPHELIUM IGE","code_information":[{"code":"302860033H","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST MOSQUITO IGE - ARUP","code_information":[{"code":"302860033I","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST MARSHELDER, ROUGH IGE - ARUP","code_information":[{"code":"302860033J","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CYPRESS,BALD (WHITE) IGE - ARUP","code_information":[{"code":"302860033K","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST HORNET, WHITE FACE IGE - ARUP","code_information":[{"code":"302860033M","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST BRAZIL NUT IGE - ARUP","code_information":[{"code":"302860033N","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST MAPLE TREE BOX ELDER IGE - ARUP","code_information":[{"code":"302860033O","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST PINEAPPLE IGE - ARUP","code_information":[{"code":"302860033T","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST LATEX IGE - ARUP","code_information":[{"code":"302860033V","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST ALTERNARIA ALTERNATA IGE - ARUP","code_information":[{"code":"302860033X","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST MUCOR RACEMOSUS IGE","code_information":[{"code":"302860033Y","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN CARROT IGE","code_information":[{"code":"3028600340","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CASHEW IGE","code_information":[{"code":"3028600342","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CAT HAIR DANDER IGE","code_information":[{"code":"3028600344","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN CEDAR, RED IGE","code_information":[{"code":"3028600346","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN CELERY IGE","code_information":[{"code":"3028600347","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST TILAPIA IGE - ARUP","code_information":[{"code":"3028600349","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST PISTACHIO IGE - ARUP","code_information":[{"code":"302860034A","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST PINE NUT, PIGNOLES IGE - ARUP","code_information":[{"code":"302860034B","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN FOOD: CATFISH","code_information":[{"code":"302860034C","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST TREE MULBERRY (MORUS ALBA) IGE - ARUP","code_information":[{"code":"302860034H","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST PINE, WHITE IGE - ARUP","code_information":[{"code":"302860034J","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST RICE IGE - ARUP","code_information":[{"code":"302860034M","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST EPICOCCUM PURPURASCEN IGE - ARUP","code_information":[{"code":"302860034N","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST HORSE DANDER IGE - ARUP","code_information":[{"code":"302860034Q","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST WALNUT TREE IGE - ARUP","code_information":[{"code":"302860034R","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST MITES BLOMIA TROPICALIS IGE","code_information":[{"code":"302860034T","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN CHEESE, CHEDDAR IGE","code_information":[{"code":"3028600351","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CHICKEN IGE","code_information":[{"code":"3028600353","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN CHICKEN FEATHERS IGE","code_information":[{"code":"3028600354","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CLADOSPORIUM HERBARUM IGE","code_information":[{"code":"3028600358","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CLAMS IGE","code_information":[{"code":"3028600359","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST GUM, SWEET IGE - ARUP","code_information":[{"code":"302860035B","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST RAGWEED SHORT/COMMON IGE - ARUP","code_information":[{"code":"302860035P","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST KIWI FRUIT IGE - ARUP","code_information":[{"code":"302860035T","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN COCKROACH, AMERICAN IGE","code_information":[{"code":"3028600362","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST COCONUT IGE","code_information":[{"code":"3028600363","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CODFISH IGE","code_information":[{"code":"3028600364","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN COFFEE IGE","code_information":[{"code":"3028600365","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CORN IGE","code_information":[{"code":"3028600366","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST COTTONWOOD TREE IGE","code_information":[{"code":"3028600369","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST COTTONWOOD TREE IGE - ARUP","code_information":[{"code":"302860036B","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN FOOD: PISTACHIO","code_information":[{"code":"302860036C","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN FOOD: PINE NUT, PIGNOLES","code_information":[{"code":"302860036D","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN FOOD: GRAPEFRUIT","code_information":[{"code":"302860036E","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN FOOD: PEAR","code_information":[{"code":"302860036G","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN FOOD: CHICKPEA","code_information":[{"code":"302860036H","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN FOOD: SWEET CHESTNUT","code_information":[{"code":"302860036I","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN FOOD: NGAL D 2 OVALBUMIN, EGG IGE","code_information":[{"code":"302860036Q","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN TREE: MULBERRY (MORUS ALBA) IGE","code_information":[{"code":"302860036U","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST MULBERRY, RED IGE - ARUP","code_information":[{"code":"302860036V","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST ASPERGILLUS FUMAGATUS IGE - ARUP","code_information":[{"code":"302860036Y","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CRAB IGE","code_information":[{"code":"3028600371","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN CRANBERRY IGE","code_information":[{"code":"3028600372","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN CUCUMBER IGE","code_information":[{"code":"3028600374","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN CYPRESS,BALD (WHITE) IGE","code_information":[{"code":"3028600376","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN WEED: DANDELION IGE","code_information":[{"code":"3028600377","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CURVULARIA LUNATA IGE - ARUP","code_information":[{"code":"3028600378","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST ALTERNARIA ALTERNATA  IGE","code_information":[{"code":"302860037S","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - AUREOBASIDIUM PULLULANS IGE","code_information":[{"code":"302860037Y","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST EGG YOLK IGE","code_information":[{"code":"3028600383","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST EGG WHOLE IGE","code_information":[{"code":"3028600384","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST EGG WHOLE IGE - ARUP","code_information":[{"code":"3028600385","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST ELM TREE IGE","code_information":[{"code":"3028600386","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST WEED ENGLISH PLANTAIN IGE","code_information":[{"code":"3028600387","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN EPICOCCUM PURPURASCEN IGE","code_information":[{"code":"3028600388","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST WEED ENGLISH PLANTAIN IGE - ARUP","code_information":[{"code":"3028600389","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST BAHIA GRASS IGE","code_information":[{"code":"302860038A","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN CHEESE MOLD IGE","code_information":[{"code":"302860038E","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CHEESE MOLD IGE - ARUP","code_information":[{"code":"302860038G","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CEDAR, MOUNTAIN IGE - ARUP","code_information":[{"code":"302860038L","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CHEESE, CHEDDAR IGE - ARUP","code_information":[{"code":"302860038P","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CHOCOLATE IGE","code_information":[{"code":"302860038R","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST DERMATOPHAGOIDES FARINAE (HOUSE DUST MITE) IGE","code_information":[{"code":"302860038U","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST DERMATOPHAGOIDES PTERONYSSINUS (HOUSE DUST MITE) IGE","code_information":[{"code":"302860038V","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST DOG DANDER IGE","code_information":[{"code":"302860038Z","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST FENNEL, DOG IGE - ARUP","code_information":[{"code":"3028600391","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN FENNEL, DOG IGE","code_information":[{"code":"3028600392","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN FIRE ANT (INVICTA) IGE","code_information":[{"code":"3028600395","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST EGG WHITE IGE","code_information":[{"code":"302860039B","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN GREEN PEA","code_information":[{"code":"302860039J","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST HELMINTHOSPORIUM SETOMELANOMMA ROSTRATA IGE","code_information":[{"code":"302860039K","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN HORMODENDRUM HORDEI","code_information":[{"code":"302860039M","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST HORMODENDRUM (CLADOSPORIUM) IGE - ARUP","code_information":[{"code":"302860039N","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST JOHNSON GRASS IGE","code_information":[{"code":"302860039Q","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN MAPLE,RED IGE","code_information":[{"code":"302860039X","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST PENICILLIUM NOTATUM IGE - ARUP","code_information":[{"code":"30286003A9","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST COW MILK IGE","code_information":[{"code":"30286003AA","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST OAK TREE RED IGE","code_information":[{"code":"30286003AG","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST OAK TREE RED IGE - ARUP","code_information":[{"code":"30286003AI","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST PECAN TREE IGE","code_information":[{"code":"30286003AP","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST PENICILLIUM NOTATUM IGE","code_information":[{"code":"30286003AQ","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST POTATO, WHITE IGE","code_information":[{"code":"30286003AZ","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST RAGWEED, GIANT IGE","code_information":[{"code":"30286003B0","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN HORSE DANDER IGE","code_information":[{"code":"30286003B1","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST MOUSE EPITHELIUM IGE - ARUP","code_information":[{"code":"30286003B2","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST PEACH IGE","code_information":[{"code":"30286003B3","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN RASPBERRY IGE","code_information":[{"code":"30286003B4","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST STRAWBERRY IGE","code_information":[{"code":"30286003B5","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN SAGEBRUSH, COMMON IGE","code_information":[{"code":"30286003BK","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN SEAFOOD PANEL","code_information":[{"code":"30286003BO","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN SEASONAL INHALANTS PANEL","code_information":[{"code":"30286003BP","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN SUMMER SQUASH IGE","code_information":[{"code":"30286003BY","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN SYCAMORE, AMERICAN IGE","code_information":[{"code":"30286003BZ","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST PEANUT IGE","code_information":[{"code":"30286003C3","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST SUNFLOWER SEED IGE - ARUP","code_information":[{"code":"30286003C5","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST TIMOTHY GRASS IGE","code_information":[{"code":"30286003CB","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN WILLOW, BLACK IGE","code_information":[{"code":"30286003CG","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - LATEX, IGE","code_information":[{"code":"30286003CK","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST GLUTEN IGE","code_information":[{"code":"30286003D0","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST PECAN NUT IGE","code_information":[{"code":"30286003D3","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST PECAN TREE IGE - ARUP","code_information":[{"code":"30286003D4","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST JUNE GRASS IGE","code_information":[{"code":"30286003DA","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN EACH","code_information":[{"code":"30286003DB","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN MUGWORT IGE","code_information":[{"code":"30286003F2","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN PENICILLIN V IGE","code_information":[{"code":"30286003F3","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN REDTOP, BENTGRASS IGE","code_information":[{"code":"30286003F4","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN YELLOW JACKET IGE","code_information":[{"code":"30286003F6","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST YELLOW JACKET IGE - ARUP","code_information":[{"code":"30286003F7","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST HOUSE DUST GREER IGE","code_information":[{"code":"30286003FF","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN MULLBERRY, RED IGE","code_information":[{"code":"30286003G2","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN GOOSE FEATHERS IGE","code_information":[{"code":"30286003H0","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN LAMB IGE","code_information":[{"code":"30286003H1","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN MUSHROOM IGE","code_information":[{"code":"30286003H2","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN RHIZOPUS NIGRICANS IGE","code_information":[{"code":"30286003H4","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN GRAPE IGE","code_information":[{"code":"30286003I0","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST LAMB'S QUARTER IGE","code_information":[{"code":"30286003I1","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN MUSSEL IGE","code_information":[{"code":"30286003I2","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN RICE IGE","code_information":[{"code":"30286003I4","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN THISTLE, RUSSIAN IGE","code_information":[{"code":"30286003I5","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST MUSSEL IGE - ARUP","code_information":[{"code":"30286003I6","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST LAMB'S QUARTER IGE - ARUP","code_information":[{"code":"30286003I7","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST HOUSE DUST STIER IGE","code_information":[{"code":"30286003J0","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN LEMON IGE","code_information":[{"code":"30286003J1","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN MUSTARD IGE","code_information":[{"code":"30286003J2","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST GRASS RYE, PERENNIAL IGE","code_information":[{"code":"30286003J4","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST HOUSE DUST GREER IGE - ARUP","code_information":[{"code":"30286003J8","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST NETTLE WEED IGE","code_information":[{"code":"30286003K2","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN PEPPER, GREEN BELL IGE","code_information":[{"code":"30286003K3","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN RYE IGE","code_information":[{"code":"30286003K4","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST TOMATO IGE","code_information":[{"code":"30286003K5","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN GUM, SWEET IGE","code_information":[{"code":"30286003L0","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST OAK, LIVE/VIRGINIA IGE - ARUP","code_information":[{"code":"30286003M2","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN TROUT IGE","code_information":[{"code":"30286003M5","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN LETTUCE IGE","code_information":[{"code":"30286003N1","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST OAT IGE","code_information":[{"code":"30286003N2","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST SALMON IGE","code_information":[{"code":"30286003N4","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST TUNA IGE","code_information":[{"code":"30286003N5","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST PIGWEED ROUGH IGE","code_information":[{"code":"30286003O3","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST PIGWEED ROUGH IGE - ARUP","code_information":[{"code":"30286003O6","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST FOOD HAZELNUT (FILBERT) IGE","code_information":[{"code":"30286003P0","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST LOBSTER IGE","code_information":[{"code":"30286003P1","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST PINE TREE AUSTRALIAN IGE","code_information":[{"code":"30286003P3","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN YEAST, BAKER'S IGE","code_information":[{"code":"30286003PP","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN MACADAMIA NUT IGE","code_information":[{"code":"30286003Q1","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN PINEAPPLE IGE","code_information":[{"code":"30286003Q3","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST SCALLOP IGE","code_information":[{"code":"30286003Q4","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN HICKORY, WHITE IGE","code_information":[{"code":"30286003R0","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN MACKEREL IGE","code_information":[{"code":"30286003R1","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST SESAME SEED IGE","code_information":[{"code":"30286003R4","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN WALNUT TREE IGE","code_information":[{"code":"30286003R5","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST MALT IGE - TEST","code_information":[{"code":"30286003S1","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN ONION IGE","code_information":[{"code":"30286003S2","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST WALNUT IGE","code_information":[{"code":"30286003S5","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST PENICILLIN G IGE","code_information":[{"code":"30286003SS","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN HOUSE DUST: HOLLISTER IGE","code_information":[{"code":"30286003T0","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN MANGO IGE","code_information":[{"code":"30286003T1","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST ORANGE IGE","code_information":[{"code":"30286003T2","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST PORK IGE","code_information":[{"code":"30286003T3","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST SHEEP SORREL (DOCK) IGE","code_information":[{"code":"30286003T4","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST SHEEP SORREL (DOCK) IGE - ARUP","code_information":[{"code":"30286003T6","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST MUCOR RACEMOSUS IGE - ARUP","code_information":[{"code":"30286003TT","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST MAPLE TREE BOX ELDER IGE","code_information":[{"code":"30286003U1","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN POTATO, SWEET IGE","code_information":[{"code":"30286003U3","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST SHRIMP IGE","code_information":[{"code":"30286003U4","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN WATERMELON IGE","code_information":[{"code":"30286003U5","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST PALM, QUEEN IGE - ARUP","code_information":[{"code":"30286003U7","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN MICROORGANISM: ALTERNARIA ALTERNATA","code_information":[{"code":"30286003U8","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN KIWI FRUIT IGE","code_information":[{"code":"30286003UU","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN HONEYBEE IGE","code_information":[{"code":"30286003V0","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN MARSHELDER, ROUGH IGE","code_information":[{"code":"30286003V1","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST WHEAT IGE","code_information":[{"code":"30286003V5","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN OYSTER IGE","code_information":[{"code":"30286003W2","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN MESQUITE IGE","code_information":[{"code":"30286003X1","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN PALM, QUEEN IGE","code_information":[{"code":"30286003X2","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN HORNET, WHITE FACE IGE","code_information":[{"code":"30286003Y0","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST SOYBEAN IGE","code_information":[{"code":"30286003Y4","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN WHITE BEAN IGE","code_information":[{"code":"30286003Y5","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN ANIMAL: MOUSE EPITHELIUM","code_information":[{"code":"30286003Y9","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN HORNET, YELLOW IGE","code_information":[{"code":"30286003Z0","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST RAGWEED SHORT/COMMON IGE","code_information":[{"code":"30286003Z3","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN SPINACH IGE","code_information":[{"code":"30286003Z4","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST PINE, WHITE IGE","code_information":[{"code":"30286003Z5","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - MULTIALLERGEN SCREEN","code_information":[{"code":"3028600501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86005","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.42,"discounted_cash":53.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - FEATHER MIX IGE","code_information":[{"code":"3028600502","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86005","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.42,"discounted_cash":53.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - PURIFIED COMPONENT EACH","code_information":[{"code":"3028600801","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.2,"discounted_cash":120.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST BETA LACTOGLOBULIN IGE","code_information":[{"code":"3028600802","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.2,"discounted_cash":120.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CASEIN IGE","code_information":[{"code":"3028600803","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.2,"discounted_cash":120.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST OVOMUCOID EGG IGE","code_information":[{"code":"3028600805","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.2,"discounted_cash":120.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - EGG COMPONENT PANEL IGE","code_information":[{"code":"3028600806","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.2,"discounted_cash":120.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST LACTALBUMIN IGE","code_information":[{"code":"3028600807","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.2,"discounted_cash":120.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - MILK COMPONENT PANEL IGE","code_information":[{"code":"3028600808","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.2,"discounted_cash":120.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGEN SPEC IGE - PEANUT COMPONENT PANEL IGE","code_information":[{"code":"3028600809","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.2,"discounted_cash":120.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST ALPHA GALACTOSE IGE - ARUP","code_information":[{"code":"3028600815","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.2,"discounted_cash":120.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST CASHEW COMPONENT RANA O 3 IGE - NUT COMP PANEL - ARUP","code_information":[{"code":"3028600816","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.2,"discounted_cash":120.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST HAZELNUT COMPONENT RCOR A 1 IGE - NUT COMP PANEL - ARUP","code_information":[{"code":"3028600817","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.2,"discounted_cash":120.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST HAZELNUT COMPONENT RCOR A 8 IGE - NUT COMP PANEL - ARUP","code_information":[{"code":"3028600818","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.2,"discounted_cash":120.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST HAZELNUT COMPONENT RCOR A 9 IGE - NUT COMP PANEL - ARUP","code_information":[{"code":"3028600819","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.2,"discounted_cash":120.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST HAZELNUT COMPONENT RCOR A 14 IGE - NUT COMP PANEL - ARUP","code_information":[{"code":"3028600820","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.2,"discounted_cash":120.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALLERGY TEST WALNUT COMPONENT RJUG R 1 IGE - NUT COMP PANEL - ARUP","code_information":[{"code":"3028600821","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.2,"discounted_cash":120.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC F-ACTIN (SMOOTH MUSCLE), IGG","code_information":[{"code":"3028601501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86015","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.94,"discounted_cash":84.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTI-SMOOTH MUSCLE ANTIBODY","code_information":[{"code":"3028601502","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86015","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.94,"discounted_cash":84.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC F ACTIN SMOOTH MUSCLE IGA - ARUP","code_information":[{"code":"3028601503","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86015","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.94,"discounted_cash":84.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SMOOTH MUSCLE IGG","code_information":[{"code":"3028601504","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86015","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.94,"discounted_cash":84.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC F ACTIN SMOOTH MUSCLE IGG WITH REFLEX TITER - ARUP","code_information":[{"code":"3028601505","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86015","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.94,"discounted_cash":84.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WBC ANTIBODY IDENTIFICATION - ANTI-NEUTROPHIL ANTIBODY","code_information":[{"code":"3028602101","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86021","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WBC ANTIBODY IDENTIFICATION- ANTI-NEUTROPHIL ANTIBDY ANTIMYELOPEROXIDASE","code_information":[{"code":"3028602103","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86021","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLATELET ANTIBODIES - HEPARIN-INDUCED PLATELET ANTIBODY","code_information":[{"code":"3028602201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.43,"discounted_cash":122.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLATELET ANTIBODY SCREEN INDIRECT","code_information":[{"code":"3028602202","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SEROTONIN RELEASE ASSAY UNFRACTIONATED HEPARIN","code_information":[{"code":"3028602203","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.43,"discounted_cash":122.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPARIN ANTIBODY","code_information":[{"code":"3028602204","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SEROTONIN RELEASE UNFRACTIONATED HEPARIN - VERSITI","code_information":[{"code":"3028602205","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPARIN-INDUCED PLATELET ANTIBODY - TGH","code_information":[{"code":"3028602209","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLATELET HIT PF4 IGG WITH REFLEX SEROTONIN RELEASE ASSAY (ARUP)","code_information":[{"code":"3028602210","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPARIN-INDUCED PLATELET ANTIBODY","code_information":[{"code":"3028602211","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.43,"discounted_cash":122.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLATELET ANTIBODIES INDIRECT (ARUP)","code_information":[{"code":"3028602212","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLATELET CROSSMATCH","code_information":[{"code":"3028602213","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.43,"discounted_cash":122.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLATELET ANTIBODY SCREEN INDIRECT - ONEBLOOD","code_information":[{"code":"3028602215","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOGLOBULIN ASSAY - PLATELET ANTIBODIES, DIRECT","code_information":[{"code":"3028602301","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86023","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.48,"discounted_cash":83.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTI NEUTROPHIL CYTO ANTIBY SCREEN","code_information":[{"code":"3028603601","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86036","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANCA - INFLAMMATORY BOWEL DISEASE PANEL - ARUP","code_information":[{"code":"3028603602","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86036","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANCA ASSOCIATED VASCULITIS PROFILE - ARUP","code_information":[{"code":"3028603603","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86036","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTI-NEUTROPHIL CYTOPLASMIC ANTIBODY, IGG BY IFA - ARUP","code_information":[{"code":"3028603604","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86036","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTI NEUTROPHIL CYTOPLASMIC ANTIBODY (ANCA)","code_information":[{"code":"3028603605","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86036","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANCA - ANCA ASSOCIATED VASCULITIS PROFILE - ARUP","code_information":[{"code":"3028603606","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86036","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEUTROPHIL CYTOPLASMIC ANTIBODY (ANCA) IGG IFA - ARUP","code_information":[{"code":"3028603607","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86036","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTINEUTROPHIL CYTOPLASMIC ANTIBODIES, TITER, FA","code_information":[{"code":"3028603701","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANCA TITER AND PATTERN","code_information":[{"code":"3028603702","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANA (ANTINUCLEAR ANTIBODIES)","code_information":[{"code":"3028603801","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.86,"discounted_cash":89.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANA - ANTINUCLEAR ANTIBODY WRFLX TITER - ARUP","code_information":[{"code":"3028603802","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.86,"discounted_cash":89.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANA IFA SCREEN W/RFLX - QWDL","code_information":[{"code":"3028603803","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.86,"discounted_cash":89.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANA REFLEXIVE PROFILE - ARUP","code_information":[{"code":"3028603804","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.86,"discounted_cash":89.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANA - LUPUS COMPREHENSIVE REFLEXIVE PANEL - ARUP","code_information":[{"code":"3028603805","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.86,"discounted_cash":89.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANA TITER - SYSTEMIC SCLEROSIS PANEL - ARUP","code_information":[{"code":"3028603901","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86039","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.47,"discounted_cash":82.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANA TITER","code_information":[{"code":"3028603902","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86039","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.47,"discounted_cash":82.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANA TITER - ANTINUCLEAR ANTIBODY HEP-2 IGG (RFLX) - ARUP","code_information":[{"code":"3028603903","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86039","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.47,"discounted_cash":82.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANA TITER -  ANTINUCLEAR ANTIBODY HEP-2 IGG W REFLEX - ARUP","code_information":[{"code":"3028603904","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86039","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.57,"discounted_cash":74.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANA TITER - ANTINUCLEAR ANTIBODY HEP-2 IGG - ARUP","code_information":[{"code":"3028603907","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86039","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.47,"discounted_cash":82.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANA ANTIBODY, HEP-2, IGG - SYSTEMIC SCLEROSIS PANEL - ARUP","code_information":[{"code":"3028603909","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86039","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.47,"discounted_cash":82.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTINUCLEAR AB HEP-2 IGG - EXTENDED MYOSITIS PANEL-ARUP","code_information":[{"code":"3028603912","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86039","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.47,"discounted_cash":82.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY - ARUP","code_information":[{"code":"3028604101","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86041","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACHR BINDING ANTIBODY - ACETYLCHOLINE RECEPTOR AB W/REFLEX PANEL - ARUP","code_information":[{"code":"3028604102","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86041","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACHR BINDING ANTIBODY - ACHR, TITIN, STM AB REFLEX PANEL - ARUP","code_information":[{"code":"3028604103","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86041","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY - ARUP","code_information":[{"code":"3028604201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86042","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACHR BLOCKING ANTIBODY - ACETYLCHOLINE RECEPTOR AB W/REFLEX PANEL - ARUP","code_information":[{"code":"3028604202","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86042","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACHR BLOCKING ANTIBODY - ACHR, TITIN, STM AB REFLEX PANEL - ARUP","code_information":[{"code":"3028604203","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86042","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACETYLCHOLINE REC (ACHR) MOD AB","code_information":[{"code":"3028604301","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86043","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.41,"discounted_cash":135.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AQUAPORIN-4 RECEPTOR AB","code_information":[{"code":"3028605101","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86051","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.8,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AQUAPORIN 4 RECEPTOR ANTIBODY WITH REFLEX - ARUP","code_information":[{"code":"3028605102","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86051","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.8,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AQUAPORIN 4 REC AB CSF","code_information":[{"code":"3028605201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86052","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.63,"discounted_cash":88.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AQUAPORIN 4 RECEPTOR ANTIBODY CSF - ARUP","code_information":[{"code":"3028605202","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86052","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.63,"discounted_cash":88.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC - AQUAPHORIN - AUTOIMMUNE ENCEPHALITIS EXTENDED PANEL - ARUP","code_information":[{"code":"3028605203","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86052","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.63,"discounted_cash":88.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEUROMYELITIS OPTICA/AQPF IGG WITH REFLEX TO TITER SERUM - ARUP","code_information":[{"code":"3028605204","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86052","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.63,"discounted_cash":88.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NMO / AQP4 IGG CSF - AUTOIMMUNE ENCEPHALITIS REFLEX PANEL CSF - ARUP","code_information":[{"code":"3028605205","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86052","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.63,"discounted_cash":88.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTISTREPTOLYSIN O TITER - ANTISTREPTOLYSIN O TITER","code_information":[{"code":"3028606001","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86060","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.16,"discounted_cash":54.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTISTREPTOLYSIN O SCREEN - ANTI-STREPTOLYSIN O","code_information":[{"code":"3028606301","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86063","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.2,"discounted_cash":20.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CRP (C-REACTIVE PROTEIN) INFLAMMATORY","code_information":[{"code":"3028614001","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86140","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.5,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C REACTIVE PROTEIN LEVEL MG/DL INFLAMMATORY","code_information":[{"code":"3028614002","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86140","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.5,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C REACTIVE PROTEIN LEVEL MG/L INFLAMMATORY","code_information":[{"code":"3028614003","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86140","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.5,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CRP (C-REACTIVE PROTEIN) HIGH SENSITIVITY - CARDIAC","code_information":[{"code":"3028614101","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86141","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.01,"discounted_cash":96.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C REACTIVE PROTEIN HIGH SENSITIVITY (CARDIO) MG/DL","code_information":[{"code":"3028614103","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86141","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.01,"discounted_cash":96.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C REACTIVE PROTEIN HIGH SENSITIVITY CARDIAC MG/L","code_information":[{"code":"3028614104","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86141","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.01,"discounted_cash":96.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BETA 2 GLYCOPROTEIN I ANTIBODY,EA - BETA-2 GLYCOPROTEIN ABS","code_information":[{"code":"3028614601","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.34,"discounted_cash":188.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BETA-2 GLYCOPROTEIN ABS IGG - PHOSLIPID ARUP","code_information":[{"code":"3028614605","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.29,"discounted_cash":170.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BETA-2 GLYCOPROTEIN ABS IGM - PHOSLIPID ARUP","code_information":[{"code":"3028614606","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.29,"discounted_cash":170.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BETA 2 GLYCOPROTEIN 1 IGA - ARUP","code_information":[{"code":"3028614607","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.29,"discounted_cash":170.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BETA 2 GLYCOPROTEIN 1 IGA - BETA 2 GLYCOPROTEIN 1 IGA IGG IGM - ARUP","code_information":[{"code":"3028614608","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.29,"discounted_cash":170.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BETA 2 GLYCOPROTEIN 1 IGG - BETA 2 GLYCOPROTEIN 1 IGA IGG IGM - ARUP","code_information":[{"code":"3028614609","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.29,"discounted_cash":170.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BETA 2 GLYCOPROTEIN 1 IGM - BETA 2 GLYCOPROTEIN 1 IGA IGG IGM - ARUP","code_information":[{"code":"3028614610","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.29,"discounted_cash":170.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BETA 2 GLYCOPROTEIN 1 IGG - BETA 2 GLYCOPROTEIN 1 IGG IGM - ARUP","code_information":[{"code":"3028614611","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.34,"discounted_cash":188.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BETA 2 GLYCOPROTEIN 1 IGM - BETA 2 GLYCOPROTEIN 1 IGG IGM - ARUP","code_information":[{"code":"3028614612","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.34,"discounted_cash":188.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIOLIPIN ANTIBODY - CARDIOLIPIN ANTIBODY","code_information":[{"code":"3028614701","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.34,"discounted_cash":188.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIOLIPIN ANTIBODY IGA ARUP","code_information":[{"code":"3028614702","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.34,"discounted_cash":188.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIOLIPIN ANTIBODY IGG ARUP","code_information":[{"code":"3028614703","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.29,"discounted_cash":170.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIOLIPIN ANTIBODY IGM ARUP","code_information":[{"code":"3028614704","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.29,"discounted_cash":170.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIOLIPIN ANTIBODY IGG - ARUP PHOSLIPID","code_information":[{"code":"3028614705","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.29,"discounted_cash":170.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIOLIPIN ANTIBODY IGM - ARUP PHOSLIPID","code_information":[{"code":"3028614706","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.29,"discounted_cash":170.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIOLIPIN ANTIBODY IGA - ARUP","code_information":[{"code":"3028614707","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.29,"discounted_cash":170.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIOLIPIN ANTIBODY IGG - ARUP","code_information":[{"code":"3028614708","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.34,"discounted_cash":188.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIOLIPIN ANTIBODY IGM - ARUP","code_information":[{"code":"3028614709","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.34,"discounted_cash":188.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIOLIPIN IGG - ANTIPHOSPHOLIPID SYNDROME REFLEX PANEL - ARUP","code_information":[{"code":"3028614710","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.34,"discounted_cash":188.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIOLIPIN IGM - ANTIPHOSPHOLIPID SYNDROME REFLEX PANEL - ARUP","code_information":[{"code":"3028614711","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.34,"discounted_cash":188.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIOLIPIN IGG - CARDIOLIPIN IGG IGM ANTIBODIES - ARUP","code_information":[{"code":"3028614712","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.34,"discounted_cash":188.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIOLIPIN IGM - CARDIOLIPIN IGG IGM ANTIBODIES - ARUP","code_information":[{"code":"3028614713","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.34,"discounted_cash":188.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHOSPHOLIPID ANTIBODY - PHOSPHATIDYLSERINE ANTIBODIES","code_information":[{"code":"3028614801","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86148","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.85,"discounted_cash":106.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHOSPHOLIPID ANTIBODY - PHOSPHATIDYLSERINE ANTIBODY IGG","code_information":[{"code":"3028614802","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86148","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHOSPHOLIPID ANTIBODY - PHOSPHATIDYLSERINE ANTIBODY IGM","code_information":[{"code":"3028614803","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86148","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHOSPHOLIPID ANTIBODY - PHOSPHOLIPID ANTIBODIES","code_information":[{"code":"3028614805","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86148","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHOSPHATIDYLSERINE IGG - NON-CRITERIA APS - ARUP","code_information":[{"code":"3028614809","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86148","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHOSPHATIDYLSERINE IGM - NON-CRITERIA APS - ARUP","code_information":[{"code":"3028614810","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86148","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHOSPHOLIPID IGG - PHOSPHATIDYLSERINE ANTIBODIES IGG & IGM - ARUP","code_information":[{"code":"3028614811","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86148","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHOSPHOLIPID IGM - PHOSPHATIDYLSERINE ANTIBODIES IGG & IGM - ARUP","code_information":[{"code":"3028614812","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86148","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COLD AGGLUTININ SCREEN - COLD AGGLUTININ SCREEN","code_information":[{"code":"3028615601","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86156","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.33,"discounted_cash":51.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COLD AGGLUTININ SCREEN - COLD AGGLUTININ SCREEN REF LAB","code_information":[{"code":"3028615602","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86156","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.33,"discounted_cash":51.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COLD AGGLUTININ SCREEN - ARUP","code_information":[{"code":"3028615603","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86156","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.33,"discounted_cash":51.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COLD AGGLUTININ, TITER - COLD AGGLUTININ TITER","code_information":[{"code":"3028615701","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86157","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.42,"discounted_cash":53.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C4 COMPLEMENT","code_information":[{"code":"3028616001","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.63,"discounted_cash":88.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C3 COMPLEMENT","code_information":[{"code":"3028616002","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COMPLEMENT, ANTIGEN - C2 COMPLEMENT","code_information":[{"code":"3028616003","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.63,"discounted_cash":88.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COMPLEMENT, ANTIGEN - C1 ESTERASE INHIBITOR COMPLEMENT","code_information":[{"code":"3028616004","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.63,"discounted_cash":88.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COMPLEMENT, ANTIGEN - C1 COMPLEMENT","code_information":[{"code":"3028616005","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.63,"discounted_cash":88.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COMPLEMENT, ANTIGEN - C5 COMPLEMENT","code_information":[{"code":"3028616006","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COMPLEMENT, ANTIGEN - COMPLEMENT","code_information":[{"code":"3028616007","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C1 ESTERASE INHIBITOR, ESTERASE INHIB PANEL - ARUP","code_information":[{"code":"3028616012","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.63,"discounted_cash":88.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C4 LUPUS COMPREHENSIVE REFLEXIVE PANEL - ARUP","code_information":[{"code":"3028616013","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C3 LUPUS COMPREHENSIVE REFLEXIVE PANEL - ARUP","code_information":[{"code":"3028616015","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.63,"discounted_cash":88.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C3 COMPLEMENT - ARUP","code_information":[{"code":"3028616018","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.63,"discounted_cash":88.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C1 ESTERASE INHIBITOR FUNCTIONAL -  ARUP","code_information":[{"code":"3028616102","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86161","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.63,"discounted_cash":88.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COMPLEMENT/FUNCTION ACTIVITY - C1, FUNCTIONAL","code_information":[{"code":"3028616103","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86161","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.63,"discounted_cash":88.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C1 ESTERASE INHIBITOR, FUNCTIONAL, ESTERASE INHIB PANEL - ARUP","code_information":[{"code":"3028616104","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86161","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.63,"discounted_cash":88.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COMPLEMENT, TOTAL (CH50) - COMPLEMENT TOTAL","code_information":[{"code":"3028616201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86162","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.18,"discounted_cash":150.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COMPLEMENT TOTAL (CH50) - ARUP","code_information":[{"code":"3028616202","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86162","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.18,"discounted_cash":150.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYCLIC CIRULLINATED PEPTIDE ANTIBODY - CYCLIC CITRUL PEPTIDE ANTIBDY","code_information":[{"code":"3028620001","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86200","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.81,"discounted_cash":86.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYCLIC CIRULLINATED PEPTIDE IGG/A - RHEUMATOID ARTHRITIS PANEL - ARUP","code_information":[{"code":"3028620002","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86200","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.81,"discounted_cash":86.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYCLIC CITRUL PEPTIDE (CCP) IGG & IGA - ARUP","code_information":[{"code":"3028620004","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86200","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.01,"discounted_cash":96.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYCLIC CITRULLINATED PEPTIDE IGG","code_information":[{"code":"3028620005","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86200","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.01,"discounted_cash":96.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEOXYRIBONUCLEASE, ANTIBODY - ANTI DNASE B ANTIBODY","code_information":[{"code":"3028621501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86215","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.04,"discounted_cash":89.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTI DNASE B ANTIBODY - ARUP","code_information":[{"code":"3028621502","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86215","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.04,"discounted_cash":89.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTI DNA DOUBLE STRANDED","code_information":[{"code":"3028622501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":100.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTI DNA DOUBLE STRANDED - ARUP","code_information":[{"code":"3028622503","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":100.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DNA ANTIBODY DOUBLE STRANDED IGG W/REFLEX TO IFA TITER - ARUP","code_information":[{"code":"3028622505","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.94,"discounted_cash":100.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENDOMYSIAL IGG ANTIBODY","code_information":[{"code":"3028623101","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86231","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.18,"discounted_cash":42.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENDOMYSIAL IGA ANTIBODY TITER","code_information":[{"code":"3028623103","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86231","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENDOMYSIAL IGA ANTIBODY","code_information":[{"code":"3028623104","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86231","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENDOMYSIAL IGG - ARUP","code_information":[{"code":"3028623105","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86231","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.18,"discounted_cash":42.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENDOMYSIAL IGA - ARUP","code_information":[{"code":"3028623106","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86231","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.18,"discounted_cash":42.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENDOMYSIAL IGA BY IFA - CELIAC DISEASE REFLEX CASCADE - ARUP","code_information":[{"code":"3028623107","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86231","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.18,"discounted_cash":42.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - SJOGRENS SYNDROME-A EXT NU AB","code_information":[{"code":"3028623501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - SJOGRENS SYNDROME-B EXT NUC AB","code_information":[{"code":"3028623502","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - ANTI JO-1 IGG","code_information":[{"code":"3028623503","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SCLERODERMA SCL-70 IGG - SYSTEMIC SCLEROSIS PROFILE - ARUP","code_information":[{"code":"3028623504","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - RIBOSOMAL P PROTEIN ANTIBODY","code_information":[{"code":"3028623505","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - EXTRACTABLE NUCLEAR ANTIGEN ANTIBODIES","code_information":[{"code":"3028623506","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RNA POLYMERASE III IGG - SYSTEMIC SCLEROSIS PANEL - ARUP","code_information":[{"code":"3028623507","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.2,"discounted_cash":120.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - SMITH ANTIBODY","code_information":[{"code":"3028623508","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PM1 ANTIBODY","code_information":[{"code":"3028623509","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SCLERODERMA (SCL-70) ANTIBODY- SYSTEMIC SCLEROSIS PANEL - ARUP","code_information":[{"code":"3028623511","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RNA POLYMERASE III IGG - SYSTEMIC SCLEROSIS PANEL - ARUP","code_information":[{"code":"3028623513","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - ENA PM1 ABY","code_information":[{"code":"3028623515","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RIBOSOMAL P PROTEIN IGG - ARUP","code_information":[{"code":"3028623516","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTI SMITH ANTIBODY","code_information":[{"code":"3028623517","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RIBONUCLEIC PROTEIN (RNP) IGG","code_information":[{"code":"3028623518","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SSA (RO) IGG","code_information":[{"code":"3028623519","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SSB (LA) IGG","code_information":[{"code":"3028623520","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SSB (LA) IGG - ARUP","code_information":[{"code":"3028623521","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SSA52 (RO52) IGG - EXTRACTABLE NUCLEAR ANTIGEN ANTIBODIES - ARUP","code_information":[{"code":"3028623522","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SSA60 (RO60) IGG - EXTRACTABLE NUCLEAR ANTIGEN ANTIBODIES - ARUP","code_information":[{"code":"3028623523","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SSB (LA) IGG - EXTRACTABLE NUCLEAR ANTIGEN ANTIBODIES ARUP","code_information":[{"code":"3028623524","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SMITH ENA IGG - ENA ANTIBODIES - ARUP","code_information":[{"code":"3028623525","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SMITH/RNP ENA IGG - ENA ANTIBODIES - ARUP","code_information":[{"code":"3028623526","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SSB (LA) IGG - EXTRACTABLE NUCLEAR ANTIGEN ANTIBODIES- ARUP","code_information":[{"code":"3028623527","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SSA52 (RO52) IGG - EXTRACTABLE NUCLEAR ANTIGEN ANTIBODIES- ARUP","code_information":[{"code":"3028623528","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SSA60 (RO60) IGG- EXTRACTABLE NUCLEAR ANTIGEN ANTIBODIES- ARUP","code_information":[{"code":"3028623529","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FIBRILLARIN U3 RNP IGG - ARUP","code_information":[{"code":"3028623530","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC JO1 IGG - DERMATOMYOSITIS POLYMYOSITIS PANEL - ARUP","code_information":[{"code":"3028623531","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC JO1 IGG - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"3028623532","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PMSCL 100 IGG - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"3028623533","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FIBRILLARIN (U3 RNP) IGG - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"3028623534","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SSA52 (RO52) ENA IGG - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"3028623535","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SSA60 (RO60) IGG - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"3028623536","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SMITH RNP IGG - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"3028623537","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PM/SCL 100 IGG IMMUNOBLOT - ARUP","code_information":[{"code":"3028623538","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SCLERODERMA SCL70 ENA IGG - ARUP","code_information":[{"code":"3028623539","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SMITH ENA IGG - ARUP","code_information":[{"code":"3028623540","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SMITH RNP ENA IGG - ARUP","code_information":[{"code":"3028623541","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.2,"discounted_cash":120.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SSA52 (RO52) ENA IGG - SSA RO ANTIBODY - ARUP","code_information":[{"code":"3028623542","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SMITH/RNP ENA IGG - SYSTEMIC SCLEROSIS PANEL - ARUP","code_information":[{"code":"3028623543","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PM/SCL 100 IGG - SYSTEMIC SCLEROSIS PANEL - ARUP","code_information":[{"code":"3028623544","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SSA52 (RO52) IGG - CONNECTIVE TISSUE DISEASE PROFILE - ARUP","code_information":[{"code":"3028623545","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SSA60 (RO60) IGG - CONNECTIVE TISSUE DISEASE PROFILE - ARUP","code_information":[{"code":"3028623546","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SSB (LA) IGG - CONNECTIVE TISSUE DISEASE PANEL - ARUP","code_information":[{"code":"3028623547","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC JO1 IGG - CONNECT TISSUE DIS PROFILE - ARUP","code_information":[{"code":"3028623548","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SCLERODERMA SCL-70 ANTIBODY - CONNECT TISSUE DIS PROFILE - ARUP","code_information":[{"code":"3028623549","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SMITH ANTIBODY - CONNECTIVE TISSUE DIS PROFILE - ARUP","code_information":[{"code":"3028623550","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.2,"discounted_cash":120.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC JO1 IGG - ARUP","code_information":[{"code":"3028623551","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SCLERODERMA SCL-70 ANTIBODY","code_information":[{"code":"3028623552","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLUORESCENT ANTIBODY; SCREEN - ANTI NEUTROPHIL CYTO ANTIBDY","code_information":[{"code":"3028625501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLUORESCENT NONINFECTIOUS ANTIBODY - SCREEN EACH","code_information":[{"code":"3028625504","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLUORESCENT ANTIBODY; SCREEN - GLOMERULAR BASEMT MEMB IGG AB","code_information":[{"code":"3028625505","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLUORESCENT NONINFECTIOUS ANTIBODY - SMOOTH MUSCLE ANTIBODY","code_information":[{"code":"3028625506","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLUORESCENT NONINFECTIOUS ANTIBODY - STRIATED MUSCLE ANTIBODY","code_information":[{"code":"3028625507","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLUORESCENT NONINFECTIOUS ANTIBODY - MITOCHONDRIAL ANTIBODY","code_information":[{"code":"3028625508","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC N-METHYL-D-ASPARTATE RECEPTOR ANTIBODY","code_information":[{"code":"3028625509","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC N-METHYL-D-ASPARTATE RECEPTOR ANTIBODY CSF","code_information":[{"code":"3028625510","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AQUAPORIN 4 RECEPTOR ANTIBODY CSF","code_information":[{"code":"3028625511","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PARANEOPLASTIC ANTIBODIES PCCA/ANNA","code_information":[{"code":"3028625512","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PARANEOPLASTIC ANTIBODIES PCCA/ANNA CSF","code_information":[{"code":"3028625513","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLUORESCENT ANTIBODY - EPIDERMAL ANTIBODY","code_information":[{"code":"3028625516","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.63,"discounted_cash":88.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLUORESCENT ANTIBODY - ENDOMYSIAL ANTIBODY","code_information":[{"code":"3028625518","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLUORESCENT ANTIBODY - MYOCARDIAL ANTIBODY","code_information":[{"code":"3028625520","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLUORESCENT ANTIBODY - RETICULIN ANTIBODY","code_information":[{"code":"3028625525","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLUORESCENT ANTIBODY - RETICULIN IGA ANTIBODY","code_information":[{"code":"3028625526","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLUORESCENT ANTIBODY - NEUROMYELITIS OPTICA","code_information":[{"code":"3028625530","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC N METHYL D ASPARTATE (NMDA) RECEPTOR IGG WITH REFLEX CSF - ARUP","code_information":[{"code":"3028625531","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PARANEOPLASTIC ANTIBODIES (PCCA/ANNA) CSF - ARUP","code_information":[{"code":"3028625532","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MGLUR1 IGG - AUTOIMMUNE ENCEPHALITIS EXTENDED PANEL - ARUP","code_information":[{"code":"3028625533","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMPA RECEPTOR IGG - AUTOIMMUNE ENCEPHALITIS EXTENDED PANEL -ARUP","code_information":[{"code":"3028625534","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GABA BR IGG - AUTOIMMUNE ENCEPHALITIS EXTENDED PANEL - ARUP","code_information":[{"code":"3028625535","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CASPR2 IGG - AUTOIMMUNE ENCEPHALITIS EXTENDED PANEL - ARUP","code_information":[{"code":"3028625536","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LGI1 IGG - AUTOIMMUNE ENCEPHALITIS EXTENDED PANEL - ARUP","code_information":[{"code":"3028625537","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DPPX IGG - AUTOIMMUNE ENCEPHALITIS EXTENDED PANEL - ARUP","code_information":[{"code":"3028625538","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IGLONS IGG - AUTOIMMUNE ENCEPHALITIS EXTENDED PANEL - ARUP","code_information":[{"code":"3028625539","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GABA AR IGG - AUTOIMMUNE ENCEPHALITIS EXTENDED PANEL - ARUP","code_information":[{"code":"3028625540","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NMDA RECEPTOR IGG - AUTOIMMUNE ENCEPHALITIS EXTENDED PANEL -ARUP","code_information":[{"code":"3028625541","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLOMERULAR BASEMENT MEMBRANE IGG - ARUP","code_information":[{"code":"3028625542","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LGI1 IGG - LGI1 & CASPR2 ANTIBODIES SCREEN - ARUP","code_information":[{"code":"3028625543","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CASPR2 IGG - LGI1 & CASPR2 ANTIBODIES SCREEN - ARUP","code_information":[{"code":"3028625544","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MUSCLE SPECIFIC KINASE (MUSK) IGG - ARUP","code_information":[{"code":"3028625545","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TITIN ANTIBODY - MYASTHENIA GRAVIS PANEL - ARUP","code_information":[{"code":"3028625546","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC N METHYL D ASPARTATE (NMDA) RECEPTOR IGG WITH REFLEX - ARUP","code_information":[{"code":"3028625547","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PARANEOPLASTIC ANTIBODIES REFLEX TITER & WB - ARUP","code_information":[{"code":"3028625548","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CV2.1 IGG IFA - PARANEOPLASTIC REFLEX PANEL - ARUP","code_information":[{"code":"3028625549","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PCCA/ANNA IGG - PARANEOPLASTIC REFLEX PANEL - ARUP","code_information":[{"code":"3028625550","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTI-PARIETAL CELL ANTIBODY","code_information":[{"code":"3028625551","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHOSPHOLIPASE A2 RECEPTOR IGG WITH REFLEX - ARUP","code_information":[{"code":"3028625552","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PURKINJE CELL / NEURONAL NUCLEAR IGG - SENSORY NEUROPATHY PANEL - ARUP","code_information":[{"code":"3028625553","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CASPR2 IGG CSF - AUTOIMMUNE NEUROLOGIC DISEASE REFLEX PANEL - ARUP","code_information":[{"code":"3028625554","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CV2.1 IGG CSF - AUTOIMMUNE NEUROLOGIC DISEASE REFLEX PANEL - ARUP","code_information":[{"code":"3028625555","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DPPX IGG CSF - AUTOIMMUNE NEUROLOGIC DISEASE REFLEX PANEL - ARUP","code_information":[{"code":"3028625556","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GABA BR IGG CSF - AUTOIMMUNE NEUROLOGIC DISEASE REFLEX PANEL - ARUP","code_information":[{"code":"3028625557","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ITPR1 IGG CSF -AUTOIMMUNE NEUROLOGIC DISEASE REFLEX PANEL - ARUP","code_information":[{"code":"3028625558","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LGI1 IGG CSF - AUTOIMMUNE NEUROLOGIC DISEASE REFLEX PANEL - ARUP","code_information":[{"code":"3028625559","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GABA AR IGG CSF - AUTOIMMUNE NEUROLOGIC DISEASE REFLEX PANEL - ARUP","code_information":[{"code":"3028625560","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMPA RECPTOR IGG CSF - AUTOIMMUNE NEUROLOGIC DISEASE REFLEX PANEL - ARUP","code_information":[{"code":"3028625561","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IGLON5 IGG CSF - AUTOIMMUNE NEUROLOGIC DISEASE REFLEX PANEL - ARUP","code_information":[{"code":"3028625562","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NMDA RECEPTOR IGG CSF - AUTOIMMUNE NEUROLOGIC DISEASE REFLEX PANEL -ARUP","code_information":[{"code":"3028625563","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PCCA/ANNA IGG CSF - AUTOIMMUNE NEUROLOGIC DISEASE REFLEX PANEL - ARUP","code_information":[{"code":"3028625564","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GABA BR IGG BY CBA IFA WITH REFLEX TO TITER CSF - ARUP","code_information":[{"code":"3028625565","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MGLUR1 IGG - AUTOIMMUNE ENCEPHALITIS REFLEX PANEL CSF - ARUP","code_information":[{"code":"3028625566","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NMDA RECEPTOR IGG - AUTOIMMUNE ENCEPHALITIS REFLEX PANEL CSF - ARUP","code_information":[{"code":"3028625567","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMPA RECEPTOR IGG - AUTOIMMUNE ENCEPHALITIS REFLEX PANEL CSF - ARUP","code_information":[{"code":"3028625568","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GABA BR IGG - AUTOIMMUNE ENCEPHALITIS REFLEX PANEL CSF - ARUP","code_information":[{"code":"3028625569","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CASPR2 IGG - AUTOIMMUNE ENCEPHALITIS REFLEX PANEL CSF - ARUP","code_information":[{"code":"3028625570","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LGI IGG - AUTOIMMUNE ENCEPHALITIS REFLEX PANEL CSF - ARUP","code_information":[{"code":"3028625571","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DPPX IGG - AUTOIMMUNE ENCEPHALITIS REFLEX PANEL CSF - ARUP","code_information":[{"code":"3028625572","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GABA AR IGG - AUTOIMMUNE ENCEPHALITIS REFLEX PANEL CSF - ARUP","code_information":[{"code":"3028625573","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IGLON5 IGG - AUTOIMMUNE ENCEPHALITIS REFLEX PANEL CSF - ARUP","code_information":[{"code":"3028625574","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC STRIATED MUSCLE IGG WITH REFLEX - ARUP","code_information":[{"code":"3028625575","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMPA RECEPTOR IGG - AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PANEL CSF - ARUP","code_information":[{"code":"3028625576","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CASPR2 IGG - AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PANEL CSF - ARUP","code_information":[{"code":"3028625577","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CV2.1 IGG - AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PANEL CSF - ARUP","code_information":[{"code":"3028625578","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DPPX IGG - AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PANEL CSF - ARUP","code_information":[{"code":"3028625579","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GABA BR IGG - AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PANEL CSF - ARUP","code_information":[{"code":"3028625580","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IGLON5 IGG - AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PANEL CSF - ARUP","code_information":[{"code":"3028625581","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LGI1 IGG - AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PANEL CSF - ARUP","code_information":[{"code":"3028625582","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MGLUR1 IGG - AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PANEL CSF - ARUP","code_information":[{"code":"3028625583","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NMDA RECEPTOR IGG - AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PANEL CSF - ARUP","code_information":[{"code":"3028625584","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PCCA/ANNA IGG - AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PANEL CSF - ARUP","code_information":[{"code":"3028625585","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MGLUR1 IGG CSF - AUTOIMMUNE NEUROLOGIC DISEASE REFLEX PANEL - ARUP","code_information":[{"code":"3028625586","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC STRIATED MUSCLE AB - ACHR, TITIN, STM AB REFLEX PANEL - ARUP","code_information":[{"code":"3028625587","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CV2 AB - AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PNL, SERUM - ARUP","code_information":[{"code":"3028625588","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PURKINJE CELL AB - AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PNL, SERUM - ARUP","code_information":[{"code":"3028625589","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NMDA RECEPT AB - AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PNL, SERUM - ARUP","code_information":[{"code":"3028625590","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GABA-BR AB - AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PNL, SERUM - ARUP","code_information":[{"code":"3028625591","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMPA RECEPT AB - AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PNL, SERUM - ARUP","code_information":[{"code":"3028625592","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DPPX AB - AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PNL, SERUM - ARUP","code_information":[{"code":"3028625593","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IGLON5 AB - AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PNL, SERUM - ARUP","code_information":[{"code":"3028625594","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MGLUR1 AB - AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PNL, SERUM - ARUP","code_information":[{"code":"3028625595","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CASPR2 AB - AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PNL, SERUM - ARUP","code_information":[{"code":"3028625596","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LGI1 AB - AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PNL, SERUM - ARUP","code_information":[{"code":"3028625597","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLUORESCENT ANTIBODY; TITER - ANTIMITOCHONDRIAL AB","code_information":[{"code":"3028625601","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTI-SMOOTH MUSCLE ANTIBODY TITER","code_information":[{"code":"3028625602","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLUORESCENT ANTIBODY; TITER - ENDOMYSIAL ANTIBODY, IGA TITER","code_information":[{"code":"3028625603","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLUORESCENT ANTIBODY; TITER - DSDNA IGG","code_information":[{"code":"3028625604","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLUORESCENT NONINFECTIOUS ANTIBODY - TITER - EACH ANTIBODY","code_information":[{"code":"3028625605","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PARIETAL CELL ANTIBODY TITER","code_information":[{"code":"3028625616","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLUORESCENT ANTIBODY TITER - NEUTROPHIL CYTOPLASMIC (ANCA)","code_information":[{"code":"3028625626","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLUORESCENT ANTIBODY TITER - STRIATED MUSCLE","code_information":[{"code":"3028625627","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTI-MITOCHONDRIAL TITER","code_information":[{"code":"3028625629","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PARIETAL CELL ANTIBODY TITER","code_information":[{"code":"3028625630","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PURKINJE CELL ANTIBODY TITER CSF - ARUP","code_information":[{"code":"3028625633","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DOUBLE-STRANDED DNA (DSDNA) IGG IFA - ARUP","code_information":[{"code":"3028625634","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHOSPHOLIPASE A2 RECEPTOR IGG TITER - ARUP","code_information":[{"code":"3028625635","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC STRIATED MUSCLES IGG TITER - ARUP","code_information":[{"code":"3028625636","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CASPR2 IGG IFA SERUM TITER - ARUP","code_information":[{"code":"3028625637","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOG IGG TITER SERUM - ARUP","code_information":[{"code":"3028625642","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEUROMYELITIS OPTICA/AQP4-IGG TITER SERUM - ARUP","code_information":[{"code":"3028625643","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.75,"discounted_cash":258.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CV2.1 IGG TITER CSF - ARUP","code_information":[{"code":"3028625655","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IGLON5 IGG TITER CSF - ARUP","code_information":[{"code":"3028625658","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLIADIN ANTIBODY (DEAMIDATED), IGA","code_information":[{"code":"3028625802","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.8,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLIADIN ANTIBODY (DEAMIDATED), IGG","code_information":[{"code":"3028625803","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.8,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLIADIN IGA - CELIAC CASCADE SCREEN","code_information":[{"code":"3028625804","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.48,"discounted_cash":42.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLIADIN IGA","code_information":[{"code":"3028625805","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.48,"discounted_cash":42.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLIADIN IGA - CELIAC COMPREHENSIVE PANEL","code_information":[{"code":"3028625806","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.48,"discounted_cash":42.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLIADIN IGG - CELIAC COMPREHENSIVE PANEL","code_information":[{"code":"3028625807","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.48,"discounted_cash":42.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLIADIN IGA - GLIADIN PEPTIDE ANTIBODIES IGA AND IGG - ARUP","code_information":[{"code":"3028625808","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.48,"discounted_cash":42.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLIADIN IGG - GLIADIN PEPTIDE ANTIBODIES IGA AND IGG - ARUP","code_information":[{"code":"3028625809","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.48,"discounted_cash":42.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLIADIN IGA PEPTIDE ANTIBODIES - ARUP","code_information":[{"code":"3028625810","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.48,"discounted_cash":42.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLIADIN IGG","code_information":[{"code":"3028625811","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.48,"discounted_cash":42.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLIADIN IGG PEPTIDE ANTIBODIES - ARUP","code_information":[{"code":"3028625812","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.48,"discounted_cash":42.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLIADIN ANTIBODY (DEAMIDATED), IGA - CELIAC DISEASE REFLEX CASCADE -ARUP","code_information":[{"code":"3028625813","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.48,"discounted_cash":42.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLIADIN ANTIBODY (DEAMIDATED), IGG - CELIAC DISEASE REFLEX CASCADE -ARUP","code_information":[{"code":"3028625814","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.48,"discounted_cash":42.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CANCER ANTIGEN 15-3","code_information":[{"code":"3028630001","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86300","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.88,"discounted_cash":153.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY, TUMOR ANTIGEN, CA 15-3 - CANCER ANTIGEN 27.29","code_information":[{"code":"3028630002","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86300","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.88,"discounted_cash":153.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CANCER ANTIGEN 27.29 - ARUP","code_information":[{"code":"3028630004","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86300","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.88,"discounted_cash":153.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CANCER ANTIGEN 19-9","code_information":[{"code":"3028630101","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86301","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.88,"discounted_cash":153.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CANCER ANTIGIEN 19-9 BODY FLUID - ARUP","code_information":[{"code":"3028630103","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86301","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.88,"discounted_cash":153.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CA 125","code_information":[{"code":"3028630401","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86304","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.88,"discounted_cash":153.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CA 125 - RISK OF OVARIAN MALIGNANCY ALGORITHM - ARUP","code_information":[{"code":"3028630404","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86304","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.88,"discounted_cash":153.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EPIDIDYMIS PROTEIN 4","code_information":[{"code":"3028630501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86305","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.13,"discounted_cash":139.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HE4 - RISK OF OVARIAN MALIGNANCY ALGORITHM - ARUP","code_information":[{"code":"3028630502","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86305","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.13,"discounted_cash":139.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HUMAN EPIDIDYMIS PROTEIN 4 (HE4) - ARUP","code_information":[{"code":"3028630503","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86305","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.13,"discounted_cash":139.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MONONUCLEOSIS SCREEN","code_information":[{"code":"3028630801","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86308","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY TUMOR ANTIGEN - CHROMOGRANIN A","code_information":[{"code":"3028631601","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86316","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.88,"discounted_cash":153.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEURON SPECIFIC ENOLASE","code_information":[{"code":"3028631602","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86316","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.88,"discounted_cash":153.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALPHA FETOPROTEIN TUMOR MARKER CSF","code_information":[{"code":"3028631603","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86316","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.13,"discounted_cash":139.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHROMOGRANIN A - ARUP","code_information":[{"code":"3028631604","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86316","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.88,"discounted_cash":153.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEURON SPECIFIC ENOLASE - ARUP","code_information":[{"code":"3028631605","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86316","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.88,"discounted_cash":153.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYFRA 21-1 (CYTOKERATIN 19 FRAGMENT - ARUP","code_information":[{"code":"3028631606","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86316","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.88,"discounted_cash":153.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY,INFECT AGENT,QUANT - RUBELLA ANTIBODY IGG","code_information":[{"code":"3028631701","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY,INFECT AGENT,QUANT - TETANUS ANTIBODY, IGG","code_information":[{"code":"3028631702","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY,INFECT AGENT,QUANT - STREP PNEUMONIAE ANTIBODY SEROTYPES","code_information":[{"code":"3028631704","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY,INFECT AGENT,QUANT - OTHER","code_information":[{"code":"3028631705","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREUTZFELDT JACOB DISEASE CSF","code_information":[{"code":"3028631706","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HAEMOPHILUS INFLUENZAE B ANTIBODY IGG","code_information":[{"code":"3028631707","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIPHTHERIA ANTIBODY","code_information":[{"code":"3028631708","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY,INFECT AGENT,QUANT - DIPHTHERIA","code_information":[{"code":"3028631711","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY,INFECT AGENT,QUANT - EPSTEIN BAR VIRUS IGM","code_information":[{"code":"3028631712","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY,INFECT AGENT,QUANT - HAEMOPHILUS INFLUENZAE","code_information":[{"code":"3028631715","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY,INFECT AGENT,QUANT - PNEUMOCOCCAL","code_information":[{"code":"3028631716","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY,INFECT AGENT,QUANT - TETANUS","code_information":[{"code":"3028631718","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY,INFECT AGENT,QUANT - TOXOPLASMA","code_information":[{"code":"3028631719","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS B SURFACE ANTIBODY QUANT - QWDL","code_information":[{"code":"3028631720","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CREUTZFELDT-JAKOB DISEASE - 14 3 3 PROTEIN CSF - ARUP","code_information":[{"code":"3028631721","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASPERGILLUS FUMIGATUS IGG - ARUP","code_information":[{"code":"3028631722","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIPHTHERIA IGG - ARUP","code_information":[{"code":"3028631723","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 1 IGG (P13,PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631724","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 10A IGG (PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631725","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 11A IGG (PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631726","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 12F IGG (PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631727","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 14 IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631728","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 15B IGG (PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631729","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 17F IGG (PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631730","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 18C IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631731","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 19A IGG (P13,PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631732","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 19F IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631733","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 2 IGG (PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631734","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 20 IGG (PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631735","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 22F IGG (PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631736","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 23F IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631737","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 3 IGG (P13,PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631738","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 33F IGG (PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631739","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 4 IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631740","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 5 IGG (P13,PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631741","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 6B IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631742","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 7F IGG (P13,PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631743","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 8 IGG (PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631744","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 9N IGG (PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631745","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 9V IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631746","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIPHTHERIA IGG - DIPHTHERIA AND TETANUS ANTIBODIES IGG - ARUP","code_information":[{"code":"3028631747","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TETANUS IGG - DIPHTHERIA AND TETANUS ANTIBODIES IGG - ARUP","code_information":[{"code":"3028631748","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TETANUS IGG - ARUP","code_information":[{"code":"3028631749","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HAEMOPHILUS INFLUENZAE B IGG - ARUP","code_information":[{"code":"3028631750","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 1 IGG (P13,PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631751","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 12F IGG (PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631752","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 14 IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631753","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 18C IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631754","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 19F IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631755","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 23F IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631756","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 3 IGG (P13,PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631757","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 4 IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631758","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 5 IGG (P13,PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631759","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 6B IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631760","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 7F IGG (P13,PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631761","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 8 IGG (PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631762","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 9N IGG (PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631763","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMO SEROTYPE 9V IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631764","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.79,"discounted_cash":110.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SERUM IMMUNOELECTROPHORESIS","code_information":[{"code":"3028632001","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86320","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.34,"discounted_cash":200.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY GEL DIFFUSION EACH ANTIGEN OR ANTIBODY QUAL","code_information":[{"code":"3028633103","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HYPERSENSITIVITY PNEUMONITIS 2 PANEL","code_information":[{"code":"3028633104","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC S VIRIDIS AB PRECIPITIN - HYPERSENSITIVITY PNEUMONITIS 2 - ARUP","code_information":[{"code":"3028633105","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC T CANDIDUS AB PRECIPITIN - HYPERSENSITIVITY PNEUMONITIS 2 - ARUP","code_information":[{"code":"3028633106","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC A PULLULANS AB PRECIPITIN - HYPER PNEUMO EXTENDED PANEL - ARUP","code_information":[{"code":"3028633107","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC M FAENI AB PRECIPITIN - HYPER PNEUMO EXTENDED PANEL - ARUP","code_information":[{"code":"3028633108","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PIGEON SERUM AB PRECIPITIN - HYPER PNEUMO EXTENDED PANEL - ARUP","code_information":[{"code":"3028633109","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC S VIRIDIS AB PRECIPITIN - HYPER PNEUMO EXTENDED PANEL - ARUP","code_information":[{"code":"3028633110","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC T CANDIDUS AB PRECIPITIN - HYPER PNEUMO EXTENDED PANEL - ARUP","code_information":[{"code":"3028633111","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOASSAY IMMUNE COMPLEX ASSAY C1Q","code_information":[{"code":"3028633201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86332","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.5,"discounted_cash":162.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNE COMPLEX ASSAY - C1Q BINDING","code_information":[{"code":"3028633203","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86332","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.5,"discounted_cash":162.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNE COMPLEX ASSAY - OTHER","code_information":[{"code":"3028633205","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86332","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.73,"discounted_cash":179.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CIRCULATING IMMUNE COMPLEX C3 FRAGMENTS - ARUP","code_information":[{"code":"3028633208","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86332","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.5,"discounted_cash":162.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOFIXATION ELECTROPHORESIS - EACH ANALYTE","code_information":[{"code":"3028633402","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.95,"discounted_cash":164.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOFIXATION ELECTROPHORESIS - MONOCLONAL PROTEIN STUDY SERUM - ARUP","code_information":[{"code":"3028633403","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.95,"discounted_cash":164.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOFIXATION ELECTROPHORESIS - MONOCLONAL PROTEIN STUDY EXTENDED SERUM - ARUP","code_information":[{"code":"3028633405","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.95,"discounted_cash":164.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOFIXATION ELECTROPHORESIS - ARUP","code_information":[{"code":"3028633406","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.95,"discounted_cash":164.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOFIX ELECTROPHORESIS BILL - ARUP","code_information":[{"code":"3028633407","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.95,"discounted_cash":164.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOFIXATION ADD ON SERUM","code_information":[{"code":"3028633408","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.95,"discounted_cash":164.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOFIXATION SERUM","code_information":[{"code":"3028633409","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.95,"discounted_cash":164.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOFIXATION ELECTROPHORESIS - ARUP","code_information":[{"code":"3028633410","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.95,"discounted_cash":164.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOFIXATION SERUM - ARUP","code_information":[{"code":"3028633413","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.95,"discounted_cash":164.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOFIXATION ELECTROPHORESIS - MONOCLONAL PROTEIN STUDY SERUM - ARUP","code_information":[{"code":"3028633417","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.95,"discounted_cash":164.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNFIX E-PHORSIS/URINE/CSF - MONOCLONAL PROTEIN URINE","code_information":[{"code":"3028633502","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.65,"discounted_cash":216.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNFIX E-PHORSIS/URINE/CSF - EACH ANALYTE","code_information":[{"code":"3028633503","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOFIXATION ELECTROPHORESIS 24 HOUR URINE","code_information":[{"code":"3028633504","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.65,"discounted_cash":216.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOFIXATION - IMMUNOFIXATION URINE - ARUP","code_information":[{"code":"3028633505","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.65,"discounted_cash":216.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOFIXATION URINE ADD ON","code_information":[{"code":"3028633506","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.65,"discounted_cash":216.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOFIXATION URINE","code_information":[{"code":"3028633507","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.65,"discounted_cash":216.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BETA 2 TRANSFERRIN BODY FLUID - ARUP","code_information":[{"code":"3028633508","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.65,"discounted_cash":216.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOFIXATION - IMMUNOFIXATION WITH FREE LIGHT CHAINS URINE - ARUP","code_information":[{"code":"3028633509","type":"CDM"},{"code":"0301","type":"RC"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.65,"discounted_cash":216.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INHIBIN A - ADDITIONAL CHARGE","code_information":[{"code":"3028633601","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86336","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.62,"discounted_cash":104.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INHIBIN A - ARUP","code_information":[{"code":"3028633605","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86336","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.62,"discounted_cash":104.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSULIN ANTIBODIES - INSULIN ANTIBODY","code_information":[{"code":"3028633701","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86337","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.56,"discounted_cash":157.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSULIN ANTIBODY - ARUP","code_information":[{"code":"3028633702","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86337","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.56,"discounted_cash":157.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTRINSIC FACTOR BLOCKING ANTIBODY - ARUP","code_information":[{"code":"3028634001","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86340","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ISLET CELL ANTIBODY - ANTI-ISLET CELL AB","code_information":[{"code":"3028634101","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.56,"discounted_cash":173.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUTAMIC ACID DECARBOXYLASE CSF","code_information":[{"code":"3028634102","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.72,"discounted_cash":249.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSULINOMA ANTIGEN 2 ANTIBODY","code_information":[{"code":"3028634103","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.72,"discounted_cash":249.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUTAMIC ACID DECARBOXYLASE 65","code_information":[{"code":"3028634104","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.56,"discounted_cash":173.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ISLET CELL CYTOPLASMIC IGG - ARUP","code_information":[{"code":"3028634105","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.72,"discounted_cash":249.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUTAMIC ACID DECARBOXYLASE ANTIBODY CSF - ARUP","code_information":[{"code":"3028634106","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.72,"discounted_cash":249.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUTAMIC ACID DECARBOXYLASE-AUTOIMMUNE ENCEPHALITIS EXTENDED PANEL-ARUP","code_information":[{"code":"3028634107","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.72,"discounted_cash":249.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ISLET ANTIGEN 2 (IA-2) AUTOANTIBODY - ARUP","code_information":[{"code":"3028634108","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.93,"discounted_cash":156.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUTAMIC ACID DECAROXYLASE CSF-AUTOIMMUNE NEURO DISEASE PANEL RFLX-ARUP","code_information":[{"code":"3028634109","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.72,"discounted_cash":249.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUTAMIC ACID DECARBOXYLASE-AUTOIMMUNE ENCEPHALITIS REFLEX PNL CSF-ARUP","code_information":[{"code":"3028634110","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.72,"discounted_cash":249.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUTAMIC ACID DECARBOXYLASE-AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA CSF-ARUP","code_information":[{"code":"3028634111","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.72,"discounted_cash":249.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUTAMIC ACID DECARBOXYLASE ANTIBODY - ARUP","code_information":[{"code":"3028634112","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.72,"discounted_cash":249.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GAD AB - AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PNL, SERUM - ARUP","code_information":[{"code":"3028634113","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.72,"discounted_cash":249.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CELLULAR FUNCTION STIMULATION AND BIOMARKER ASSAY","code_information":[{"code":"3028635201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86352","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.51,"discounted_cash":475.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LYMPHOCYTE TRANSFORMATION - LYMPHOCYTE CULTURE, PRIMED","code_information":[{"code":"3028635301","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86353","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.61,"discounted_cash":171.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC B CELLS, TOTAL COUNT - LYMPHOCYTE SUBSET PANEL 5 - ARUP","code_information":[{"code":"3028635501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86355","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.54,"discounted_cash":251.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC B CELLS, TOTAL COUNT - LYMPHOCYTE SUBSET PANEL 5 - ARUP","code_information":[{"code":"3028635502","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86355","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.54,"discounted_cash":251.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC B CELLS, TOTAL - B CELL CD20 EXPRESSION BY FLOW, QUANT - ARUP","code_information":[{"code":"3028635503","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86355","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.54,"discounted_cash":251.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MONONUCLEAR ANTIGEN QUANT","code_information":[{"code":"3028635601","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86356","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.19,"discounted_cash":179.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CD20 CELLS, QUANT - B CELL CD20 EXPRESSION BY FLOW, QUANT - ARUP","code_information":[{"code":"3028635604","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86356","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.19,"discounted_cash":179.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NATURAL KILLER CELLS, TOTAL COUNT - LYMPHOCYTE SUBSET PANEL 5 - ARUP","code_information":[{"code":"3028635701","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86357","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.54,"discounted_cash":251.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NATURAL KILLER CELLS, TOTAL COUNT - LYMPHOCYTE SUBSET PANEL 5 - ARUP","code_information":[{"code":"3028635702","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86357","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.54,"discounted_cash":251.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC T CELLS TOTAL COUNT","code_information":[{"code":"3028635901","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86359","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.54,"discounted_cash":251.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC T CELL COUNT - LYMPHOCYTE SUBSET PANEL 3 - ARUP","code_information":[{"code":"3028635902","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86359","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.54,"discounted_cash":251.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC T CELL COUNT - LYMPHOCYTE SUBSET PANEL 4 - ARUP","code_information":[{"code":"3028635903","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86359","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.54,"discounted_cash":251.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC T CELL COUNT - LYMPHOCYTE SUBSET PANEL 5 - ARUP","code_information":[{"code":"3028635904","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86359","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.54,"discounted_cash":251.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CD4/CD8 COUNT - LYMPHOCYTE SUBSET PANEL 3 - ARUP","code_information":[{"code":"3028636001","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":313.87,"discounted_cash":313.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CD4/CD8 COUNT - LYMPHOCYTE SUBSET PANEL 4 - ARUP","code_information":[{"code":"3028636002","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":313.87,"discounted_cash":313.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CD4/CD8 COUNT -  LYMPHOCYTE SUBSET PANEL 5 - ARUP","code_information":[{"code":"3028636003","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":313.87,"discounted_cash":313.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CD4/CD8 COUNT","code_information":[{"code":"3028636004","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":313.87,"discounted_cash":313.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CD4/CD8 COUNT - LYMPHOCYTE SUBSET PANEL 3 - ARUP","code_information":[{"code":"3028636005","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":313.87,"discounted_cash":313.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CD4/CD8 COUNT - LYMPHOCYTE SUBSET PANEL 4 - ARUP","code_information":[{"code":"3028636006","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":313.87,"discounted_cash":313.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CD4/CD8 COUNT - LYMPHOCYTE SUBSET PANEL 5 - ARUP","code_information":[{"code":"3028636007","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":313.87,"discounted_cash":313.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC T CELL ABSOLUTE COUNT - T-HELPER CELLS (CD4) COUNT","code_information":[{"code":"3028636101","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86361","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.19,"discounted_cash":179.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LYMPHOCYTE SUBSET PANEL 2 - CD4 PERCENT AND ABSOLUTE - ARUP","code_information":[{"code":"3028636102","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86361","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.19,"discounted_cash":179.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CD4 ABSOLUTE COUNT ONLY - LYMPHOCYTE SUBSET PANEL 1 - ARUP","code_information":[{"code":"3028636103","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86361","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.19,"discounted_cash":179.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOG-IGG IMMUNOFLUOR - AUTOIMMUNE ENCEPHALITIS EXTENDED PANEL - ARUP","code_information":[{"code":"3028636201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86362","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYELIN OLIGODENTROCYTE GLYCOPROTEIN (MOG) IGG WITH REFLEX - ARUP","code_information":[{"code":"3028636202","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86362","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TISSUE TRANSGLUTAMINASE IGG - CELIAC COMPREHENSIVE PANEL","code_information":[{"code":"3028636404","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TISSUE TRANSGLUTAMINASE IGA - CELIAC COMPREHENSIVE PANEL","code_information":[{"code":"3028636405","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TISSUE TRANSGLUTAMINASE IGG - CELIAC DISEASE REFLEX CASCADE - ARUP","code_information":[{"code":"3028636406","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.24,"discounted_cash":21.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TISSUE TRANSGLUTAMINASE IGA - CELIAC DISEASE REFLEX CASCADE - ARUP","code_information":[{"code":"3028636407","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.24,"discounted_cash":21.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MUSCLE-SPECIFIC KINASE (MUSK) IGG BY CBA-IFA WITH REFLEX - ARUP","code_information":[{"code":"3028636602","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86366","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.43,"discounted_cash":122.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROSOMAL ANTIBODY - ANTI-MICROSOMAL AB","code_information":[{"code":"3028637601","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.09,"discounted_cash":107.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROSOMAL ANTIBODY - THYROID PEROXIDASE ANTIBODY","code_information":[{"code":"3028637602","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.09,"discounted_cash":107.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROID PEROXIDASE ANTIBODY","code_information":[{"code":"3028637603","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.09,"discounted_cash":107.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIVER KIDNEY MICROSOMAL ANTIBODY","code_information":[{"code":"3028637604","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":58.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIVER KIDNEY MICROSOME IGG - ARUP","code_information":[{"code":"3028637605","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.09,"discounted_cash":107.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROID PEROXIDASE (TPO) ANTIBODY - THYROID ANTIBODIES - ARUP","code_information":[{"code":"3028637606","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.09,"discounted_cash":107.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROSOMAL ANTIBODY - THYROID PEROXIDASE ANTIBODY - ARUP","code_information":[{"code":"3028637610","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.09,"discounted_cash":107.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROID PEROXIDASE ANTIBODY - ARUP","code_information":[{"code":"3028637611","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.09,"discounted_cash":107.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MITOCHONDRIAL M2 ANTIBODIES - ARUP","code_information":[{"code":"3028638103","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86381","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.02,"discounted_cash":128.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MITOCHONDRIAL M2 ANTIBODIES","code_information":[{"code":"3028638105","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86381","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MITOCHONDRIAL ANTIBODY M2 IGG AB","code_information":[{"code":"3028638106","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86381","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.02,"discounted_cash":128.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEUTRALIZATION TEST, VIRAL - RABIES ANTIBODY TITER","code_information":[{"code":"3028638201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86382","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.41,"discounted_cash":112.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RABIES ANTIBODY SCREEN - ARUP","code_information":[{"code":"3028638203","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86382","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.41,"discounted_cash":112.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PARTICLE AGGLUTINATION TEST, SCREEN - BACTERIAL ANTIGEN DETECTION","code_information":[{"code":"3028640301","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86403","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.8,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PARTICLE AGGLUTINATION TEST, SCREEN - CRYPTOCOCCAL ANTIGEN","code_information":[{"code":"3028640302","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86403","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.94,"discounted_cash":84.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PARTICLE AGGLUTINATION TST, SCRN - BACTERIAL ANTIGEN DETECT GRP B STREP","code_information":[{"code":"3028640307","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86403","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.94,"discounted_cash":84.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PARTICLE AGGLUTINATION TEST, TITER - CRYPTOCOCCUS ANTIGEN TITER","code_information":[{"code":"3028640602","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86406","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.24,"discounted_cash":37.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RHEUMATOID FACTOR TEST - RHEUMATOID FACTOR SCREEN","code_information":[{"code":"3028643001","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86430","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.18,"discounted_cash":41.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RHEUMATOID FACTOR, QUANT - RHEUMATOID FACTOR","code_information":[{"code":"3028643101","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.85,"discounted_cash":41.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RHEUMATOID FACTOR, QUANT - RHEUMATOID FACTOR, BODY FLUID","code_information":[{"code":"3028643102","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.85,"discounted_cash":41.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RHEUMATOID FACTOR, QUANT - LUPUS COMPREHENSIVE REFLEXIVE PANEL - ARUP","code_information":[{"code":"3028643103","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.85,"discounted_cash":41.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RHEUMATOID FACTOR","code_information":[{"code":"3028643104","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.85,"discounted_cash":41.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RHEUMATOID FACTOR TITER REFLEX","code_information":[{"code":"3028643107","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.85,"discounted_cash":41.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RHEUMATOID FACTOR - LUPUS COMPREHENSIVE REFLEX PANEL - ARUP","code_information":[{"code":"3028643108","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.85,"discounted_cash":41.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TB TEST CELL MEDIATED ANTIGEN RESPONSE,GAMMA INTERFRON","code_information":[{"code":"3028648001","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86480","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.93,"discounted_cash":457.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC QUANTIFERON TB PLUS - ARUP","code_information":[{"code":"3028648002","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86480","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.93,"discounted_cash":457.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC QUANTIFERON TB PLUS 4 TUBE - ARUP","code_information":[{"code":"3028648003","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86480","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.93,"discounted_cash":457.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC QUANTIFERON TB GOLD PLUS 1 TUBE - QWDL","code_information":[{"code":"3028648004","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86480","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.93,"discounted_cash":457.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC STREPTOCOCCUS PNEUMONIA IGG, 14 SEROTYPES - ARUP","code_information":[{"code":"3028658102","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86581","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.37,"discounted_cash":231.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VDRL CSF","code_information":[{"code":"3028659201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.01,"discounted_cash":32.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RPR QUAL","code_information":[{"code":"3028659202","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.01,"discounted_cash":32.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SYPHILIS TEST NON TREPONEMAL ANTIBODY QUAL - VDRL","code_information":[{"code":"3028659203","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.01,"discounted_cash":32.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DONOR RPR SCREEN","code_information":[{"code":"3028659204","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.01,"discounted_cash":32.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RPR QUAL W REFLEX TITER - ARUP","code_information":[{"code":"3028659205","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.94,"discounted_cash":28.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RPR (MONITOR) W/REFL TITER - QWDL","code_information":[{"code":"3028659206","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.01,"discounted_cash":32.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VDRL WITH REFLEX TO TITER, CSF - ARUP","code_information":[{"code":"3028659207","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.01,"discounted_cash":32.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VDRL WITH REFLEX TO TITER, SERUM - ARUP","code_information":[{"code":"3028659208","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.01,"discounted_cash":32.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RAPID PLASMA REAGIN (RPR) QUAL","code_information":[{"code":"3028659211","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.01,"discounted_cash":32.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RPR TITER","code_information":[{"code":"3028659301","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86593","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.94,"discounted_cash":28.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SYPHILIS TEST NON TREPONEMAL ANTIBODY QUANT - VDRL TITER","code_information":[{"code":"3028659302","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86593","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.94,"discounted_cash":28.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DONOR RPR TITER","code_information":[{"code":"3028659303","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86593","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.94,"discounted_cash":28.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VDRL TITER CSF","code_information":[{"code":"3028659305","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86593","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.94,"discounted_cash":28.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VDRL TITER - ARUP","code_information":[{"code":"3028659306","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86593","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.94,"discounted_cash":28.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VDRL TITER CSF - ARUP","code_information":[{"code":"3028659307","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86593","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.94,"discounted_cash":28.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RPR TITER - ARUP","code_information":[{"code":"3028659308","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86593","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.94,"discounted_cash":28.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VOLTAGE GATED CALCIUM CHANNEL AB","code_information":[{"code":"3028659601","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86596","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.43,"discounted_cash":122.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VOLTAGE GATED CALCIUM CHANNEL ANTIBODY - ARUP","code_information":[{"code":"3028659602","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86596","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.43,"discounted_cash":122.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTINOMYCES ANTIBODY - HYPERSENSITIVITY PNUEMONITIS PROFILE","code_information":[{"code":"3028660201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86602","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.89,"discounted_cash":67.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ADENOVIRUS, ANTIBODY - ADENOVIRUS ANTIBODIES","code_information":[{"code":"3028660301","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86603","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ADENOVIRUS ANTIBODIES - ARUP","code_information":[{"code":"3028660304","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86603","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASPERGILLUS ANTIBODY - ASPERGILLUS ABS","code_information":[{"code":"3028660601","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HYPERSENSITIVITY PNEUMONITIS 1 - IMMUNOASSAY ANTIBODY - A FUMIGATUS #1, A FUMIGATUS #6","code_information":[{"code":"3028660602","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HYPERSENSITIVITY PNEUOMONITIS 2 -  IMMUNOASSAY ANTIBODY - A FLAVUS #2, A FUMIGATUS #2, A FUMIGATUS #3","code_information":[{"code":"3028660603","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FUNGAL ANTIBODIES - ASPERGILLUS","code_information":[{"code":"3028660604","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC A FLAVUS AB PRECIPITIN - HYPERSENSITIVITY PNEUMONITIS 2 - ARUP","code_information":[{"code":"3028660608","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC A FUMIGATUS #2 AB PRECIPITIN - HYPERSENSITIVITY PNEUMONITIS 2 - ARUP","code_information":[{"code":"3028660609","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC A FUMIGATUS #3 AB PRECIPITIN - HYPERSENSITIVITY PNEUMONITIS 2 - ARUP","code_information":[{"code":"3028660610","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASPERGILLUS AB BY COMPLEMENT FIXATION - FUNGAL AB W/RFLX SERUM - ARUP","code_information":[{"code":"3028660611","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASPERGILLUS ANTIBODY BY IMMUNODIFFUSION - ARUP","code_information":[{"code":"3028660612","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC A FUMIGATUS #1 AB PRECIPITIN - HYPER PNEUMO EXTENDED PANEL - ARUP","code_information":[{"code":"3028660613","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC A FUMIGATUS #6 AB PRECIPITIN - HYPER PNEUMO EXTENDED PANEL - ARUP","code_information":[{"code":"3028660614","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC A FLAVUS AB PRECIPITIN - HYPER PNEUMO EXTENDED PANEL - ARUP","code_information":[{"code":"3028660615","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC A FUMIGATUS #2 AB PRECIPITIN - HYPER PNEUMO EXTENDED PANEL - ARUP","code_information":[{"code":"3028660616","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC A FUMIGATUS #3 AB PRECIPITIN - HYPER PNEUMO EXTENDED PANEL - ARUP","code_information":[{"code":"3028660617","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BACTERIUM ANTIBODY - LISTERIA ANTIBODY","code_information":[{"code":"3028660903","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86609","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BARTONELLA HENSELAE ANTIBODY","code_information":[{"code":"3028661102","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.89,"discounted_cash":67.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BARTONELLA QUINTANA ANTIBODY","code_information":[{"code":"3028661103","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.89,"discounted_cash":67.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BARTONELLA HENSELAE IGG - ARUP","code_information":[{"code":"3028661104","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.89,"discounted_cash":67.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BARTONELLA QUINTANA IGM - ARUP","code_information":[{"code":"3028661105","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.89,"discounted_cash":67.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BARTONELLA QUINTANA IGG - ARUP","code_information":[{"code":"3028661106","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.89,"discounted_cash":67.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BARTONELLA HENSELAE IGM - ARUP","code_information":[{"code":"3028661107","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.89,"discounted_cash":67.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BARTONELLA QUINTANA IGM - BARTONELLA AB PANEL - ARUP","code_information":[{"code":"3028661108","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.89,"discounted_cash":67.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BARTONELLA HENSELAE IGG - BARTONELLA AB PANEL - ARUP","code_information":[{"code":"3028661109","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.89,"discounted_cash":67.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BARTONELLA QUINTANA IGG - BARTONELLA AB PANEL - ARUP","code_information":[{"code":"3028661110","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.89,"discounted_cash":67.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BARTONELLA HENSELAE IGM - BARTONELLA AB PANEL - ARUP","code_information":[{"code":"3028661111","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.89,"discounted_cash":67.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLASTOMYCES, ANTIBODY - BLASTOMYCES ANTIBODIES","code_information":[{"code":"3028661201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86612","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FUNGAL ANTIBODIES - BLASTOMYCES","code_information":[{"code":"3028661202","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86612","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLASTOMYCES DERMATITIDIS AB EIA W/ RFLX TO IMMUNODIFFUSION SERUM - ARUP","code_information":[{"code":"3028661203","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86612","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLASTOMYCES ANTIBODY BY EIA - FUNGAL ANTIBODIES W/ REFLEX SERUM - ARUP","code_information":[{"code":"3028661204","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86612","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLASTOMYCES DERMATITIDIS ANTIBODIES IMMUNODIFFUSION SERUM - ARUP","code_information":[{"code":"3028661205","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86612","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BORDETELLA ANTIBODY - BORDETELLA PERTUSSIS ANTIBODY","code_information":[{"code":"3028661501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86615","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BORDETELLA PERTUSSIS ANTIBODIES IGG & IGM","code_information":[{"code":"3028661502","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86615","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BORDETELLA PERTUSSIS IGA IMMUNOBLOT","code_information":[{"code":"3028661503","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86615","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BORDETELLA PERTUSSIS IGG IMMUNOBLOT","code_information":[{"code":"3028661504","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86615","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BORDETELLA PERTUSSIS IGM IMMUNOBLOT","code_information":[{"code":"3028661505","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86615","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BORDETELLA PERTUSSIS ANTIBODY IGA BLOT - ARUP","code_information":[{"code":"3028661507","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86615","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BORDETELLA PERTUSSIS IGG BLOT - ARUP","code_information":[{"code":"3028661508","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86615","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":97.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BORDETELLA PERTUSSIS IGG - BORDETELLA PERTUSSIS IGG IGM AB - ARUP","code_information":[{"code":"3028661509","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86615","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BORDETELLA PERTUSSIS IGM BLOT - ARUP","code_information":[{"code":"3028661510","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86615","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LYME DISEASE ANTIBODY, CONFIRMATORY - LYME DISEASE, WESTERN BLOT","code_information":[{"code":"3028661701","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.51,"discounted_cash":103.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BORRELIA BURGDORFERI IMMUNOBLOT IGM","code_information":[{"code":"3028661703","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.51,"discounted_cash":103.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BORRELIA BURGDORFERI ANTIBODY IMMUNOBLOT CSF","code_information":[{"code":"3028661704","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.51,"discounted_cash":103.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BORRELIA BURGDORFERI IMMUNOBLOT IGG","code_information":[{"code":"3028661705","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.51,"discounted_cash":103.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC B. BURGDORFERI (LYME) IGM CSF","code_information":[{"code":"3028661706","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.51,"discounted_cash":103.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC B. BURGDORFERI (LYME) IGG - ARUP","code_information":[{"code":"3028661707","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.51,"discounted_cash":103.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BORRELIA BUGDORFERI/LYME IGG BY IMMUNOBLOT - LYME ANTIBODIES - ARUP","code_information":[{"code":"3028661708","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.51,"discounted_cash":103.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BORRELIA BUGDORFERI/LYME IGM BY IMMUNOBLOT - LYME ANTIBODIES - ARUP","code_information":[{"code":"3028661709","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.51,"discounted_cash":103.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BORRELIA BURGDORFERI IGM BY IMMUNOBLOT REFLEX - ARUP","code_information":[{"code":"3028661713","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.51,"discounted_cash":103.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC B BURGDORFERI ANTIBODY - LYME STANDARD 2-TIER, 1ST TIER - ARUP","code_information":[{"code":"3028661802","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86618","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.53,"discounted_cash":113.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LYME DISEASE ANTIBODY - LYME DISEASE (BORRELIA BURGDORFERI), QUANT","code_information":[{"code":"3028661803","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86618","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.56,"discounted_cash":125.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BRUCELLA, ANTIBODY - BRUCELLA SPECIES ANTIBODY","code_information":[{"code":"3028662201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86622","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.47,"discounted_cash":66.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BRUCELLA SPECIES ANTIBODY TOTAL - ARUP","code_information":[{"code":"3028662202","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86622","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.47,"discounted_cash":66.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BRUCELLA ANTIBODY - FEBRILE ANTIBODIES ID PANEL - ARUP","code_information":[{"code":"3028662203","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86622","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.47,"discounted_cash":66.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CAMPYLOBACTER, ANTIBODY - CAMPYLOBACTER JEJUNI ANTIBODY","code_information":[{"code":"3028662501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86625","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CANDIDA, ANTIBODY - CANDIDA ANTIBODY","code_information":[{"code":"3028662801","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86628","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CANDIDA IGA - CANDIDA ANTIBODIES IGA IGG IGM - ARUP","code_information":[{"code":"3028662802","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86628","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CANDIDA IGG - CANDIDA ANTIBODIES IGA IGG IGM - ARUP","code_information":[{"code":"3028662803","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86628","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CANDIDA IGM - CANDIDA ANTIBODIES IGA IGG IGM - ARUP","code_information":[{"code":"3028662804","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86628","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C PSITTACI IGG TITER - CHLAMYDIA ANTIBODY PANEL IGG IGM - ARUP","code_information":[{"code":"3028663101","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.02,"discounted_cash":79.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C PSITTACI IGG TITER - CHLAMYDIA ANTIBODY PANEL IGG IGM - ARUP","code_information":[{"code":"3028663102","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.02,"discounted_cash":79.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C PNEUMONIAE IGG - CHLAMYDIA ANTIBODY PANEL IGG - ARUP","code_information":[{"code":"3028663105","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.02,"discounted_cash":79.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C PSITTACI IGG - CHLAMYDIA ANTIBODY PANEL IGG - ARUP","code_information":[{"code":"3028663106","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.02,"discounted_cash":79.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C TRACHOMATIS IGG - CHLAMYDIA ANTIBODY PANEL IGG - ARUP","code_information":[{"code":"3028663107","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.02,"discounted_cash":79.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C PNEUMONIAE IGG TITER - CHLAMYDIA ANTIBODY PANEL IGG IGM - ARUP","code_information":[{"code":"3028663108","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.02,"discounted_cash":79.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C TRACHOMATIS IGG TITER - CHLAMYDIA ANTIBODY PANEL IGG IGM - ARUP","code_information":[{"code":"3028663109","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.02,"discounted_cash":79.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C PSITTACI IGM TITER - CHLAMYDIA ANTIBODY PANEL IGG IGM - ARUP","code_information":[{"code":"3028663201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86632","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.59,"discounted_cash":84.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C PNEUMONIAE IGM TITER - CHLAMYDIA ANTIBODY PANEL IGG IGM - ARUP","code_information":[{"code":"3028663202","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86632","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.59,"discounted_cash":84.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C PSITTACI IGM TITER - CHLAMYDIA ANTIBODY PANEL IGG IGM - ARUP","code_information":[{"code":"3028663203","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86632","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.59,"discounted_cash":84.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C TRACHOMATIS IGM TITER - CHLAMYDIA ANTIBODY PANEL IGG IGM - ARUP","code_information":[{"code":"3028663204","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86632","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.59,"discounted_cash":84.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COCCIDIOIDES, ANTIBODY - COCCIDIOIDES ANTIBODIES","code_information":[{"code":"3028663501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.8,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FUNGAL ANTIBODIES - COCCIDIOEDES","code_information":[{"code":"3028663502","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.8,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COCCIDIOIDES, ANTIBODY - COCCIDIOIDES COMP FIX","code_information":[{"code":"3028663503","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.8,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COCCIDIOIDES, ANTIBODY - COCCIDIOIDES IMMUNODIFFUSION","code_information":[{"code":"3028663506","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.8,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COCCIDIOIDES BY COMPLEMENT FIXATION-COCCIDIOIDES AB PNL SERUM ELISA-ARUP","code_information":[{"code":"3028663507","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.8,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COCCIDIOIDES BY IMMUNODIFFUSION - COCCIDIOIDES AB PNL SERUM ELISA - ARUP","code_information":[{"code":"3028663508","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.8,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COCCIDIOIDES IGG - COCCIDIOIDES AB PNL SERUM ELISA - ARUP","code_information":[{"code":"3028663509","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.8,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COCCIDIOIDES IGM - COCCIDIOIDES AB PNL SERUM ELISA - ARUP","code_information":[{"code":"3028663510","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.8,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COCCIDIOIDES IGG BY ELISA - COCCIDIOIDES ANTIBODY REFLEX PANEL - ARUP","code_information":[{"code":"3028663511","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.8,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COCCIDIOIDES IGM BY ELISA - COCCIDIOIDES ANTIBODY REFLEX PANEL - ARUP","code_information":[{"code":"3028663512","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.8,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COCCIDIOIDES IGG BY ELISA - COCCIDIOIDES IGG IGM AB - ARUP","code_information":[{"code":"3028663513","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.8,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COCCIDIOIDES IGM BY ELISA - COCCIDIOIDES IGG IGM AB - ARUP","code_information":[{"code":"3028663514","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.8,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COCCIDIOIDES BY COMPLEMENT FIXATION - FUNGAL AB W/RFLX SERUM - ARUP","code_information":[{"code":"3028663515","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.8,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COCCIDIOIDES ANTIBODY TITER COMPLEMENT FIXATION - ARUP","code_information":[{"code":"3028663516","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.8,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COCCIDIOIDES ANTIBODY BY IMMUNODIFFUSION REFLEX - ARUP","code_information":[{"code":"3028663517","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.8,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC Q FEVER ANTIBODY - Q FEVER ANTIBODY","code_information":[{"code":"3028663801","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86638","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":81.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COXIELLA BURNETTI ANTIBODY IGG","code_information":[{"code":"3028663802","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86638","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":81.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COXIELLA BURNETTI ANTIBODY IGG PHASE 2 TITER","code_information":[{"code":"3028663804","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86638","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":81.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COXIELLA BURNETTI ANTIBODY IGM PHASE 2 TITER","code_information":[{"code":"3028663806","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86638","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":81.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC Q FEVER (COXIELLA BURNETII) IGG PHASE 1 - Q FEVER ANTIBODY - ARUP","code_information":[{"code":"3028663807","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86638","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":81.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC Q FEVER (COXIELLA BURNETII) IGG PHASE 2 - Q FEVER ANTIBODY - ARUP","code_information":[{"code":"3028663808","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86638","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":81.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC Q FEVER (COXIELLA BURNETII) IGG PHASE 1 - Q FEVER IGG IGM AB RFLX - ARUP","code_information":[{"code":"3028663810","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86638","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":81.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC Q FEVER (COXIELLA BURNETII) IGG PHASE 2 - Q FEVER IGG IGM AB RFLX - ARUP","code_information":[{"code":"3028663811","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86638","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":81.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC Q FEVER (COXIELLA BURNETII) IGM PHASE 1 - Q FEVER IGG IGM AB RFLX - ARUP","code_information":[{"code":"3028663812","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86638","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":81.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC Q FEVER (COXIELLA BURNETII) IGM PHASE 2 - Q FEVER IGG IGM AB RFLX - ARUP","code_information":[{"code":"3028663813","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86638","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":81.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC Q FEVER (COXIELLA BURNETII) IGG PHASE 2 TITER - ARUP","code_information":[{"code":"3028663814","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86638","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.25,"discounted_cash":81.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CRYPTOCOCCUS ANTIBODY - CRYPTOCOCCUS ANTIBODY","code_information":[{"code":"3028664101","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86641","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.72,"discounted_cash":95.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CMV ANTIBODY - CMV IGG","code_information":[{"code":"3028664401","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.87,"discounted_cash":105.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTOMEGALOVIRUS (CMV) IGG - CMV ANTIBODIES IGG IGM - ARUP","code_information":[{"code":"3028664403","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.87,"discounted_cash":105.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTOMEGALOVIRUS (CMV) IGG - TORCH ANTIBODIES IGG - ARUP","code_information":[{"code":"3028664405","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.87,"discounted_cash":105.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CMV ANTIBODY, IGM - CMV IGM","code_information":[{"code":"3028664501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86645","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.33,"discounted_cash":124.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTOMEGALOVIRUS (CMV) IGM - CMV ANTIBODIES IGG IGM - ARUP","code_information":[{"code":"3028664503","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86645","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.33,"discounted_cash":124.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTOMEGALOVIRUS (CMV) IGM - TORCH ANTIBODIES - ARUP","code_information":[{"code":"3028664504","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86645","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.33,"discounted_cash":124.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTOMEGALOVIRUS (CMV) IGM - ARUP","code_information":[{"code":"3028664505","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86645","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.33,"discounted_cash":124.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENCEPHALITIS CALIFORN ANTBDY - ENCEPHALITIS, CALIFORNIA ANTIBODY IGG","code_information":[{"code":"3028665101","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86651","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENCEPHALITIS CALIFORN ANTBDY - ENCEPHALITIS, CALIFORNIA ANTIBODY IGM","code_information":[{"code":"3028665102","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86651","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENCEPHAL ANTIBODY CALIF - ADDITIONAL CHARGE","code_information":[{"code":"3028665103","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86651","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CALIFORNIA ENCEPHALITIS IGG - ARBOVIRUS PANEL IGG - ARUP","code_information":[{"code":"3028665105","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86651","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CALIFORNIA ENCEPHALITIS IGG CSF- ARBOVIRUS PANEL IGG CSF - ARUP","code_information":[{"code":"3028665107","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86651","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CALIFORNIA ENCEPHALITIS IGM CSF - ARBOVIRUS PANEL, IGM CSF - ARUP","code_information":[{"code":"3028665108","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86651","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CALIFORNIA ENCEPHALITIS IGM - ARBOVIRUS PANEL IGM - ARUP","code_information":[{"code":"3028665109","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86651","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENCEPHALTIS EAST EQNE ANBDY - ENCEPHALITIS, EASTERN EQUINE ANTI IGG","code_information":[{"code":"3028665201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86652","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENCEPHALTIS EAST EQNE ANBDY - ENCEPHALITIS, EASTERN EQUINE ANTI IGM","code_information":[{"code":"3028665202","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86652","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENCEPHAL ANTIBODY EAST EQU - ADDITIONAL CHARGE","code_information":[{"code":"3028665203","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86652","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENCEPHALTIS EAST EQNE ANBDY - ENCEPHALITIS, EASTERN EQUINE ANTI IGG CSF","code_information":[{"code":"3028665204","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86652","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENCEPHALTIS EAST EQNE ANBDY - ENCEPHALITIS, EASTERN EQUINE ANTI IGM CSF","code_information":[{"code":"3028665205","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86652","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EASTERN EQUINE ENCEPHALITIS IGG - ARBOVIRUS PANEL IGG - ARUP","code_information":[{"code":"3028665206","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86652","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EASTERN EQUINE ENCEPHALITIS IGM - ARBOVIRUS PANEL IGM - ARUP","code_information":[{"code":"3028665207","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86652","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EASTERN EQUINE ENCEPHALITIS IGG CSF - ARBOVIRUS PANEL IGG CSF - ARUP","code_information":[{"code":"3028665208","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86652","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EASTERN EQUINE ENCEPHALITIS IGM CSF - ARBOVIRUS PANEL IGM CSF - ARUP","code_information":[{"code":"3028665209","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86652","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENCEPHALTIS ST LOUIS ANTBODY - ENCEPHALITIS, ST. LOUIS ANTIBODY, IGG","code_information":[{"code":"3028665301","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86653","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENCEPHALTIS ST LOUIS ANTBODY - ENCEPHALITIS, ST. LOUIS ANTIBODY, IGM","code_information":[{"code":"3028665302","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86653","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENCEPHAL ANTIBODY ST LOUIS - ADDITIONAL CHARGE","code_information":[{"code":"3028665303","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86653","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENCEPHALTIS ST LOUIS ANTBODY - ENCEPHALITIS, ST. LOUIS ANTIBODY, IGG CSF","code_information":[{"code":"3028665304","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86653","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENCEPHALTIS ST LOUIS ANTBODY - ENCEPHALITIS, ST. LOUIS ANTIBODY, IGM CSF","code_information":[{"code":"3028665305","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86653","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ST LOUIS ENCEPHALITIS IGG - ARBOVIRUS PANEL IGG - ARUP","code_information":[{"code":"3028665306","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86653","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ST LOUIS ENCEPHALITIS IGM - ARBOVIRUS PANEL IGM - ARUP","code_information":[{"code":"3028665307","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86653","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ST LOUIS ENCEPHALITIS IGG CSF - ARBOVIRUS PANEL IGG CSF - ARUP","code_information":[{"code":"3028665308","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86653","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ST LOUIS ENCEPHALITIS IGM CSF - ARBOVIRUS PANEL IGM CSF - ARUP","code_information":[{"code":"3028665309","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86653","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENCEPHALTIS WEST EQNE ANTBDY - ENCEPHALITIS, WESTERN EQUINE ANTI IGG","code_information":[{"code":"3028665401","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86654","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENCEPHALTIS WEST EQNE ANTBDY - ENCEPHALITIS, WESTERN EQUINE ANTI IGM","code_information":[{"code":"3028665402","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86654","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENCEPHAL ANTIBODY WEST EQU - ADDITIONAL CHARGE","code_information":[{"code":"3028665403","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86654","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENCEPHALTIS WEST EQNE ANTBDY - ENCEPHALITIS, WESTERN EQUINE ANTI IGG CSF","code_information":[{"code":"3028665404","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86654","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENCEPHALTIS WEST EQNE ANTBDY - ENCEPHALITIS, WESTERN EQUINE ANTI IGM CSF","code_information":[{"code":"3028665405","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86654","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WESTERN EQUINE ENCEPHALITIS IGG -ARBOVIRUS PANEL IGG - ARUP","code_information":[{"code":"3028665406","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86654","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WESTERN EQUINE ENCEPHALITIS IGM - ARBOVIRUS PANEL IGM - ARUP","code_information":[{"code":"3028665407","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86654","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WESTERN EQUINE ENCEPHALITIS IGG CSF-ARBOVIRUS PANEL IGG CSF - ARUP","code_information":[{"code":"3028665408","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86654","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WESTERN EQUINE ENCEPHALITIS IGM CSF-ARBOVIRUS PANEL IGM CSF - ARUP","code_information":[{"code":"3028665409","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86654","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENTEROVIRUS ANTIBODY - ENTEROVIRUS PANEL","code_information":[{"code":"3028665801","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.81,"discounted_cash":86.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENTEROVIRUS ANTIBODY - POLIOVIRUS ANTIBODIES, TYPES 1, 2, AND 3","code_information":[{"code":"3028665802","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.81,"discounted_cash":86.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENTEROVIRUS ANTIBODY - ENTEROVIRUS PANEL COXSACKIE","code_information":[{"code":"3028665803","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.81,"discounted_cash":86.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ECHOVIRUS TYPE 6 - ECHOVIRUS ANTIBODY PANEL - ARUP","code_information":[{"code":"3028665806","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.81,"discounted_cash":86.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ECHOVIRUS TYPE 7 - ECHOVIRUS ANTIBODY PANEL - ARUP","code_information":[{"code":"3028665807","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.81,"discounted_cash":86.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ECHOVIRUS TYPE 11 - ECHOVIRUS ANTIBODY PANEL - ARUP","code_information":[{"code":"3028665808","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.81,"discounted_cash":86.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ECHOVIRUS TYPE 30 - ECHOVIRUS ANTIBODY PANEL - ARUP","code_information":[{"code":"3028665809","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.81,"discounted_cash":86.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ECHOVIRUS TYPE 9 - ECHOVIRUS ANTIBODY PANEL - ARUP","code_information":[{"code":"3028665810","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.81,"discounted_cash":86.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC POLIO VIRUS TYPE 1 - POLIOVIRUS ANTIBODIES TYPES 1 AND 3 - ARUP","code_information":[{"code":"3028665811","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.81,"discounted_cash":86.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC POLIO VIRUS TYPE 3 - POLIOVIRUS ANTIBODIES TYPES 1 AND 3 - ARUP","code_information":[{"code":"3028665812","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.81,"discounted_cash":86.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EPSTEIN BARR VIRUS EARLY IGG","code_information":[{"code":"3028666301","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86663","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EBV - EARLY IGG - EPSTEIN-BARR VIRUS ANTIBODY PANEL 1 - ARUP","code_information":[{"code":"3028666302","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86663","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EPSTEIN BARR VIRUS EARLY ANTIGEN IGG - ARUP","code_information":[{"code":"3028666303","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86663","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EPSTEIN-BARR NUCLEAR ANTIGEN - EPSTEIN-BARR VIRUS NUCLEAR ANTIGEN AB","code_information":[{"code":"3028666401","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86664","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.25,"discounted_cash":113.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EBV - NUCLEAR AG, IGG - EPSTEIN-BARR VIRUS ANTIBODY PANEL 1 - ARUP","code_information":[{"code":"3028666402","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86664","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.25,"discounted_cash":113.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EPSTEIN-BARR CAPSID VCA, IGG","code_information":[{"code":"3028666501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.18,"discounted_cash":134.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EPSTEIN-BARR CAPSID VCA, IGM","code_information":[{"code":"3028666502","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.32,"discounted_cash":121.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EPSTEIN BARR VIRUS CAPSID VCA IGG - EBV ANTIBODY PANEL","code_information":[{"code":"3028666503","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.18,"discounted_cash":134.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EPSTEIN-BARR VIRUS VCA, IGG","code_information":[{"code":"3028666505","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.18,"discounted_cash":134.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VCA IGG - EPSTEIN-BARR VIRUS ANTIBODY PANEL 1 - ARUP","code_information":[{"code":"3028666509","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.18,"discounted_cash":134.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EPSTEIN BARR VIRUS AB TO VIRAL CAPSID AG, IGM - ARUP","code_information":[{"code":"3028666512","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.18,"discounted_cash":134.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VCA IGM - EPSTEIN-BARR VIRUS ANTIBODY PANEL 1 - ARUP","code_information":[{"code":"3028666513","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.18,"discounted_cash":134.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EPSTEIN BARR VIRUS CAPSID VCA IGM - ARUP","code_information":[{"code":"3028666517","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.18,"discounted_cash":134.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EPSTEIN BARR VIRUS CAPSID VCA IGM - EBV ANTIBODY PANEL","code_information":[{"code":"3028666520","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.18,"discounted_cash":134.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EHRLICHIA ANTIBODY - EHRLICHIA CHAFFEENSIS PANEL","code_information":[{"code":"3028666601","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86666","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.89,"discounted_cash":67.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EHRLICHIA ANTIBODY - ANAPLASMA PHAGOCYTOPHILUM IGG","code_information":[{"code":"3028666602","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86666","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.89,"discounted_cash":67.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EHRLICHIA ANTIBODY - ANAPLASMA PHAGOCYTOPHILUM IGM","code_information":[{"code":"3028666603","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86666","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.89,"discounted_cash":67.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANAPLASMA PHGOCYTOPHILUM IGG - ANAPLASMA PHAGOCYTOPHYLLIU IGG IGM - ARUP","code_information":[{"code":"3028666604","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86666","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.89,"discounted_cash":67.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANAPLASMA PHGOCYTOPHILUM IGM - ANAPLASMA PHAGOCYTOPHYLLIU IGG IGM - ARUP","code_information":[{"code":"3028666605","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86666","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.89,"discounted_cash":67.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FUNGUS, ANTIBODY - SACCHAROMYCES CEREVISIAE ANTIBODIES, IGG AND IGA","code_information":[{"code":"3028667112","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.36,"discounted_cash":82.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC S CEREVISIAE IGG/IGA - INFLAMMATORY BOWEL DISEASE PANEL - ARUP","code_information":[{"code":"3028667113","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.36,"discounted_cash":82.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FUNGUS, ANTIBODY - OTHER ORGANISM ANTIBODIES","code_information":[{"code":"3028667115","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.36,"discounted_cash":82.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GIARDIA LAMBLIA AB IGA","code_information":[{"code":"3028667402","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86674","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.52,"discounted_cash":51.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC G LAMBLIA AB IGM","code_information":[{"code":"3028667403","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86674","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.52,"discounted_cash":51.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GIARDIA LAMBLIA AB IGG","code_information":[{"code":"3028667405","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86674","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.52,"discounted_cash":51.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HELICOBACTER PYLORI - HELICOBACTER PYLORI IGG","code_information":[{"code":"3028667702","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86677","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.41,"discounted_cash":112.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HELMINTH, ANTIBODY - CYSTICERCOSIS ANTIBODY, IGG","code_information":[{"code":"3028668201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86682","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.81,"discounted_cash":86.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HELMINTH, ANTIBODY - ECHINOCOCCUS ANTIBODY, IGG","code_information":[{"code":"3028668202","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86682","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.81,"discounted_cash":86.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HELMINTH, ANTIBODY - SCHISTOSOMA ANTIBODY, IGG","code_information":[{"code":"3028668204","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86682","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.81,"discounted_cash":86.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HELMINTH, ANTIBODY - TOXACARA ANTIBODY","code_information":[{"code":"3028668205","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86682","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.81,"discounted_cash":86.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HELMINTH, ANTIBODY - STRONGYLOIDES ANTIBODY, IGG","code_information":[{"code":"3028668206","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86682","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.81,"discounted_cash":86.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC STRONGYLOIDES IGG - ARUP","code_information":[{"code":"3028668207","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86682","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.81,"discounted_cash":86.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOXOCARA IGG - ARUP","code_information":[{"code":"3028668208","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86682","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.81,"discounted_cash":86.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ECHINOCOCCUS IGG - ARUP","code_information":[{"code":"3028668209","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86682","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.81,"discounted_cash":86.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SCHISTOSOMA IGG - ARUP","code_information":[{"code":"3028668210","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86682","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.81,"discounted_cash":86.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HTLV/HIV CONFIRMATORY TEST - HIV-1 WESTERN BLOT","code_information":[{"code":"3028668901","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86689","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.73,"discounted_cash":67.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HUMAN T-LYMPHOTROPIC VIRUS (HTLV) I AND II ANTIBODY WESTERN BLOT - ARUP","code_information":[{"code":"3028668903","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86689","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.73,"discounted_cash":67.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS, DELTA AGENT - HEPATITIS DELTA VIRUS","code_information":[{"code":"3028669201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86692","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.79,"discounted_cash":126.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS DELTA VIRUS - ARUP","code_information":[{"code":"3028669202","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86692","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.79,"discounted_cash":126.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX TEST, UNSPECIFIED TYPE - HSV NON-SPECIFIC TYPE IGG AB","code_information":[{"code":"3028669401","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86694","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.72,"discounted_cash":95.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX TEST, UNSPECIFIED TYPE - HSV NON-SPECIFIC ANTIBODY","code_information":[{"code":"3028669402","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86694","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.72,"discounted_cash":95.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX TEST, UNSPECIFIED TYPE - HSV NON-SPECIFIC TYPE IGM AB","code_information":[{"code":"3028669403","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86694","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.72,"discounted_cash":95.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX VIRUS (HSV) 1/2 IGG CSF - ARUP","code_information":[{"code":"3028669406","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86694","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.72,"discounted_cash":95.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX VIRUS (HSV) TYPE 1/2 IGM CSF - ARUP","code_information":[{"code":"3028669407","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86694","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.72,"discounted_cash":95.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX VIRUS (HSV) 1/2 COMBINED IGG - ARUP","code_information":[{"code":"3028669408","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86694","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.72,"discounted_cash":95.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX VIRUS (HSV) TYPE 1/2 IGM - ARUP","code_information":[{"code":"3028669409","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86694","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.72,"discounted_cash":95.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX VIRUS (HSV) 1/2 IGG - TORCH ANTIBODIES IGG - ARUP","code_information":[{"code":"3028669410","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86694","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.72,"discounted_cash":95.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX VIRUS (HSV) 1/2 IGM - TORCH ANTIBODIES IGM - ARUP","code_information":[{"code":"3028669411","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86694","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.72,"discounted_cash":95.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX VIRUS(HSV) 1/2 IGG W/ RFLX TYPE 1/2 GLYCO G SPECIFIC-ARUP","code_information":[{"code":"3028669412","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86694","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.72,"discounted_cash":95.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX TEST, TYPE 1 IGG","code_information":[{"code":"3028669501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":97.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX TEST, TYPE 1 - HSV 1 IGM ANTIBODY","code_information":[{"code":"3028669502","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX 1 GLYCOPROTEIN G AB IGG","code_information":[{"code":"3028669503","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":97.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TYPE 1 IGG - HERPES SIMPLEX VIRUS 1/2 IGG TYPE SPECIFIC AB - QWDL","code_information":[{"code":"3028669505","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":97.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TYPE 1 IGG - HERPES SIMPLEX 1/2 GLYCOPROTEIN G IGG AB - ARUP","code_information":[{"code":"3028669506","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":97.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX VIRUS TYPE 1 IGG - HSV 1 AND 2 ANTIBODY IGG","code_information":[{"code":"3028669508","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":97.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HSV TYPE 1 IGG - HSV 1 GLYCOPROTEIN G IGG - ARUP","code_information":[{"code":"3028669509","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":97.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HSV 1 GLYCOPROTEIN G-SPECIFIC IGG - HSV 1&2 GLYCOPROTEIN G IGG AB - ARUP","code_information":[{"code":"3028669512","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":97.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HSV TYPE 2 IGG - HSV 2 GLYCOPROTEIN G IGG - ARUP","code_information":[{"code":"3028669601","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.8,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX TEST, TYPE 2 - HSV 2 IGM ANTIBODY","code_information":[{"code":"3028669602","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.8,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX VIRUS 2 IGM AB TITER","code_information":[{"code":"3028669603","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.11,"discounted_cash":129.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TYPE 2 IGG - HERPES SIMPLEX VIRUS 1/2 IGG TYPE SPECIFIC AB - QWDL","code_information":[{"code":"3028669604","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.8,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TYPE 2 IGG - HERPES SIMPLEX VIRUS 2 GLYCOPROTEIN G AB IGG - ARUP","code_information":[{"code":"3028669605","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.8,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TYPE 2 IGG - HERPES SIMPLEX VIRUS-2 IGG INHIBITION BY ELISA - ARUP","code_information":[{"code":"3028669606","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.11,"discounted_cash":129.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TYPE 2 IGG - HERPES SIMPLEX 1/2 GLYCOPROTEIN G IGG AB - ARUP","code_information":[{"code":"3028669607","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.8,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HSV 2 GLYCOPROTEIN G IGG - ARUP","code_information":[{"code":"3028669609","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.8,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HSV 2 IGG INHIBITION ELISA - ARUP","code_information":[{"code":"3028669611","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.8,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX VIRUS TYPE 2 IGG - HSV 1 AND 2 ANTIBODY IGG","code_information":[{"code":"3028669615","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.8,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HSV 2 GLYCOPROTEIN G-SPECIFIC IGG - HSV 1&2 GLYCOPROTEIN G IGG AB - ARUP","code_information":[{"code":"3028669617","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.8,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HISTOPLASMA - HISTOPLASMA ANTIBODIES","code_information":[{"code":"3028669801","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.38,"discounted_cash":92.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FUNGAL ANTIBODIES - HISTOPLASMA","code_information":[{"code":"3028669802","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.38,"discounted_cash":92.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HISTOPLASMA MYCELIA AB BY COMPLEMENTFIXATION-FUNGAL AB W/RFLX SERUM-ARUP","code_information":[{"code":"3028669808","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.38,"discounted_cash":92.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HISTOPLASMA YEAST AB BY COMPLEMENT FIXATION-FUNGAL AB W/RFLX SERUM-ARUP","code_information":[{"code":"3028669809","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.38,"discounted_cash":92.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HISTOPLASMA MYCELIA ANTIBODIES - HISTOPLASMA ANTIBODIES BY CF - ARUP","code_information":[{"code":"3028669810","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.38,"discounted_cash":92.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HISTOPLASMA YEAST ANTIBODIES - HISTOPLASMA ANTIBODIES BY CF - ARUP","code_information":[{"code":"3028669811","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.38,"discounted_cash":92.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HIV-1 - HIV 1 ANTIBODY EIA","code_information":[{"code":"3028670101","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86701","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.22,"discounted_cash":130.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HIV 1 - HIV 1/2 AB DIFF, SUPPLEMENTAL - ARUP","code_information":[{"code":"3028670103","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86701","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.22,"discounted_cash":130.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HIV 1 - HIV 1 AND 2 ANTIBODY DIFFERENTIATION","code_information":[{"code":"3028670104","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86701","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.22,"discounted_cash":130.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HIV-2 - HIV-2 ANTIBODIES","code_information":[{"code":"3028670201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86702","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.15,"discounted_cash":90.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HIV 2 - HIV 1/2 AB DIFF, SUPPLEMENTAL - ARUP","code_information":[{"code":"3028670202","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86702","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.15,"discounted_cash":90.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HIV 2 - HIV 1 AND 2 ANTIBODY DIFFERENTIATION","code_information":[{"code":"3028670203","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86702","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.15,"discounted_cash":90.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HIV-1/HIV-2, SINGLE ASSAY - RAPID HIV 1 AND 2 SCREEN","code_information":[{"code":"3028670301","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86703","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.25,"discounted_cash":161.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS B CORE ANTIBODY TOTAL","code_information":[{"code":"3028670401","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86704","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS B CORE ANTIBODY IGM","code_information":[{"code":"3028670501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86705","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.02,"discounted_cash":79.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS B VIRUS CORE IGM - HEPATITIS PANEL ACUTE","code_information":[{"code":"3028670503","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86705","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.02,"discounted_cash":79.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS B SURFACE ANTIBODY","code_information":[{"code":"3028670601","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86706","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.78,"discounted_cash":78.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DONOR HEPATITIS B SURFACE ANTIBODY","code_information":[{"code":"3028670602","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86706","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.78,"discounted_cash":78.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS B SURFACE ANTIBODY - ARUP","code_information":[{"code":"3028670603","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86706","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.78,"discounted_cash":78.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS B SURFACE ANTIBODY QUAL - QWDL","code_information":[{"code":"3028670604","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86706","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.78,"discounted_cash":78.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS BE AB TEST - HEPATITIS B E ANTIBODY","code_information":[{"code":"3028670701","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86707","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.94,"discounted_cash":84.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS B E VIRUS ANTIBODY - ARUP","code_information":[{"code":"3028670702","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86707","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.94,"discounted_cash":84.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS A ANTIBODY TOTAL","code_information":[{"code":"3028670801","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86708","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.09,"discounted_cash":91.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS A IGM","code_information":[{"code":"3028670901","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86709","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.7,"discounted_cash":83.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS A VIRUS IGM - HEPATITIS PANEL ACUTE","code_information":[{"code":"3028670903","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86709","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.7,"discounted_cash":83.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INFLUENZA VIRUS - INFLUENZA TYPE B ANTIBODY","code_information":[{"code":"3028671002","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86710","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.15,"discounted_cash":90.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INFLUENZA VIRUS - INFLUENZA TYPE A&B ANTIBODIES","code_information":[{"code":"3028671003","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86710","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.15,"discounted_cash":90.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC JOHN CUNNINGHAM ANTIBODY","code_information":[{"code":"3028671101","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86711","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.12,"discounted_cash":59.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC JOHN CUNNINGHAM VIRUS ANTIBODY INHIBITION - ARUP","code_information":[{"code":"3028671102","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86711","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.12,"discounted_cash":59.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC JC VIRUS ANTIBODY BY ELISA, SERUM, WITH REFLEX - ARUP","code_information":[{"code":"3028671103","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86711","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.12,"discounted_cash":59.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEGIONELLA - LEGIONELLA PNEUMOPHILA TOTL AB","code_information":[{"code":"3028671301","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86713","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.4,"discounted_cash":102.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEGIONELLA ANTIBODY IGM 1-6","code_information":[{"code":"3028671303","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86713","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.4,"discounted_cash":102.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEGIONELLA ANTIBODY IGG","code_information":[{"code":"3028671304","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86713","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEGIONELLA PNEUMONPHILA IGG IGA IGM TYPE 1 THRU 6 BY ELISA - ARUP","code_information":[{"code":"3028671305","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86713","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.4,"discounted_cash":102.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEISHMANIA AB - LEISHMANIA ANTIBODY","code_information":[{"code":"3028671707","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86717","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.24,"discounted_cash":338.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEISHMANIA IGG - ARUP","code_information":[{"code":"3028671708","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86717","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.24,"discounted_cash":338.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEPTOSPIRA - LEPTOSPIRA ANTIBODY","code_information":[{"code":"3028672001","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86720","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.96,"discounted_cash":107.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEPTOSPIRA IGM - ARUP","code_information":[{"code":"3028672002","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86720","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.96,"discounted_cash":107.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LYMPH CHORIOMENINGITIS - LYMPHOCYTIC CHORIOMENINGITIS ANTIBODY","code_information":[{"code":"3028672701","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86727","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LCM VIRUS IGG - LYMPHOCYTIC CHORIOMENINGITIS ANTIBODY - ARUP","code_information":[{"code":"3028672702","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86727","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LCM VIRUS IGM - LYMPHOCYTIC CHORIOMENINGITIS ANTIBODY - ARUP","code_information":[{"code":"3028672703","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86727","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MUMPS - MUMPS IGG ANTIBODY","code_information":[{"code":"3028673501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.81,"discounted_cash":86.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MUMPS - MUMPS IGM ANTIBODY","code_information":[{"code":"3028673502","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.81,"discounted_cash":86.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MUMPS IGG - QUALITATIVE","code_information":[{"code":"3028673503","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.81,"discounted_cash":86.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MUMPS IGG - QUANTITATIVE","code_information":[{"code":"3028673504","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.81,"discounted_cash":86.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MUMPS IGM - ARUP","code_information":[{"code":"3028673507","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.81,"discounted_cash":86.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYCOPLASMA - MYCOPLASMA PNEUMONIAE ANTIBODY, IGM","code_information":[{"code":"3028673801","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86738","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":97.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYCOPLASMA PNEUMONIAE IGG","code_information":[{"code":"3028673802","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86738","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":97.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYCOPLASMA PNEUMONIAE IGG - ARUP","code_information":[{"code":"3028673804","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86738","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":97.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYCOPLASMA PNEUMONIAE IGM - MYCOPLASMA PNEUMONIAE ANTIBODY G/M - ARUP","code_information":[{"code":"3028673805","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86738","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":97.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYCOPLASMA PNEUMONIAE IGG - MYCOPLASMA PNEUMONIAE ANTIBODY G/M - ARUP","code_information":[{"code":"3028673806","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86738","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":97.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEISSERIA MENINGITIDIS - NEISSERIA MENINGITIDIS ANTIBODIES","code_information":[{"code":"3028674101","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86741","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.17,"discounted_cash":46.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PARVOVIRUS - PARVOVIRUS B19 ANTIBODY, IGG AND IGM","code_information":[{"code":"3028674701","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86747","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PARVOVIRUS - PARVOVIRUS B19 ANTIBODY, IGG","code_information":[{"code":"3028674703","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86747","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PARVOVIRUS - PARVOVIRUS B19 ANTIBODY, IGM","code_information":[{"code":"3028674704","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86747","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PARVOVIRUS B19 IGG - ARUP","code_information":[{"code":"3028674705","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86747","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PARVOVIRUS B19 IGM - ARUP","code_information":[{"code":"3028674706","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86747","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PARVOVIRUS B19 IGG - PARVOVIRUS B19 IGG AND IGM - ARUP","code_information":[{"code":"3028674707","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86747","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PARVOVIRUS B19 IGM - PARVOVIRUS B19 IGG AND IGM - ARUP","code_information":[{"code":"3028674708","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86747","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTOZOA, NOT ELSEWHERE - BABESIA MICROTI, IGG","code_information":[{"code":"3028675301","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86753","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.36,"discounted_cash":82.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTOZOA, NOT ELSEWHERE - BABESIA MICROTI, IGM","code_information":[{"code":"3028675302","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86753","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.36,"discounted_cash":82.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTOZOA, NOT ELSEWHERE - TRYPANOSOMA CRUZI ANTIBODY, IGG","code_information":[{"code":"3028675303","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86753","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.36,"discounted_cash":82.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTOZOA, NOT ELSEWHERE - TRYPANOSOMA CRUZI ANTIBODY, IGM","code_information":[{"code":"3028675304","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86753","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.36,"discounted_cash":82.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTOZOA, NOT ELSEWHERE - ANTIBODIES","code_information":[{"code":"3028675305","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86753","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.36,"discounted_cash":82.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTOZOA, NOT ELSEWHERE - E HISTOLYTICA, IGG","code_information":[{"code":"3028675306","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86753","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.36,"discounted_cash":82.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BABESIA MICROTI IGG -BABESIA IGG IGM AB - ARUP","code_information":[{"code":"3028675310","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86753","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.36,"discounted_cash":82.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BABESIA MICROTI IGM -BABESIA IGG IGM AB - ARUP","code_information":[{"code":"3028675311","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86753","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.36,"discounted_cash":82.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRYPANOSOMA CRUZI IGG - ARUP","code_information":[{"code":"3028675312","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86753","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.36,"discounted_cash":82.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC E HISTOLYTICA IGG - ARUP","code_information":[{"code":"3028675313","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86753","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.36,"discounted_cash":82.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RICKETTSIA - RICKETTSIA RICKETTSII ANTIBODY","code_information":[{"code":"3028675701","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.11,"discounted_cash":129.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RICKETTSIA - RICKETTSIA TYPHI (TYPHUS FEVER) ANTIBODY","code_information":[{"code":"3028675702","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.11,"discounted_cash":129.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RICKETTSIA - RICKETTSIA RICKETTSII ANTIBODY IGM","code_information":[{"code":"3028675703","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.11,"discounted_cash":129.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RICKETTSIA TYPHI ANTIBODY IGM","code_information":[{"code":"3028675705","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.11,"discounted_cash":129.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ROCKY MOUNTAIN SPOT FEVER IGG - ARUP","code_information":[{"code":"3028675709","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.11,"discounted_cash":129.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ROCKY MOUNTAIN SPOT FEVER IGG - ROCKY MOUNTAIN SPOT FEVER IGG IGM - ARUP","code_information":[{"code":"3028675710","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.11,"discounted_cash":129.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ROCKY MOUNTAIN SPOT FEVER IGM - ROCKY MOUNTAIN SPOT FEVER IGG IGM - ARUP","code_information":[{"code":"3028675711","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.11,"discounted_cash":129.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ROCKY MOUNTAIN SPOTTED FEVER IGM - ARUP","code_information":[{"code":"3028675712","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.11,"discounted_cash":129.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TYPHUS FEVER IGM - ARUP","code_information":[{"code":"3028675713","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.11,"discounted_cash":129.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TYPHUS FEVER IGG - ARUP","code_information":[{"code":"3028675714","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.11,"discounted_cash":129.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ROCKY MT SPOTTED FEVER IGG - FEBRILE ANTIBODIES ID PANEL - ARUP","code_information":[{"code":"3028675715","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.11,"discounted_cash":129.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ROCKY MT SPOTTED FEVER IGM - FEBRILE ANTIBODIES ID PANEL - ARUP","code_information":[{"code":"3028675716","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.11,"discounted_cash":129.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TYPHUS FEVER IGG - FEBRILE ANTIBODIES ID PANEL - ARUP","code_information":[{"code":"3028675717","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.11,"discounted_cash":129.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TYPHUS FEVER IGM - FEBRILE ANTIBODIES ID PANEL - ARUP","code_information":[{"code":"3028675718","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.11,"discounted_cash":129.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RUBELLA - RUBELLA ANTIBODY, IGM","code_information":[{"code":"3028676201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.72,"discounted_cash":95.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RUBELLA IGG QUANTITATIVE","code_information":[{"code":"3028676202","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.87,"discounted_cash":105.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RUBELLA AB IGG - ARUP","code_information":[{"code":"3028676203","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.87,"discounted_cash":105.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RUBELLA IGG QUALITATIVE","code_information":[{"code":"3028676205","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.87,"discounted_cash":105.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RUBELLA IGG - TORCH ANTIBODIES IGG - ARUP","code_information":[{"code":"3028676208","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.87,"discounted_cash":105.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RUBELLA IGM - TORCH ANTIBODIES IGM - ARUP","code_information":[{"code":"3028676209","type":"CDM"},{"code":"0301","type":"RC"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.87,"discounted_cash":105.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RUBEOLA ANTIBODY IGG","code_information":[{"code":"3028676501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RUBEOLA - RUBEOLA ANTIBODY, IGM","code_information":[{"code":"3028676502","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RUBEOLA (MEASLES) - MEASLES MUMPS, IGG","code_information":[{"code":"3028676503","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RUBEOLA ANTIBODY, IGG - ARUP","code_information":[{"code":"3028676504","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MEASLES ANTIBODY (IGG) - QWDL","code_information":[{"code":"3028676505","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RUBEOLA (MEASLES) IGM - ARUP","code_information":[{"code":"3028676510","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SALMONELLA - SALMONELLA ANTIBODY","code_information":[{"code":"3028676801","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86768","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SALMONELLA ANTIBODIES - FEBRILE ANTIBODIES IDENTIFICATION PANEL - ARUP","code_information":[{"code":"3028676802","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86768","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SALMONELLA TYPHY / PARATYPHI ANTIBODY - ARUP","code_information":[{"code":"3028676803","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86768","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SARS-COV-2 COVID-19 ANTIBODY - COVID-19 ANTIBODY TITER, IGG AND IGM","code_information":[{"code":"3028676901","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86769","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.59,"discounted_cash":281.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COVID-19 SARS-COV-2 ANTIBODY","code_information":[{"code":"3028676902","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86769","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.59,"discounted_cash":281.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COVID-19 SARS-COV-2 IGG SPIKE SEMI-QUANTITATIVE BY CIA - ARUP","code_information":[{"code":"3028676903","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86769","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.59,"discounted_cash":281.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COVID-19 SARS-COV-2 IGG QUALITATIVE - ARUP","code_information":[{"code":"3028676905","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86769","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.59,"discounted_cash":281.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOXOPLASMA - TOXOPLASMA GONDII IGG ANTIBODY","code_information":[{"code":"3028677701","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86777","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.87,"discounted_cash":105.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOXOPLASMA GONDII IGG ELISA CSF - ARUP","code_information":[{"code":"3028677705","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86777","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.87,"discounted_cash":105.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOXOPLASMA GONDII IGG - TORCH ANTIBODIES IGG - ARUP","code_information":[{"code":"3028677706","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86777","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.87,"discounted_cash":105.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOXOPLASMA GONDII IGG - TOXOPLASMA IGG IGM ANTIBODY - ARUP","code_information":[{"code":"3028677707","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86777","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.87,"discounted_cash":105.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOXOPLASMA, IGM - TOXOPLASMA GONDII ANTIBODY, IGM","code_information":[{"code":"3028677801","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86778","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":58.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOXOPLASMA ANTIBODY IGM","code_information":[{"code":"3028677802","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86778","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":58.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOXOPLASMA ANTIBODY IGM CSF","code_information":[{"code":"3028677803","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86778","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":58.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOXOPLASMA GONDII IGM ELISA CSF - QDID","code_information":[{"code":"3028677804","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86778","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":58.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOXOPLASMA GONDII IGM - TORCH ANTIBODIES IGM - ARUP","code_information":[{"code":"3028677806","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86778","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":58.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOXOPLASMA GONDII IGM - TOXOPLASMA IGG IGM ANTIBODY - ARUP","code_information":[{"code":"3028677807","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86778","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":58.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TREPONEMA PALLIDUM CONFIRMATION","code_information":[{"code":"3028678001","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":97.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTIBODY TREPONEMA PALLIDUM - FTA ANTIBODIES, IGG AND IGM","code_information":[{"code":"3028678002","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":97.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TREPONEMA PALLIDUM (SYPHILIS) ANTIBODY - ARUP","code_information":[{"code":"3028678007","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":97.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TREPONEMA PALLIDUM ANTIBODY","code_information":[{"code":"3028678008","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":97.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TREPONEMA PALLIDUM CONFIRMATION","code_information":[{"code":"3028678010","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":97.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TREPONEMA PALLIDUM IGG BY ELISA - ARUP","code_information":[{"code":"3028678012","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":97.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TREPONEMA PALLIDUM IGG BY IFA (FTA-ABS) - ARUP","code_information":[{"code":"3028678013","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":97.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRICHINELLA - TRICHINELLA ANTIBODY","code_information":[{"code":"3028678401","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86784","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.96,"discounted_cash":43.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRICHINELLA ANTIBODY - ARUP","code_information":[{"code":"3028678402","type":"CDM"},{"code":"0306","type":"RC"},{"code":"86784","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.96,"discounted_cash":43.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VARICELLA ZOSTER IGG","code_information":[{"code":"3028678701","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":94.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VARICELLA-ZOSTER - VARICELLA ZOSTER IGM","code_information":[{"code":"3028678702","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":94.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VARICELLA ZOSTER ANTIBODY, IGG - ARUP","code_information":[{"code":"3028678703","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":94.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VARICELLA ZOSTER ANTIBODY (IGG) - QWDL","code_information":[{"code":"3028678704","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":94.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VARICELLA ZOSTER IGM - ARUP","code_information":[{"code":"3028678708","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":94.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VARICELLA ZOSTER IGM - VARICELLA ZOSTER IGG AND IGM - ARUP","code_information":[{"code":"3028678709","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.78,"discounted_cash":94.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VARICELLA ZOSTER IGG - VZ IGG AND IGM - ARUP","code_information":[{"code":"3028678710","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WEST NILE VIRUS AB, IGM - WEST NILE ANTIBODIES, IGG AND IGM","code_information":[{"code":"3028678801","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86788","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.41,"discounted_cash":112.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WEST NILE VIRUS AB, IGM - WEST NILE VIRUS ANTIBODY, IGM","code_information":[{"code":"3028678802","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86788","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.41,"discounted_cash":112.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENCEPHALITIS PANEL WEST NILE VIRUS ANTIBODY IGM CSF","code_information":[{"code":"3028678804","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86788","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.41,"discounted_cash":112.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WEST NILE VIRUS IGG - WEST NILE VIRUS CSF - ARUP","code_information":[{"code":"3028678805","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86788","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.41,"discounted_cash":112.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WEST NILE ENCEPHALITIS IGM - ARBOVIRUS PANEL IGM - ARUP","code_information":[{"code":"3028678806","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86788","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.41,"discounted_cash":112.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WEST NILE VIRUS IGM - WEST NILE VIRUS CSF - ARUP","code_information":[{"code":"3028678807","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86788","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.41,"discounted_cash":112.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WEST NILE ENCEPHALITIS CSF - ARBOVIRUS PANEL IGM CSF - ARUP","code_information":[{"code":"3028678808","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86788","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.41,"discounted_cash":112.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WEST NILE VIRUS IGM CSF - ARUP","code_information":[{"code":"3028678809","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86788","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.41,"discounted_cash":112.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WEST NILE VIRUS ANTIBODY - WEST NILE VIRUS ANTIBODY, IGG","code_information":[{"code":"3028678901","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86789","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.72,"discounted_cash":95.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENCEPHALITIS PANEL WEST NILE VIRUS ANTIBODY IGG CSF","code_information":[{"code":"3028678902","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86789","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.72,"discounted_cash":95.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENCEPHALITIS PANEL WEST NILE VIRUS ANTIBODY IGG","code_information":[{"code":"3028678903","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86789","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.72,"discounted_cash":95.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENCEPHALITIS PANEL WEST NILE VIRUS - ARBOVIRUS PANEL IGG - ARUP","code_information":[{"code":"3028678904","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86789","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.72,"discounted_cash":95.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WEST NILE VIRUS IGG - WNV CSF - ARUP","code_information":[{"code":"3028678906","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86789","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.72,"discounted_cash":95.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTIBODY NONSPECIFIC - OTHER","code_information":[{"code":"3028679001","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTIBODY CHIKUNGUNYA IGG","code_information":[{"code":"3028679003","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTIBODY CHIKUNGUNYA IGM","code_information":[{"code":"3028679004","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTIBODY HEPATITIS E IGG","code_information":[{"code":"3028679006","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTIBODY HEPATITIS E IGM","code_information":[{"code":"3028679007","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTIBODY HTLV I AND II","code_information":[{"code":"3028679009","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTIBODY DENGUE FEVER IGM","code_information":[{"code":"3028679011","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTIBODY HERPES VIRUS 6 IGM","code_information":[{"code":"3028679012","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHIKUNGUNYA IGG - CHIKUNGUNYA ANTIBODIES IGG IGM - ARUP","code_information":[{"code":"3028679021","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHIKUNGUNYA IGM - CHIKUNGUNYA ANTIBODIES IGG IGM - ARUP","code_information":[{"code":"3028679022","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DENGUE FEVER IGG - DENGUE FEVER IGG IGM AB - ARUP","code_information":[{"code":"3028679028","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DENGUE FEVER IGM - DENGUE FEVER IGG IGM AB - ARUP","code_information":[{"code":"3028679029","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DENGUE FEVER IGM - ARUP","code_information":[{"code":"3028679030","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS E IGG - ARUP","code_information":[{"code":"3028679031","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS E IGM - ARUP","code_information":[{"code":"3028679032","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES VIRUS 6 IGG - ARUP","code_information":[{"code":"3028679033","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES VIRUS 6 IGM - ARUP","code_information":[{"code":"3028679034","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HTLV I AND II ANTIBODY WITH REFLEX - ARUP","code_information":[{"code":"3028679035","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC YERSINIA - YERSINIA ANTIBODY, IGA, IGM, IGG","code_information":[{"code":"3028679301","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86793","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.17,"discounted_cash":46.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC YERSENIA IGA - YERSINIA ANTIBODY WEST BLOT - ARUP","code_information":[{"code":"3028679302","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86793","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.17,"discounted_cash":46.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC YERSENIA IGG - YERSINIA ANTIBODY WEST BLOT - ARUP","code_information":[{"code":"3028679303","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86793","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.17,"discounted_cash":46.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTIBODY ZIKA VIRUS IGM","code_information":[{"code":"3028679401","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86794","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.41,"discounted_cash":112.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ZIKA VIRUS IGM - ARUP","code_information":[{"code":"3028679402","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86794","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.41,"discounted_cash":112.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROGLOBULIN ANTIBODY - ANTI-THYROGLOBULIN AB","code_information":[{"code":"3028680001","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.95,"discounted_cash":116.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROGLOBULIN ANTIBODY - ANTI-THYROGLOBULIN AB WITH REFLEX TO THYROGLOBULIN","code_information":[{"code":"3028680003","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.95,"discounted_cash":116.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTI THYROGLOBULIN (ATHYG) ANTIBODY","code_information":[{"code":"3028680004","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.95,"discounted_cash":116.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROGLOBULIN ANTIBODY WITH REFLEX - ARUP","code_information":[{"code":"3028680007","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.95,"discounted_cash":116.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROGLOBULIN ANTIBODY - THYROID ANTIBODIES - ARUP","code_information":[{"code":"3028680008","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.95,"discounted_cash":116.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS C ANTIBODY","code_information":[{"code":"3028680301","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.87,"discounted_cash":105.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS C AB TEST - HEPATITIS C AB DONOR","code_information":[{"code":"3028680303","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.87,"discounted_cash":105.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITUS C VIRUS ANTIBODY - HEPATITIS PANEL, ACUTE","code_information":[{"code":"3028680304","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.87,"discounted_cash":105.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DONOR HEPATITIS C ANTIBODY","code_information":[{"code":"3028680305","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.87,"discounted_cash":105.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS C ANTIBODY BY CIA WITH REFLEX - ARUP","code_information":[{"code":"3028680306","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.87,"discounted_cash":105.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS C AB W/REFL TO HCV RNA, QN, PCR - QWDL","code_information":[{"code":"3028680308","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.87,"discounted_cash":105.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS C ANTIBODY WITH REFLEX HCV PCR- ARUP","code_information":[{"code":"3028680311","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.87,"discounted_cash":105.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HLA TYPING, A,B,OR C /SINGLE - HLA-B27 ANTIGEN","code_information":[{"code":"3028681201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86812","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.52,"discounted_cash":172.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HLA B27 ANTIGEN - ARUP","code_information":[{"code":"3028681202","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86812","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.52,"discounted_cash":172.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HLA TYPING, A,B,OR C /MULTI - HLA A AND B PHENOTYPE","code_information":[{"code":"3028681301","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86813","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.32,"discounted_cash":387.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HLA TYPING CLASS I, MULTI ANTIGENS - PLATELET","code_information":[{"code":"3028681302","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86813","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.32,"discounted_cash":387.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HLA TYPING, DR/DQ,MULTI ANTGN - HLA TYPING, DR/DQ, MULTIPLE ANTIGENS","code_information":[{"code":"3028681701","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86817","type":"HCPCS"}],"standard_charges":[{"gross_charge":708.98,"discounted_cash":708.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HLA ANTIBODY SCREEN CLASS I AND CLASS II","code_information":[{"code":"3028682801","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86828","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.51,"discounted_cash":428.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HLA AB ID CLASS I HD","code_information":[{"code":"3028683201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86832","type":"HCPCS"}],"standard_charges":[{"gross_charge":1133.13,"discounted_cash":1133.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HLA AB ID CLASS I UNDILUTED HD - POST TRANSPLANT ANTIBODY MONITORING","code_information":[{"code":"3028683207","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86832","type":"HCPCS"}],"standard_charges":[{"gross_charge":1133.13,"discounted_cash":1133.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HLA AB ID CLASS II HD","code_information":[{"code":"3028683301","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86833","type":"HCPCS"}],"standard_charges":[{"gross_charge":1140.3,"discounted_cash":1140.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HLA AB ID CLASS II UNDILUTED HD - POST TRANSPLANT ANTIBODY MONITORING","code_information":[{"code":"3028683307","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86833","type":"HCPCS"}],"standard_charges":[{"gross_charge":1140.3,"discounted_cash":1140.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DONOR SPECIFIC ANTIBODY CLASS I 1:8 DILUTION","code_information":[{"code":"3028683402","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86834","type":"HCPCS"}],"standard_charges":[{"gross_charge":1251.46,"discounted_cash":1251.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DONOR SPECIFIC ANTIBODY CLASS II 1:8 DILUTION","code_information":[{"code":"3028683502","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86835","type":"HCPCS"}],"standard_charges":[{"gross_charge":1130.36,"discounted_cash":1130.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COMPATIBILITY TEST EA UNIT INCUBATION","code_information":[{"code":"3028692101","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86921","type":"HCPCS"}],"standard_charges":[{"gross_charge":1101.73,"discounted_cash":1101.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRICHROME STAIN - OVA AND PARASITE EXAM","code_information":[{"code":"3028720902","type":"CDM"},{"code":"0302","type":"RC"},{"code":"87209","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.93,"discounted_cash":62.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OVA AND PARASITE COMPLEX STAIN - O&P EXAM BODY FLUID OR URINE - ARUP","code_information":[{"code":"3028720903","type":"CDM"},{"code":"0302","type":"RC"},{"code":"87209","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.93,"discounted_cash":62.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HIV1/2 ANTIBODY/ANTIGEN SCREEN","code_information":[{"code":"3028738901","type":"CDM"},{"code":"0302","type":"RC"},{"code":"87389","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.28,"discounted_cash":84.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HIV 1 & 2 ANTIBODY/ANTIGEN WITH REFLEX DIFF -ARUP","code_information":[{"code":"3028738903","type":"CDM"},{"code":"0302","type":"RC"},{"code":"87389","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.28,"discounted_cash":84.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HIV 1 & 2 ANTIGEN/ANTIBODY WITH REFLEX HIV1WB - ARUP","code_information":[{"code":"3028738904","type":"CDM"},{"code":"0302","type":"RC"},{"code":"87389","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.28,"discounted_cash":84.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HIV 1 & 2 ANTIGEN/ANTIBODY WITH REFLEX CIA - ARUP","code_information":[{"code":"3028738906","type":"CDM"},{"code":"0302","type":"RC"},{"code":"87389","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.28,"discounted_cash":84.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SARS COVID-19 AG BY IMMUNOASSAY","code_information":[{"code":"3028742601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87426","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.97,"discounted_cash":260.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HIV-1/HIV-2, SINGLE ASSAY - HIV 1 AND 2 SCREEN","code_information":[{"code":"302G043201","type":"CDM"},{"code":"0312","type":"RC"},{"code":"G0432","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.02,"discounted_cash":144.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SARS COV2 2019 DNA RNA AMP HIGH THROUGHPUT","code_information":[{"code":"302U000301","type":"CDM"},{"code":"0306","type":"RC"},{"code":"U0003","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.85,"discounted_cash":500.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WBC COUNT W DIFF","code_information":[{"code":"3058500401","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85004","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.41,"discounted_cash":43.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD SMEAR,MICRO EXAM,MANUAL DIFF WBC - MANUAL DIFFERENTIAL","code_information":[{"code":"3058500701","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85007","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.31,"discounted_cash":28.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MANUAL DIFFERENTIAL","code_information":[{"code":"3058500702","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85007","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.31,"discounted_cash":28.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD SMEAR,MICRO EXAM - SLIDE REVIEW","code_information":[{"code":"3058500801","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85008","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.01,"discounted_cash":12.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEMATOCRIT","code_information":[{"code":"3058501401","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.58,"discounted_cash":15.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEMATOCRIT - HEMATOCRIT (BODY FLUID)","code_information":[{"code":"3058501402","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.23,"discounted_cash":17.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEMATOCRIT - POCT HEMATOCRIT","code_information":[{"code":"3058501404","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.23,"discounted_cash":17.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEMOGLOBIN","code_information":[{"code":"3058501801","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.23,"discounted_cash":17.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COMPLETE CBC & AUTO WBC DIFF","code_information":[{"code":"3058502501","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85025","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.85,"discounted_cash":57.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CBC","code_information":[{"code":"3058502701","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.01,"discounted_cash":48.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLATELET COUNT MANUAL","code_information":[{"code":"3058503201","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85032","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.94,"discounted_cash":28.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RED BLOOD CELL (RBC) COUNT - RED BLOOD CELL COUNT","code_information":[{"code":"3058504101","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85041","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.03,"discounted_cash":20.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RETICULOCYTE COUNT, MANUAL","code_information":[{"code":"3058504401","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85044","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.94,"discounted_cash":28.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RETICULOCYTE COUNT, AUTO - RETICULOCYTES","code_information":[{"code":"3058504501","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85045","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.71,"discounted_cash":26.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RETICULOCYTE COUNT, AUTO, W CELL PARAM - HEMOGLOBIN (PG) IN RETIC","code_information":[{"code":"3058504601","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85046","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.62,"discounted_cash":40.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEUKOCYTE (WBC) COUNT - EOSINOPHIL COUNT","code_information":[{"code":"3058504802","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85048","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.7,"discounted_cash":16.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEUKOCYTE (WBC) COUNT - WHITE BLOOD COUNT","code_information":[{"code":"3058504803","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85048","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.7,"discounted_cash":16.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLATELET COUNT","code_information":[{"code":"3058504902","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85049","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.24,"discounted_cash":33.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RETICULATED PLATELET ASSAY","code_information":[{"code":"3058505501","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85055","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.43,"discounted_cash":263.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BONE MARROW SMEAR INTERPRETATION","code_information":[{"code":"3058509702","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85097","type":"HCPCS"}],"standard_charges":[{"gross_charge":4381.88,"discounted_cash":4381.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BONE MARROW,SMEAR INTERPRETATION - BONE MARROW SMEAR INTERP","code_information":[{"code":"3058509703","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85097","type":"HCPCS"}],"standard_charges":[{"gross_charge":4381.88,"discounted_cash":4381.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOT FACTOR II PROTHROM SPEC - FACTOR 2 ACTIVITY","code_information":[{"code":"3058521001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85210","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.81,"discounted_cash":86.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FACTOR 2 ACTIVITY","code_information":[{"code":"3058521002","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85210","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.81,"discounted_cash":86.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOC CLOT FACTOR V TEST - FACTOR 5 ACTIVITY","code_information":[{"code":"3058522001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85220","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.49,"discounted_cash":130.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FACTOR 5 ACTIVITY","code_information":[{"code":"3058522002","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85220","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.49,"discounted_cash":130.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOT FACTOR VII PROCONVERTIN - FACTOR 7 ACTIVITY","code_information":[{"code":"3058523001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85230","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.09,"discounted_cash":119.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FACTOR 7 ACTIVITY","code_information":[{"code":"3058523002","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85230","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.09,"discounted_cash":119.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FACTOR 8 ACTIVITY","code_information":[{"code":"3058524001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.09,"discounted_cash":119.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FACTOR 8 ACTIVITY - VON WILLEBRAND MULTIMERIC (ARUP)","code_information":[{"code":"3058524005","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.09,"discounted_cash":119.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOT FACTOR VIII VW RISTOCTN - FACTOR VIII RISTOCETIN COFACTR","code_information":[{"code":"3058524501","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85245","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.59,"discounted_cash":153.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VON WILLEBRAND RISTOCETIN FACTOR ACIVITY - VON WILLEBRAND MULTIMERIC PANEL(ARUP)","code_information":[{"code":"3058524503","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85245","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.59,"discounted_cash":153.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOT FACTOR VIII VW ANTIGEN - VON WILLEBRAND ANTIGEN","code_information":[{"code":"3058524603","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85246","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.87,"discounted_cash":169.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VON WILLEBRAND FACTOR ANTIGEN - VON WILLEBRAND MULTIMERIC PANEL(ARUP)","code_information":[{"code":"3058524605","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85246","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.87,"discounted_cash":169.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOT FACTOR VIII VWF MULTIMETRIC ANALYSIS","code_information":[{"code":"3058524701","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85247","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.59,"discounted_cash":153.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOT FACTOR VIII VWF MULTIMETRIC ANALYSIS - VON WILLEBRAND MULTIMERIC PANEL(ARUP)","code_information":[{"code":"3058524702","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85247","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.59,"discounted_cash":153.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOT FACTOR IX PTC/CHRSTMAS - FACTOR 9 ACTIVITY","code_information":[{"code":"3058525001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85250","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.7,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FACTOR 9 ACTIVITY","code_information":[{"code":"3058525002","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85250","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.7,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOT FACTOR X STUART-POWER - FACTOR 10 ACTIVITY","code_information":[{"code":"3058526001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85260","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.09,"discounted_cash":119.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOT FACTOR XI PTA - FACTOR 11 ACTIVITY","code_information":[{"code":"3058527001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85270","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.09,"discounted_cash":119.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FACTOR 11 ACTIVITY","code_information":[{"code":"3058527002","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85270","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.09,"discounted_cash":119.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOT FACTOR XII HAGEMAN - FACTOR 12 ACTIVITY","code_information":[{"code":"3058528001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85280","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.11,"discounted_cash":129.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FACTOR 12 ACTIVITY","code_information":[{"code":"3058528002","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85280","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.11,"discounted_cash":129.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOT FACTOR XIII FIBRIN STAB - FACTOR 13 ACTIVITY","code_information":[{"code":"3058529001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85290","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.07,"discounted_cash":109.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FACTOR 13 SOLUBILITY SCREEN","code_information":[{"code":"3058529101","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85291","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.22,"discounted_cash":61.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTITHROMBIN III","code_information":[{"code":"3058530001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85300","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.4,"discounted_cash":87.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTITHROMBIN III ANTIGEN","code_information":[{"code":"3058530101","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85301","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.35,"discounted_cash":72.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOT INHIB PROTEIN C,ANTIGEN - PROTEIN C ANTIGEN TOTAL","code_information":[{"code":"3058530201","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85302","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.6,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN C ANTIGEN TOTAL - PROTEIN C AND S ANTIGEN PANEL - ARUP","code_information":[{"code":"3058530203","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85302","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.6,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOT INHIB PROTEIN C,ACTIV - PROTEIN C ACTIVITY","code_information":[{"code":"3058530301","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85303","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.17,"discounted_cash":102.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOT INHIB PROTEIN S,TOTAL - PROTEIN S ANTIGEN TOTAL","code_information":[{"code":"3058530502","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85305","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.91,"discounted_cash":77.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTEIN S ANTIGEN TOTAL - PROTEIN C AND S ANTIGEN PANEL - ARUP","code_information":[{"code":"3058530504","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85305","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.91,"discounted_cash":77.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOT INHIB PROTEIN S,FREE - PROTEIN S ACTIVITY","code_information":[{"code":"3058530601","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.25,"discounted_cash":113.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOT INHIB PROTEIN S,FREE - PROTEIN S ANTIGEN FREE","code_information":[{"code":"3058530602","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.4,"discounted_cash":102.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACTIVATED PROT C (APC) RESISTNCE ASSAY - APC RESISTANCE","code_information":[{"code":"3058530701","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85307","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.4,"discounted_cash":102.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FACTOR INHIBITOR","code_information":[{"code":"3058533501","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FACTOR 8 INHIBITOR HUMAN","code_information":[{"code":"3058533502","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COAGULATION TIME, ACTIVATED - ACTIVATED CLOTTING TIME","code_information":[{"code":"3058534701","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85347","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.01,"discounted_cash":32.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC KAOLIN CLOT TIME WITH REFLEX","code_information":[{"code":"3058534705","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85347","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.01,"discounted_cash":32.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC KAOLIN CLOT TIME - LUPUS ANTICOAGULANT SCREEN","code_information":[{"code":"3058534706","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85347","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.01,"discounted_cash":32.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FIBRIN DEGRAD PRODUCTS, AGGLUTINATION - FIBRIN SPLIT PRODUCTS","code_information":[{"code":"3058536201","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85362","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.47,"discounted_cash":50.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FIBRIN DEGRADPRODUCTS,D-DIMER, QUAL - D-DIMER,SEMIQUANT","code_information":[{"code":"3058537801","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85378","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.55,"discounted_cash":64.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC D-DIMER QUANTITATIVE","code_information":[{"code":"3058537901","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85379","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.09,"discounted_cash":75.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FIBRIN DEGRADPRODUCTS,D-DIMER, ULTRASENS - D-DIMER, RAPID","code_information":[{"code":"3058538001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85380","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.89,"discounted_cash":67.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FIBRINOGEN QUANTITATIVE","code_information":[{"code":"3058538401","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85384","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.39,"discounted_cash":71.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FIBRINOGEN, ANTIGEN - FIBRINOGEN ANTIGEN","code_information":[{"code":"3058538501","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85385","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.61,"discounted_cash":50.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FIBRINOGEN ANTIGEN - ARUP","code_information":[{"code":"3058538502","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85385","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.61,"discounted_cash":50.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SPECIAL COAGULATION INTERPRETATION AND REPORT","code_information":[{"code":"3058539001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85390","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.51,"discounted_cash":103.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ADAMTS13 ACTIVITY","code_information":[{"code":"3058539701","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85397","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.91,"discounted_cash":205.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALPHA 2 ANTIPLASMIN","code_information":[{"code":"3058541001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85410","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.99,"discounted_cash":26.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLASMINOGEN ACTIVATOR INHIBITOR","code_information":[{"code":"3058541501","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85415","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.17,"discounted_cash":60.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FETAL HEMOGLOBIN BY KLEIHAUER BETKE STAIN ON MATERNAL BLOOD - CFD","code_information":[{"code":"3058546001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85460","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.2,"discounted_cash":51.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FETAL HEMOGLOBIN BY KLEIHAUER BETKE STAIN ON MATERNAL BLOOD","code_information":[{"code":"3058546002","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85460","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.2,"discounted_cash":51.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEMOGLOBIN FETAL,ROSETTE - FETAL BLEED SCREEN","code_information":[{"code":"3058546101","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85461","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":68.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPARIN ASSAY - LOW MOLECULAR WGT HEPARIN","code_information":[{"code":"3058552001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85520","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPARIN ANTI XA ASSAY, UNFRACTIONATED","code_information":[{"code":"3058552002","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85520","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPARIN LEVEL - ANTI XA LOW MOLECULAR WEIGHT HEPARIN - ARUP","code_information":[{"code":"3058552005","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85520","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPARIN ANTI-XA QUALITATIVE REFLEXED - ARUP","code_information":[{"code":"3058552006","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85520","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.93,"discounted_cash":87.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPARIN NEUTRALIZATION","code_information":[{"code":"3058552501","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85525","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.44,"discounted_cash":41.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPARIN NEUTRALIZATN - PTT-D HEPARIN REFLEX BILL (ARUP)","code_information":[{"code":"3058552503","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85525","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.44,"discounted_cash":41.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPARIN NEUTRALIZATION - PLATELET MAPPING POC","code_information":[{"code":"3058552505","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85525","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.44,"discounted_cash":41.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WBC ALKALINE PHOSPHATASE - LEUKOCYTE ALKALINE PHOSPHATASE","code_information":[{"code":"3058554001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85540","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.1,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MURAMIDASE - LYSOZYME, SERUM","code_information":[{"code":"3058554901","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85549","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.77,"discounted_cash":125.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LYSOZYME SERUM - ARUP","code_information":[{"code":"3058554903","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85549","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.77,"discounted_cash":125.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RBC OSMOTIC FRAGILITY - OSMOTIC FRAGILITY RBC","code_information":[{"code":"3058555502","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85555","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.15,"discounted_cash":26.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD PLATELET AGGREGATION - PLATELET FUNCTION PANEL","code_information":[{"code":"3058557601","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.42,"discounted_cash":183.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD PLATELET AGGREGATION - P2Y12 PROFILE","code_information":[{"code":"3058557602","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.42,"discounted_cash":183.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD PLATELET AGGREGATION - POCT PLATELET AGGREGATION","code_information":[{"code":"3058557603","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.42,"discounted_cash":183.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD PLATELET AGGREGATION - ASPIRIN","code_information":[{"code":"3058557604","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.42,"discounted_cash":183.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD PLATELET AGGREGATION - RISTOCETIN","code_information":[{"code":"3058557605","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.42,"discounted_cash":183.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD PLATELET AGGREGATION - COLLAGEN","code_information":[{"code":"3058557606","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.42,"discounted_cash":183.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD PLATELET AGGREGATION - THROMBIN","code_information":[{"code":"3058557607","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.42,"discounted_cash":183.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLATELET FUNCTION EPINEPHRINE","code_information":[{"code":"3058557608","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.42,"discounted_cash":183.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COLLAGEN - PLATELET AGGREGATION","code_information":[{"code":"3058557609","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.42,"discounted_cash":183.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RISTOCETIN AGGREGATION","code_information":[{"code":"3058557610","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.42,"discounted_cash":183.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIAGNOSTIC PLATELET AGGREGATION","code_information":[{"code":"3058557611","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.42,"discounted_cash":183.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLATELET FUNCTION ASPIRIN","code_information":[{"code":"3058557612","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.42,"discounted_cash":183.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLATELET FUNCTION ANALYSIS ADP","code_information":[{"code":"3058557613","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.42,"discounted_cash":183.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CITRATED MA AGGREGATION - GLOBAL HEMOSTASIS","code_information":[{"code":"3058557614","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.42,"discounted_cash":183.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RAPID TEG MA AGGREGATION- GLOBAL HEMOSTASIS","code_information":[{"code":"3058557615","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.42,"discounted_cash":183.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLATELET FUNCTION ANALYSIS ADP","code_information":[{"code":"3058557620","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.42,"discounted_cash":183.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ADP/PGE1 - P2Y12 PLATELET FUNCTION","code_information":[{"code":"3058557623","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.42,"discounted_cash":183.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ISO-TRAP - P2Y12 PLATELET FUNCTION","code_information":[{"code":"3058557624","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.42,"discounted_cash":183.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC KAOLIN MA HEPARINASE PLATELET AGGREGATION - PLATELET MAPPING POC","code_information":[{"code":"3058557625","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.42,"discounted_cash":183.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACTF MA PLATELET AGGREGATION - PLATELET MAPPING POC","code_information":[{"code":"3058557626","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.42,"discounted_cash":183.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ADP MA PLATELET AGGREGATION - PLATELET MAPPING POC","code_information":[{"code":"3058557627","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.42,"discounted_cash":183.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AA MA PLATELET AGGREGATION - PLATELET MAPPING POC","code_information":[{"code":"3058557628","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.42,"discounted_cash":183.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHOSPHOLIPID NEUTRALIZATION,PLATELET - PLATELET NEUTRALIZATION","code_information":[{"code":"3058559701","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85597","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHOSPHOLIPID NEUTRALIZATION - HEXAGONAL PHOSPHOLIPID","code_information":[{"code":"3058559801","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85598","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEXAGONAL PHOSPHOLIPID NEUTRAL (STACLOT LUPUS ANTICOAGULANT)","code_information":[{"code":"3058559802","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85598","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEXAGONAL PHOSPHOLIPID NEUTRAL REFLEX - ARUP","code_information":[{"code":"3058559804","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85598","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.94,"discounted_cash":132.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTHROMBIN TIME INR","code_information":[{"code":"3058561001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.01,"discounted_cash":32.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTHROMBIN TIME - PROTHROMBIN MIXING STUDY","code_information":[{"code":"3058561002","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.01,"discounted_cash":32.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTHROMBIN TIME INR COUMADIN CLINIC","code_information":[{"code":"3058561003","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.01,"discounted_cash":32.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTHROMBIN TIME - PROTIME DILUTION PROTOCOL","code_information":[{"code":"3058561004","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.01,"discounted_cash":32.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTHROMBIN TIME - SURGICAL LAB","code_information":[{"code":"3058561006","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.01,"discounted_cash":32.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTHROMBIN TIME INR - SPECIAL COAG","code_information":[{"code":"3058561007","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.01,"discounted_cash":32.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTHROMBIN TIME INR - ARUP INHIB SCRN","code_information":[{"code":"3058561008","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.01,"discounted_cash":32.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTHROMBIN TIME INR - ARUP PHOSLIPID","code_information":[{"code":"3058561009","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.01,"discounted_cash":32.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTHROMBIN TIME INR - LUPUS ANTICOAGULANT PANEL WITH REFLEX -ARUP","code_information":[{"code":"3058561010","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.01,"discounted_cash":32.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTHROMBIN TIME SPECIAL COAGULATION - INHIBITOR SCREEN","code_information":[{"code":"3058561012","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.01,"discounted_cash":32.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTHROMBIN TIME - PT AND PTT PANEL","code_information":[{"code":"3058561013","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.01,"discounted_cash":32.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTHROMBIN TIME -ANTIPHOSPHOLIPID SYNDROME REFLEX PANEL - ARUP","code_information":[{"code":"3058561014","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.01,"discounted_cash":32.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC POC PROTHROMBIN TIME INR","code_information":[{"code":"3058561016","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.01,"discounted_cash":32.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTHROMBIN TEST,SUBSTI,FRACTN - EQUAL MIX,PT/INR","code_information":[{"code":"3058561101","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85611","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.54,"discounted_cash":29.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROTHROMBIN TIME 1:1 MIX","code_information":[{"code":"3058561103","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85611","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.54,"discounted_cash":29.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RUSSELL VIPER VENOM, DILUTED - DRVVT (DILUTE RUSSEL VV TIME)","code_information":[{"code":"3058561301","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.16,"discounted_cash":70.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RUSSELL VIPER VENOM, DILUTED - DRVVT (DILUTE RUSSEL VV TIME) - PHOSLIPID ARUP","code_information":[{"code":"3058561302","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.16,"discounted_cash":70.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RUSSELL VIPER VENOM, DILUTED - LUPUS ANTICOAGULANT PANEL W/REFLEX -ARUP","code_information":[{"code":"3058561303","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.16,"discounted_cash":70.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DILUTED RUSSEL VIPER VENOM (DRVVT) - LUPUS ANTICOAGULANT SCREEN","code_information":[{"code":"3058561307","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.16,"discounted_cash":70.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DILUTED RUSSELL VIPER VENOM (DRVTT)","code_information":[{"code":"3058561308","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.16,"discounted_cash":70.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRVVT - ANTIPHOSPHOLIPID SYNDROME REFLX PANEL - ARUP","code_information":[{"code":"3058561310","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.16,"discounted_cash":70.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REPTILASE TIME","code_information":[{"code":"3058563501","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85635","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.48,"discounted_cash":34.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RBC SED RATE, NONAUTO - SEDIMENTATION RATE, MANUAL","code_information":[{"code":"3058565101","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85651","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.01,"discounted_cash":32.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RBC SED RATE, AUTO - SEDIMENTATION RATE, AUTOMATED","code_information":[{"code":"3058565201","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85652","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.81,"discounted_cash":17.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RBC SICKLE CELL TEST - SICKLE CELL SCREEN","code_information":[{"code":"3058566001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85660","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.62,"discounted_cash":40.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SICKLE CELL SCREEN-BLOOD UNIT","code_information":[{"code":"3058566002","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85660","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.62,"discounted_cash":40.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SICKLE CELL SOLUBILITY BILL - ARUP","code_information":[{"code":"3058566003","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85660","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.62,"discounted_cash":40.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THROMBIN TIME, PLASMA - THROMBIN TIME","code_information":[{"code":"3058567001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85670","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.09,"discounted_cash":43.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THROMBIN TIME - ARUP","code_information":[{"code":"3058567003","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85670","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.09,"discounted_cash":43.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APTT","code_information":[{"code":"3058573001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.32,"discounted_cash":44.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THROMBOPLAS TIME PARTIAL - PTT CRRT SYSTEM","code_information":[{"code":"3058573002","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.32,"discounted_cash":44.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APTT LUPUS SENSITIVE","code_information":[{"code":"3058573003","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.32,"discounted_cash":44.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THROMBOPLAS TIME PARTIAL - APTT - PHOSLIPID ARUP","code_information":[{"code":"3058573004","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.32,"discounted_cash":44.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APTT CRRT SYSTEM","code_information":[{"code":"3058573005","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.32,"discounted_cash":44.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SPECIAL COAG APTT","code_information":[{"code":"3058573006","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.32,"discounted_cash":44.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APTT, HEPZYME TREATED","code_information":[{"code":"3058573007","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.32,"discounted_cash":44.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APTT - INHIBITOR ASSAY PTT WITH REFLEX (ARUP)","code_information":[{"code":"3058573010","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.32,"discounted_cash":44.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APTT - LUPUS ANTICOAGULANT PANEL WITH REFLEX - ARUP","code_information":[{"code":"3058573011","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.32,"discounted_cash":44.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APTT, INHIBITOR SCREEN, 1-HOUR  (RFLX) (ARUP)","code_information":[{"code":"3058573012","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.32,"discounted_cash":44.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APTT-D 1:1 MIX BILL (ARUP)","code_information":[{"code":"3058573013","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.32,"discounted_cash":44.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APTT-D HEPARIN REFLEX BILL (ARUP)","code_information":[{"code":"3058573014","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.32,"discounted_cash":44.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APTT - LUPUS ANTICOAGULANT SCREEN","code_information":[{"code":"3058573015","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.32,"discounted_cash":44.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACTIVATED PARTIAL THROMBOPLASTIN TIME (APTT) LUPUS SENS-INHIBITOR SCREEN","code_information":[{"code":"3058573016","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.32,"discounted_cash":44.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACTIVATED PARTIAL THROMBOPLASTIN TIME (APTT) - PT AND PTT PANEL","code_information":[{"code":"3058573017","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.32,"discounted_cash":44.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APTT - ANTIPHOSPHOLIPID SYNDROME REFLEX PANEL - ARUP","code_information":[{"code":"3058573018","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.32,"discounted_cash":44.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THROMBOPLAS TIME PART PLASMA FRAC - PTT MIXING STUDY","code_information":[{"code":"3058573202","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.01,"discounted_cash":48.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LUPUS ANTICOAGULANT PTT 1 TO 1 MIX","code_information":[{"code":"3058573203","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.01,"discounted_cash":48.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACTIVATED PARTIAL THROMBOPLASTIN TIME 1 TO 1 MIX","code_information":[{"code":"3058573204","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.01,"discounted_cash":48.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC KAOLIN CLOT TIME, 1:1 MIX REFLEXED","code_information":[{"code":"3058573205","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.01,"discounted_cash":48.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APTT 1:1 MIX INHIBITOR SCREEN ASSAY (REFLX) (ARUP)","code_information":[{"code":"3058573206","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.01,"discounted_cash":48.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APTT 1:1 MIX INHIBITOR SCREEN 1-HOUR  (REFLX) (ARUP)","code_information":[{"code":"3058573207","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.01,"discounted_cash":48.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INHIBITOR SCREEN CHARGE","code_information":[{"code":"3058573208","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.01,"discounted_cash":48.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PTT INHIBITOR SCREEN 1:1 MIX - ARUP","code_information":[{"code":"3058573210","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.01,"discounted_cash":48.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PTT 1:1 MIX LUPUS SENSITIVE REFLEX","code_information":[{"code":"3058573211","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.01,"discounted_cash":48.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD VISCOSITY EXAMINATION - VISCOSITY, SERUM","code_information":[{"code":"3058581001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85810","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.91,"discounted_cash":77.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VISCOSITY SERUM - ARUP","code_information":[{"code":"3058581002","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85810","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.91,"discounted_cash":77.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BB PHYS.CONSULT INTERP&RP","code_information":[{"code":"3058607701","type":"CDM"},{"code":"0305","type":"RC"},{"code":"86077","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.72,"discounted_cash":164.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHYSICIAN TRANSFUSION REACTION INTERP & REPORT","code_information":[{"code":"3058607801","type":"CDM"},{"code":"0305","type":"RC"},{"code":"86078","type":"HCPCS"}],"standard_charges":[{"gross_charge":1101.73,"discounted_cash":1101.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARBOXYHEMOGLOBIN, TRANSCUTANEOUS, PER DAY","code_information":[{"code":"3058874001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"88740","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.8,"discounted_cash":32.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BACTERIAL VAGINOSIS TMA 10119 -SURESWAB BACTI VAGINOSIS/VAGINITIS -QDID","code_information":[{"code":"3068151302","type":"CDM"},{"code":"0306","type":"RC"},{"code":"81513","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.21,"discounted_cash":499.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BACTERIAL VAGINOSIS - VAGINAL PATHOGEN DNA PANEL - ARUP","code_information":[{"code":"3068151304","type":"CDM"},{"code":"0306","type":"RC"},{"code":"81513","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.21,"discounted_cash":499.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CONCENTRATION - PNEUMOCYSTIS SMEAR BY DFA - ARUP","code_information":[{"code":"3068701501","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.3,"discounted_cash":29.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INFECTIOUS AGENT CONCENTRATION FECES","code_information":[{"code":"3068701502","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.3,"discounted_cash":29.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MALARIA SMEAR THICK PREP","code_information":[{"code":"3068701506","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.3,"discounted_cash":29.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CONCENTRATION -  (ARUP)","code_information":[{"code":"3068701507","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.3,"discounted_cash":29.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SPECIMEN CONCENTRATION BODY FLUID CULTURE","code_information":[{"code":"3068701509","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.3,"discounted_cash":29.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMOCYSTIS JIROVECII CONC - P JIROVECII DFA W/REFLEX TO PCR - ARUP","code_information":[{"code":"3068701511","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.3,"discounted_cash":29.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SPECIMEN CONCENTRATION AFB CULTURE","code_information":[{"code":"3068701512","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.3,"discounted_cash":29.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD PARASITE SMEAR THICK PREP","code_information":[{"code":"3068701513","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.3,"discounted_cash":29.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMOCYSTIS JIROVECII CONC - P JIROVECII DFA - ARUP","code_information":[{"code":"3068701514","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.3,"discounted_cash":29.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SPECIMEN CONCENTRATION - SPINAL FLUID CULTURE","code_information":[{"code":"3068701515","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.3,"discounted_cash":29.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CULTURE BLOOD","code_information":[{"code":"3068704001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87040","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.33,"discounted_cash":76.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - CULTURE STOOL - SALMONELLA SHIGELLA","code_information":[{"code":"3068704501","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87045","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.16,"discounted_cash":70.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SALMONELLA SHIGELLA - STOOL CULTURE - ARUP","code_information":[{"code":"3068704502","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87045","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.16,"discounted_cash":70.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC STOOL CULTURE, ADDL PATHOGENS - CAMPYLOBACTER CULTURE, STOOL","code_information":[{"code":"3068704601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87046","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.44,"discounted_cash":63.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC STOOL CULTURE, ADDL PATHOGENS - YERSINIA CULTURE, STOOL","code_information":[{"code":"3068704602","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87046","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.44,"discounted_cash":63.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC STOOL CULTURE, ADDL PATHOGENS - ADDITIONAL PATHOGEN CULTURE, STOOL","code_information":[{"code":"3068704603","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87046","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.44,"discounted_cash":63.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VIBRIO STOOL CULTURE REFLEXED","code_information":[{"code":"3068704604","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87046","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.44,"discounted_cash":63.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CAMPYLOBACTER - STOOL CULTURE - ARUP","code_information":[{"code":"3068704605","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87046","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.44,"discounted_cash":63.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC YERSINIA STOOL CULTURE - ARUP","code_information":[{"code":"3068704606","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87046","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.44,"discounted_cash":63.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC E COLI - STOOL CULTURE - ARUP","code_information":[{"code":"3068704607","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87046","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.44,"discounted_cash":63.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC YERSINIA STOOL CULTURE REFLEX","code_information":[{"code":"3068704608","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87046","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.44,"discounted_cash":63.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - CULTURE AEROBIC","code_information":[{"code":"3068707001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.02,"discounted_cash":64.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HELICOBACTER PYLORI CULTURE","code_information":[{"code":"3068707002","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.02,"discounted_cash":64.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SURGICAL CULTURE","code_information":[{"code":"3068707004","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.02,"discounted_cash":64.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NOSE OR NP CULTURE","code_information":[{"code":"3068707005","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.02,"discounted_cash":64.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THROAT CULTURE COMPREHENSIVE","code_information":[{"code":"3068707007","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.02,"discounted_cash":64.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CULTURE BODY FLUID","code_information":[{"code":"3068707008","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.02,"discounted_cash":64.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BRONCHIAL LAVAGE CULTURE","code_information":[{"code":"3068707011","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.02,"discounted_cash":64.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CATH TIP CULTURE","code_information":[{"code":"3068707012","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.02,"discounted_cash":64.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CSF CULTURE","code_information":[{"code":"3068707013","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.02,"discounted_cash":64.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EAR CULTURE","code_information":[{"code":"3068707014","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.02,"discounted_cash":64.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENVIRONMENTAL CULTURE","code_information":[{"code":"3068707015","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.02,"discounted_cash":64.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EYE CULTURE","code_information":[{"code":"3068707018","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.02,"discounted_cash":64.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENITAL CULTURE","code_information":[{"code":"3068707019","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.02,"discounted_cash":64.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SPUTUM CULTURE","code_information":[{"code":"3068707022","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.88,"discounted_cash":57.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SINUS CULTURE","code_information":[{"code":"3068707025","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.02,"discounted_cash":64.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BONE CULTURE","code_information":[{"code":"3068707030","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.02,"discounted_cash":64.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - CULTURE AEROBIC QUANT","code_information":[{"code":"3068707101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87071","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.67,"discounted_cash":65.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CULTURE BRONCH WASH QUANTITATIVE","code_information":[{"code":"3068707102","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87071","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.67,"discounted_cash":65.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TISSUE CULTURE QUANTITATIVE","code_information":[{"code":"3068707103","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87071","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.67,"discounted_cash":65.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - CULTURE ANAEROBIC","code_information":[{"code":"3068707501","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87075","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.16,"discounted_cash":70.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANAEROBIC BACTERIA ID","code_information":[{"code":"3068707502","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87075","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.16,"discounted_cash":70.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSTRIDIUM DIFFICILE CULTURE - ARUP","code_information":[{"code":"3068707503","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87075","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.16,"discounted_cash":70.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANEROBIC CULTURE - ARUP","code_information":[{"code":"3068707504","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87075","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.16,"discounted_cash":70.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - CULTURE ANAEROBIC ADDITIONAL ID METHOD","code_information":[{"code":"3068707601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87076","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.08,"discounted_cash":59.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANAEROBIC CULTURE IDENTIFICATION - ARUP","code_information":[{"code":"3068707602","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87076","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.08,"discounted_cash":59.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BACTERIA IDENTIFICATION AEROBIC","code_information":[{"code":"3068707702","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.08,"discounted_cash":59.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ORGANISM IDENTIFICATION AEROBIC ARUP","code_information":[{"code":"3068707703","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.08,"discounted_cash":59.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BACTERIA CULTURE SCREEN - LEGIONELLA CULTURE","code_information":[{"code":"3068708101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.24,"discounted_cash":49.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NOCARDIA CULTURE","code_information":[{"code":"3068708102","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.24,"discounted_cash":49.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BACTERIA CULTURE SCREEN - PRESUMPTIVE E COLI 157 CULTURE","code_information":[{"code":"3068708103","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.24,"discounted_cash":49.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BACTERIA CULTURE SCREEN - PRESUMPTIVE PATHOGEN CULTURE","code_information":[{"code":"3068708104","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.24,"discounted_cash":49.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BACTERIA CULTURE SCREEN - PRESUMPTIVE MRSA CULTURE","code_information":[{"code":"3068708105","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.24,"discounted_cash":49.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BACTERIA CULTURE SCREEN - PRESUMPTIVE NOCARDIA CULTURE","code_information":[{"code":"3068708106","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.24,"discounted_cash":49.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BACTERIA CULTURE SCREEN - PRESUMPTIVE VRE CULTURE","code_information":[{"code":"3068708107","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.24,"discounted_cash":49.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BACTERIA CULTURE SCREEN - PRESUMPTIVE GC CULTURE","code_information":[{"code":"3068708108","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.24,"discounted_cash":49.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BACTERIA CULTURE SCREEN - PRESUMPTIVE GROUP B STREP CULTURE","code_information":[{"code":"3068708109","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.52,"discounted_cash":44.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BACTERIA CULTURE SCREEN - PRESUMPTIVE GROUP A STREP CULTURE","code_information":[{"code":"3068708110","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.24,"discounted_cash":49.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLUOROQUINOLONE RESISTANT ORGANISM CULTURE","code_information":[{"code":"3068708111","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.24,"discounted_cash":49.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACANTHAMOEBA AND NAEGLERIA CULTURE","code_information":[{"code":"3068708112","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.52,"discounted_cash":44.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACANTHAMOEBA AND NAEGLERIA CULTURE CSF","code_information":[{"code":"3068708113","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.24,"discounted_cash":49.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACTINOMYCES CULTURE","code_information":[{"code":"3068708114","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.24,"discounted_cash":49.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARBAPENEMASE RESISTANT ENTEROBACTERIACEAE CULTURE","code_information":[{"code":"3068708115","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.24,"discounted_cash":49.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VANCOMYCIN-RESISTANT ENTEROCOCCUS (VRE) CULTURE","code_information":[{"code":"3068708116","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.24,"discounted_cash":49.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VIBRIO CULTURE STOOL - ARUP","code_information":[{"code":"3068708117","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.24,"discounted_cash":49.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACANTHAMOEBA& NAEGLERIA CULTURE CSF-ARUP","code_information":[{"code":"3068708119","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.24,"discounted_cash":49.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEGIONELLA CULTURE - ARUP","code_information":[{"code":"3068708120","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.24,"discounted_cash":49.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BACTERIA CULTURE SCREEN - PRESUMPTIVE YERSINIA CULTURE","code_information":[{"code":"3068708121","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.24,"discounted_cash":49.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC STREP THROAT A CULTURE","code_information":[{"code":"3068708122","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.24,"discounted_cash":49.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CULTURE URINE QUANTITATIVE","code_information":[{"code":"3068708601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87086","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.08,"discounted_cash":59.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - CULTURE URINE PRESUMPTIVE ID","code_information":[{"code":"3068708801","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87088","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.54,"discounted_cash":54.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CULTURE FUNGI-SKIN HAIR NAILS - FUNGAL CULTURE, CUTANEOUS","code_information":[{"code":"3068710101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87101","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.2,"discounted_cash":51.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - CULTURE FUNGUS","code_information":[{"code":"3068710201","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.55,"discounted_cash":61.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - CULTURE FUNGUS SEND OUT","code_information":[{"code":"3068710202","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.55,"discounted_cash":61.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FUNGAL CULTURE","code_information":[{"code":"3068710203","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.55,"discounted_cash":61.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CANDIDA AURIS CULTURE REFLEX","code_information":[{"code":"3068710205","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.55,"discounted_cash":61.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FUNGUS BLOOD CULTURE","code_information":[{"code":"3068710301","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87103","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.9,"discounted_cash":136.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - YEAST ID","code_information":[{"code":"3068710601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87106","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.01,"discounted_cash":69.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FUNGUS IDENTIFICATION, MOLD - FUNGAL IDENTIFICATION, MOLD","code_information":[{"code":"3068710701","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87107","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.01,"discounted_cash":69.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYCOPLASMA CULTURE - MYCOPLASMA / UREAPLASMA CULTURE","code_information":[{"code":"3068710901","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87109","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.4,"discounted_cash":102.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYCOPLASMA / UREAPLASMA CULTURE - ARUP","code_information":[{"code":"3068710902","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87109","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.4,"discounted_cash":102.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - CULTURE CHLAMYDIA","code_information":[{"code":"3068711001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87110","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.33,"discounted_cash":131.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AFB CULTURE","code_information":[{"code":"3068711601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87116","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":37.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD CULTURE ACID FAST BACTERIA","code_information":[{"code":"3068711602","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87116","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.3,"discounted_cash":29.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AFB CULTURE - ARUP","code_information":[{"code":"3068711605","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87116","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.3,"discounted_cash":29.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYCOBACTERIA IDENTIFICATION - MYCOBACTERIA IDENTIFICATION","code_information":[{"code":"3068711801","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87118","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":200.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CULTURE TYPING, FLUORESCENT - HERPES SIMPLEX TYPING","code_information":[{"code":"3068714001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87140","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.73,"discounted_cash":36.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CULTURE TYPING, FLUORESCENT - TYPING EACH","code_information":[{"code":"3068714002","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87140","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.73,"discounted_cash":36.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHLAMYDIA TRACHOMATIS CULTURE - ARUP","code_information":[{"code":"3068714003","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87140","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.73,"discounted_cash":36.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX VIRUS (HSV) TYPING - ARUP","code_information":[{"code":"3068714004","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87140","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.73,"discounted_cash":36.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - SEROTYPING","code_information":[{"code":"3068714701","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87147","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - SEROTYPING MRSA PBP2","code_information":[{"code":"3068714702","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87147","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":38.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - DNA DIRECT PROBE EACH","code_information":[{"code":"3068714901","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87149","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.56,"discounted_cash":133.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYCOBACTERIUM GORDONAE DNA PROBE","code_information":[{"code":"3068714903","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87149","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.56,"discounted_cash":133.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYCOBACTERIUM TB DNA PROBE","code_information":[{"code":"3068714905","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87149","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.72,"discounted_cash":147.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYCOBACTERIUM AVIUM DNA PROBE","code_information":[{"code":"3068714906","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87149","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.56,"discounted_cash":133.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - DNA AMPLIFIED PROBE EACH","code_information":[{"code":"3068715001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87150","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - DNA AMPLIFIED PROBE MRSA","code_information":[{"code":"3068715011","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87150","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - DNA AMPLIFIED PROBE BLD CULTURE EACH ID#1","code_information":[{"code":"3068715016","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87150","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - DNA AMPLIFIED PROBE BLD CULTURE EACH ID#2","code_information":[{"code":"3068715017","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87150","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - DNA AMPLIFIED PROBE BLD CULTURE EACH ID#3","code_information":[{"code":"3068715018","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87150","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FUNGAL/YEAST ID DNA/RNA SEQUENCE","code_information":[{"code":"3068715301","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87153","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROORGANISM IDENTIFICATION - NGS","code_information":[{"code":"3068715302","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87153","type":"HCPCS"}],"standard_charges":[{"gross_charge":770.2,"discounted_cash":770.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD PATHOGEN GRAM NEG ID RESISTANCE PCR 6 + TARGETS","code_information":[{"code":"3068715401","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87154","type":"HCPCS"}],"standard_charges":[{"gross_charge":763.21,"discounted_cash":763.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD PATHOGEN GRAM POS ID RESISTANCE PCR 6 + TARGETS","code_information":[{"code":"3068715402","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87154","type":"HCPCS"}],"standard_charges":[{"gross_charge":763.21,"discounted_cash":763.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD PATHOGEN FUNGAL ID RESISTANCE PCR 6 + TARGETS","code_information":[{"code":"3068715403","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87154","type":"HCPCS"}],"standard_charges":[{"gross_charge":763.21,"discounted_cash":763.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD PATHOGEN ID AND RESISTANCE PCR 6+ TARGETS","code_information":[{"code":"3068715404","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87154","type":"HCPCS"}],"standard_charges":[{"gross_charge":763.21,"discounted_cash":763.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - CULTURE TYPING OTHER","code_information":[{"code":"3068715801","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87158","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.09,"discounted_cash":27.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARTHROPOD AND PARASITE IDENTIFICATION MACROSCOPIC","code_information":[{"code":"3068716901","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87169","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.94,"discounted_cash":28.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARTHROPOD AND PARASITE IDENTIFICATION MACROSCOPIC - ARUP","code_information":[{"code":"3068716902","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87169","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.94,"discounted_cash":28.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PINWORM EXAM - PINWORM PREP","code_information":[{"code":"3068717201","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87172","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.95,"discounted_cash":14.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TISSUE HOMOGENIZATION FOR CULTURE","code_information":[{"code":"3068717601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87176","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.09,"discounted_cash":43.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OVA AND PARASITES SMEARS - OVA AND PARASITE EXAMINATION","code_information":[{"code":"3068717701","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87177","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.24,"discounted_cash":65.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OVA AND PARASITES SMEARS - OVA AND PARASITE EXAMINATION DIRECT","code_information":[{"code":"3068717702","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87177","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.24,"discounted_cash":65.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC O&P SMEARS, CONC, ID - CRYPTOSPROIDIA & COCCIDIA EXAM, FECES - ARUP","code_information":[{"code":"3068717704","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87177","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.24,"discounted_cash":65.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OVA & PARASITE DIR SMEARS, CONC, ID - O&P EXAM BODY FLUID/URINE - ARUP","code_information":[{"code":"3068717705","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87177","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.24,"discounted_cash":65.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUSCEPTIBILITY E-TEST PER AGENT","code_information":[{"code":"3068718101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87181","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.28,"discounted_cash":32.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MIC SENSITIVITY (E-TEST)","code_information":[{"code":"3068718102","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87181","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.28,"discounted_cash":32.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - SUSCEPTIBILITY EPSILOMETER TEST/E-TEST","code_information":[{"code":"3068718103","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87181","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.28,"discounted_cash":32.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUSCEPTIBILITY KIRBY BAUER SINGLE ANTIBIOTIC","code_information":[{"code":"3068718401","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.09,"discounted_cash":50.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUSCEPTIBILITY KIRBY BAUER MULTIPLE ANTIBIOTICS","code_information":[{"code":"3068718402","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.09,"discounted_cash":50.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - CULTURE SUSCEPTIBILITY ENZYME","code_information":[{"code":"3068718501","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87185","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.7,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUSCEPTIBILITY MIC GRAM NEGATIVE","code_information":[{"code":"3068718601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.02,"discounted_cash":64.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUSCEPTIBILITY MIC MICRODILUTION GRAM NEGATIVE","code_information":[{"code":"3068718602","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.02,"discounted_cash":64.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUSCEPTIBILITY MIC URINE","code_information":[{"code":"3068718603","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.02,"discounted_cash":64.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUSCEPTIBILITY MIC MOLD","code_information":[{"code":"3068718604","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.88,"discounted_cash":57.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUSCEPTIBILITY MIC MICRODILUTION YEAST","code_information":[{"code":"3068718605","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.02,"discounted_cash":64.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUSCEPTIBILITY MIC GRAM POSITIVE","code_information":[{"code":"3068718607","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":104.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUSCEPTIBILITY MIC MICRODILUTION CEFIDEROCOL","code_information":[{"code":"3068718608","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.02,"discounted_cash":64.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUSCEPTIBILITY MIC HAEMOPHILUS","code_information":[{"code":"3068718609","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.02,"discounted_cash":64.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUSCEPTIBILITY MIC STREPTOCOCCUS","code_information":[{"code":"3068718610","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.02,"discounted_cash":64.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUSCEPTIBILITY MIC YEAST","code_information":[{"code":"3068718611","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.88,"discounted_cash":57.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUSCEPTIBILITY MIC MICRODILUTION ATM/CZA SYNERGY","code_information":[{"code":"3068718616","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.02,"discounted_cash":64.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBE SUSCEPTIBLE MIC - ARUP","code_information":[{"code":"3068718617","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.02,"discounted_cash":64.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MINIMAL BACTERICIDAL CONC","code_information":[{"code":"3068718701","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87187","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.6,"discounted_cash":140.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTIBIOTIC SENS,MACROBROTH,EACH","code_information":[{"code":"3068718801","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87188","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.34,"discounted_cash":44.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTIBIOTIC SENS - MYCOBACTERIA","code_information":[{"code":"3068719001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87190","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.97,"discounted_cash":48.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EOSINOPHILS SMEAR URINE","code_information":[{"code":"3068720502","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.94,"discounted_cash":28.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GRAM STAIN","code_information":[{"code":"3068720503","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.01,"discounted_cash":32.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DFT - DIFFERENTIAL BRONCHIAL LAVAGE/WASH","code_information":[{"code":"3068720505","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.01,"discounted_cash":32.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EOSINOPHILS SMEAR URINE - EOSINOPHILS PRESENCE IN URINE","code_information":[{"code":"3068720508","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.01,"discounted_cash":32.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SMEAR,FLUOR STAIN,INTERP - AFB STAIN","code_information":[{"code":"3068720601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.4,"discounted_cash":39.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FUNGAL STAIN, FLUORESCENT","code_information":[{"code":"3068720602","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.62,"discounted_cash":35.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SMEAR,FLUOR STAIN,INTERP - CRYPTOSPORIDIUM","code_information":[{"code":"3068720605","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.62,"discounted_cash":35.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AFB STAIN ONLY - ARUP","code_information":[{"code":"3068720606","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.62,"discounted_cash":35.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SMEAR,INCLUSION BODIES/PARASITES,INTERP - MALARIA SMEAR","code_information":[{"code":"3068720701","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.07,"discounted_cash":40.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMOEBA SCREEN CSF","code_information":[{"code":"3068720702","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.07,"discounted_cash":40.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROSPORIDIA FECES","code_information":[{"code":"3068720703","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.07,"discounted_cash":40.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMOEBA SCREEN CSF","code_information":[{"code":"3068720706","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.07,"discounted_cash":40.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMOEBA GEIMSA STAIN - ACANTHAMOEBA AND NAEGLERIA CULTURE CSF - ARUP","code_information":[{"code":"3068720708","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.07,"discounted_cash":40.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MALARIA RAPID SCREEN WITH GIEMSA - ARUP","code_information":[{"code":"3068720709","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.07,"discounted_cash":40.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INCLUSION BODY STAIN - CRYPTOSPORIDIA & COCCIDIA EXAM, FECES - ARUP","code_information":[{"code":"3068720710","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.07,"discounted_cash":40.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PARASITE BLOOD SMEAR","code_information":[{"code":"3068720711","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.07,"discounted_cash":40.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WET PREP GENITAL","code_information":[{"code":"3068721001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87210","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.09,"discounted_cash":43.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SMEAR,STAIN,WET MNT,INTERP - POCT FERN TEST, SALIVA","code_information":[{"code":"3068721002","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87210","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.09,"discounted_cash":43.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TISSUE EXAM BY KOH - KOH PREP","code_information":[{"code":"3068722001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87220","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FUNGAL (KOH) STAIN","code_information":[{"code":"3068722002","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87220","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.94,"discounted_cash":28.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSAY, TOXIN OR ANTITOXIN - CLOSTRIDIUM DIFFICILE TOXINS TISSUE CULT","code_information":[{"code":"3068723001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87230","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.33,"discounted_cash":131.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSTRIDIUM DIFFICILE CYTOTOXIN CELL ASSAY - ARUP","code_information":[{"code":"3068723002","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87230","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.33,"discounted_cash":131.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - CULTURE VIRUS TISSUE","code_information":[{"code":"3068725201","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87252","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.63,"discounted_cash":173.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VIRAL CULTURE NONRESPIRATORY - ARUP","code_information":[{"code":"3068725203","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87252","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.63,"discounted_cash":173.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VIRAL CULTURE RESPIRATORY - ARUP","code_information":[{"code":"3068725204","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87252","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.63,"discounted_cash":173.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - CULTURE VIRUS ADDITIONAL STUDY","code_information":[{"code":"3068725301","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87253","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.67,"discounted_cash":134.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX VIRUS (HSV) CULTURE - ARUP","code_information":[{"code":"3068725304","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87253","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.67,"discounted_cash":134.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - VIRUS IMMUNO ID","code_information":[{"code":"3068725401","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87254","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.22,"discounted_cash":130.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTOMEGALOVIRUS (CMV) CULTURE RAPID - ARUP","code_information":[{"code":"3068725402","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87254","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.02,"discounted_cash":144.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VARICELLA ZOSTER VIRUS CULTURE - ARUP","code_information":[{"code":"3068725403","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87254","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.02,"discounted_cash":144.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX VIRUS CULTURE - ARUP","code_information":[{"code":"3068725502","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87255","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.89,"discounted_cash":249.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX VIRUS (HSV) WITH REFLEX TO HSV TYPING CULTURE - ARUP","code_information":[{"code":"3068725503","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87255","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.89,"discounted_cash":249.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ADENOVIRUS DFA - RESPIRATORY VIRUSES DFA WITH REFLEX - ARUP","code_information":[{"code":"3068726004","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87260","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.51,"discounted_cash":50.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX TYPE 2 AG, DFA","code_information":[{"code":"3068727301","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87273","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.93,"discounted_cash":41.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX VIRUS 2 - VZV AND HSV DFA W/ RFLX TO CULTURE - ARUP","code_information":[{"code":"3068727302","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87273","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.93,"discounted_cash":41.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX TYPE 1 AG, DFA","code_information":[{"code":"3068727401","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87274","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.93,"discounted_cash":41.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX VIRUS 1 - VZV AND HSV DFA W/ RFLX TO CULTURE - ARUP","code_information":[{"code":"3068727402","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87274","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.93,"discounted_cash":41.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INFLUENZA B AG, DFA","code_information":[{"code":"3068727501","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87275","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.36,"discounted_cash":82.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INFLUENZA A AG, DFA","code_information":[{"code":"3068727601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87276","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.85,"discounted_cash":106.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEGION PNEUMO AG, DFA - LEGIONELLA PNEUMOPHILIA ANTIGEN","code_information":[{"code":"3068727801","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87278","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.71,"discounted_cash":115.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PARAINFLUENZA AG BY DFA","code_information":[{"code":"3068727901","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87279","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.19,"discounted_cash":110.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RESP SYNCYTIAL AG, DFA","code_information":[{"code":"3068728001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87280","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.71,"discounted_cash":99.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMOCYSTIS CARINII AG, DFA - PNEUMOCYSTIS SMEAR BY DFA","code_information":[{"code":"3068728101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87281","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.6,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMOCYSTIS JIROVECII AG, DFA -  (ARUP)","code_information":[{"code":"3068728102","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87281","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.6,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMOCYSTIS JIROVECII DFA - P JIROVECII DFA W/REFLEX TO PCR - ARUP","code_information":[{"code":"3068728103","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87281","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.6,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VARICELLA DFA - VZV AND HSV DFA WITH CULTURE IF INDICATED - ARUP","code_information":[{"code":"3068729001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87290","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.15,"discounted_cash":90.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AG DETECTION IMMUNOFLOUR EA ORG","code_information":[{"code":"3068729902","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87299","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.96,"discounted_cash":107.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS - ASPERGILLUS GALACT","code_information":[{"code":"3068730501","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87305","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.63,"discounted_cash":88.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASPERGILLUS GALACTOMANNAN ANTIGEN","code_information":[{"code":"3068730502","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87305","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.63,"discounted_cash":88.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASPERGILLUS GALACTOMANNAN ANTIGEN BRONCH","code_information":[{"code":"3068730503","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87305","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.63,"discounted_cash":88.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSTRIDIOIDES DIFFICILE TOXINS EIA","code_information":[{"code":"3068732401","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87324","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.63,"discounted_cash":88.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSTRIDIOIDES DIFFICILE TOXINS EIA","code_information":[{"code":"3068732402","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87324","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.63,"discounted_cash":88.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CRYPTOCOCCUS ANTIGEN, LATERAL FLOW","code_information":[{"code":"3068732704","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87327","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.6,"discounted_cash":98.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CRYPTOSPORIDIUM - OVA AND PARASITE ANTIGEN SCREEN","code_information":[{"code":"3068732801","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87328","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CRYPTOSPORIDIUM ANTIGEN STOOL - ARUP","code_information":[{"code":"3068732802","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87328","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GIARDIA LAMBLIA - OVA AND PARASITE ANTIGEN SCREEN","code_information":[{"code":"3068732901","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87329","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.63,"discounted_cash":88.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GIARDIA ANTIGEN STOOL - ARUP","code_information":[{"code":"3068732902","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87329","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.63,"discounted_cash":88.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IAAD IA ENTAMOEBA HISTOLYTICA GRP - ENTAMOEBA HYSTOLYTICA GRP EIA","code_information":[{"code":"3068733701","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87337","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.93,"discounted_cash":41.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENTAMOEBA HISTOLYTICA ANTIGEN - ARUP","code_information":[{"code":"3068733702","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87337","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.93,"discounted_cash":41.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HELICOBACTER PYLORI ANTIGEN STOOL","code_information":[{"code":"3068733801","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87338","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.87,"discounted_cash":105.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HELICOBACTER PYLORI ANTIGEN STOOL","code_information":[{"code":"3068733802","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87338","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.87,"discounted_cash":105.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS B SURFACE ANTIGEN","code_information":[{"code":"3068734001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.33,"discounted_cash":76.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS B SURFACE ANTIGEN (HBSAG) DONOR","code_information":[{"code":"3068734003","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.33,"discounted_cash":76.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS B VIRUS SURFACE ANTIGEN - HEPATITIS PANEL ACUTE","code_information":[{"code":"3068734004","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.33,"discounted_cash":76.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS B VIRUS SURFACE ANTIGEN WITH REFLEX TO CONFIRMATION - ARUP","code_information":[{"code":"3068734005","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.33,"discounted_cash":76.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS B VIRUS SURFACE ANTIGEN WITH REFLEX CONFIRMATION - QWDL","code_information":[{"code":"3068734006","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.33,"discounted_cash":76.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION - HEPATITIS B SURFACE","code_information":[{"code":"3068734101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87341","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.16,"discounted_cash":36.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS B SURFACE ANTIGEN CONFIRMATION - ARUP","code_information":[{"code":"3068734102","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87341","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.16,"discounted_cash":36.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IAAD IA HEPATITIS BE ANTIGEN - HEPATITIS B E ANTIGEN","code_information":[{"code":"3068735001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87350","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.94,"discounted_cash":84.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEAPATITIS B E ANTIGEN - ARUP","code_information":[{"code":"3068735002","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87350","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.94,"discounted_cash":84.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IAAD IA HISTOPLASM CAPSULATUM - HISTOPLASMA ANTIGEN URINE","code_information":[{"code":"3068738501","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87385","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.04,"discounted_cash":89.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IAAD IA HISTOPLASM CAPSULATUM - HISTOPLASMA ANTIGEN, SERUM","code_information":[{"code":"3068738502","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87385","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.04,"discounted_cash":89.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HISTOPLASM ANTIGEN URINE - ARUP","code_information":[{"code":"3068738503","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87385","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.04,"discounted_cash":89.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HISTOPLASMA ANTIGEN SERUM - ARUP","code_information":[{"code":"3068738504","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87385","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.04,"discounted_cash":89.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - IMMUNOASSAY INFLUENZA A","code_information":[{"code":"3068740001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87400","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.61,"discounted_cash":94.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - IMMUNOASSAY INFLUENZA B","code_information":[{"code":"3068740002","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87400","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.61,"discounted_cash":94.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IAAD IA RESPIRATORY SYNCTIAL VIRUS - RSV RAPID ANTIGEN SCREEN","code_information":[{"code":"3068742001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87420","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.38,"discounted_cash":92.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IAAD IA ROTAVIRUS - ROTAVIRUS ANTIGEN STOOL","code_information":[{"code":"3068742501","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87425","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.63,"discounted_cash":88.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ROTAVIRUS ANTIGEN STOOL","code_information":[{"code":"3068742502","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87425","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.63,"discounted_cash":88.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IAAD IA SHIGA-LIKE TOXIN - SHIGA-LIKE TOXIN ANTIGEN, EIA","code_information":[{"code":"3068742701","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87427","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IAAD IA SHIGA-LIKE TOXIN - SHIGA-LIKE TOXIN ANTIGEN,  FECES","code_information":[{"code":"3068742702","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87427","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SHIGA-LIKE TOXIN ANTIGEN EIA STOOL","code_information":[{"code":"3068742703","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87427","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SHIGA-LIKE TOXIN ANTIGEN EIA STOOL - ARUP","code_information":[{"code":"3068742704","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87427","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SARS-COV-2  ATGN DETECT IMMUNOASSAY QUAL / SEMIQUANT PLUS FLU A AND B","code_information":[{"code":"3068742801","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87428","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.24,"discounted_cash":470.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - IMMUNOASSAY GROUP A STREP","code_information":[{"code":"3068743001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87430","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.46,"discounted_cash":85.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEGIONELLA ANTIGEN URINE","code_information":[{"code":"3068744901","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.63,"discounted_cash":88.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IAAD IA MULT STEP METHOD NOS EACH ORGANISM - STREP PNEUMO AG, UR","code_information":[{"code":"3068744902","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.63,"discounted_cash":88.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSTRIDIUM DIFFICILE AG TOXINS EIA","code_information":[{"code":"3068744903","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.63,"discounted_cash":88.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CAMPYLOBACTER AG TOXINS EIA - ARUP","code_information":[{"code":"3068744904","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC 1,3 BETA D-GLUCAN (FUNGITELL)","code_information":[{"code":"3068744905","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLASTOMYCES ANTIGEN","code_information":[{"code":"3068744906","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.63,"discounted_cash":88.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLASTOMYCES DERMATITIDIS ANTIGEN, URINE (ARUP)","code_information":[{"code":"3068744907","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.63,"discounted_cash":88.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COCCIDIOIDES ANTIGEN BY EIA (ARUP)","code_information":[{"code":"3068744908","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.63,"discounted_cash":88.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC 1,3 BETA-D-GLUCAN (FUNGITELL) (ARUP)","code_information":[{"code":"3068744909","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.63,"discounted_cash":88.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CAMPYLOBACTER ANTIGEN STOOL - ARUP","code_information":[{"code":"3068744910","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.63,"discounted_cash":88.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLASTOMYCES DERMATITIDIS ANTIGEN URINE - ARUP","code_information":[{"code":"3068744911","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.63,"discounted_cash":88.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLASTOMYCES DERMATITIDIS ANTIGEN SERUM OR PLASMA - ARUP","code_information":[{"code":"3068744912","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.63,"discounted_cash":88.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COCCIDIOIDES ANTIGEN EIA - ARUP","code_information":[{"code":"3068744913","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.63,"discounted_cash":88.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INF AGENT ANTIGEN DETECT IA NOS EA ORG","code_information":[{"code":"3068744916","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.14,"discounted_cash":80.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANAPLASMA PHAGOCYTOPHILUM AMP PROBE","code_information":[{"code":"3068746801","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87468","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANAPLASMA PHAGOCYTOPHILUM PCR - EHRLICHIA & ANAPLASMA SPECIES PCR - ARUP","code_information":[{"code":"3068746802","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87468","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANAPLASMA PHAGOCYTOPHILUM PCR - TICK BORNE DISEASE PANEL PCR - ARUP","code_information":[{"code":"3068746803","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87468","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BABESIA MICROTI AMP PROBE","code_information":[{"code":"3068746901","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87469","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BABESIA MICROTI PCR - TICK BORNE DISEASE PANEL PCR - ARUP","code_information":[{"code":"3068746902","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87469","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BARTONELLA, DNA, AMP PROBE - BARTONELLA, DNA, AMP PROBE","code_information":[{"code":"3068747101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87471","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BARTONELLA DNA QUALITATIVE PCR - ARUP","code_information":[{"code":"3068747103","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87471","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LYME DIS, DNA, AMP PROBE - LYME DISEASE (BORRELIA BURGDORFERI), PCR","code_information":[{"code":"3068747601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87476","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DNA/RNA AMP PROBE - LYME DISEASE (BORRELIA BURGDORFERI), PCR CSF","code_information":[{"code":"3068747602","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87476","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LYME DISEASE (BORRELIA BURGDORFERI) PCR - ARUP","code_information":[{"code":"3068747603","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87476","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CANDIDA, DNA, DIR PROBE - CANDIDA DNA PROBE","code_information":[{"code":"3068748001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87480","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.56,"discounted_cash":133.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CANDIDA, DNA, AMP PROBE - CANDIDA DNA, PCR","code_information":[{"code":"3068748101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87481","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CANDIDA DNA PCR - VAGINAL PATHOGEN DNA PANEL","code_information":[{"code":"3068748106","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87481","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CANDIDA AURIS PCR - ARUP","code_information":[{"code":"3068748107","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87481","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CANDIDA GLABRATA - VAGINAL PATHOGEN DNA PANEL - ARUP","code_information":[{"code":"3068748110","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87481","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CANDIDA SPECIES BY TMA - VAGINAL PATHOGEN DNA PANEL - ARUP","code_information":[{"code":"3068748115","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87481","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CANDIDA GLABRATA - CANDIDA AND TRICHOMONAS BY TMA - ARUP","code_information":[{"code":"3068748116","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87481","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CANDIDA SPECIES - CANDIDA AND TRICHOMONAS BY TMA - ARUP","code_information":[{"code":"3068748117","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87481","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CANDIDA AURIS PCR SCREENING","code_information":[{"code":"3068748118","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87481","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C ALBICANS - CANDIDA SPECIES BY PCR - ARUP","code_information":[{"code":"3068748119","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87481","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C GLABRATA - CANDIDA SPECIES BY PCR - ARUP","code_information":[{"code":"3068748120","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87481","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C PARAPSILOSIS COMPLEX - CANDIDA SPECIES BY PCR - ARUP","code_information":[{"code":"3068748121","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87481","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C TROPICALIS - CANDIDA SPECIES BY PCR - ARUP","code_information":[{"code":"3068748122","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87481","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C KRUSEI - CANDIDA SPECIES BY PCR - ARUP","code_information":[{"code":"3068748123","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87481","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC C DUBLINIENSIS - CANDIDA SPECIES BY PCR - ARUP","code_information":[{"code":"3068748124","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87481","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - DNA AMP PROBE 12-25 TARGETS","code_information":[{"code":"3068748301","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87483","type":"HCPCS"}],"standard_charges":[{"gross_charge":1458.73,"discounted_cash":1458.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EHRLICHIA CHAFEENSIS AMP PROBE","code_information":[{"code":"3068748401","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87484","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EHRLICHIA CHAFFEENSIS PCR  - EHRLICHIA & ANAPLASMA SPECIES PCR - ARUP","code_information":[{"code":"3068748402","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87484","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EHRLICHIA CHAFFEENSIS PCR - TICK BORNE DISEASE PANEL PCR - ARUP","code_information":[{"code":"3068748403","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87484","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHYLMD PNEUM, DNA, AMP PROBE - CHLAMYDIA PNEUMONIAE DNA PROBE, AMP","code_information":[{"code":"3068748601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87486","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHLAMYDIA TRACHOMATIS PCR","code_information":[{"code":"3068749101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHYLMD TRACH,  DNA,  AMP PROBE - CHLAMYDIA DNA PCR TMA","code_information":[{"code":"3068749103","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHLAMYDIA TRACHOMATIS - C TRACHOMATIS & N GONORRHOEAE TMA - ARUP","code_information":[{"code":"3068749106","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHLAMYDIA TRACHOMATIS - C TRACHOMATIS & N GONORRHOEAE TMA W/RFLX - ARUP","code_information":[{"code":"3068749107","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHLAMYDIA TRACHOMATIS BY TMA - ARUP","code_information":[{"code":"3068749108","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHLAMYDIA TRACHOMATIS - SEXUALLY TRANSMITTED DISEASE PANEL 1 - ARUP","code_information":[{"code":"3068749109","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHLAMYDIA TRACHOMATIS CONFIRMATION TMA - ARUP","code_information":[{"code":"3068749110","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSTRIDIOIDES DIFFICILE TOXIN TCBD GENE PCR","code_information":[{"code":"3068749301","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87493","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.74,"discounted_cash":275.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTOMEG, DNA, AMP PROBE - CYTOMEGALOVIRUS DNA PROBE, AMPLIFIED","code_information":[{"code":"3068749601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87496","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTOMEGALOVIRUS (CMV) PCR URINE","code_information":[{"code":"3068749602","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87496","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CONGENITAL CYTOMEGALOVIRUS PCR","code_information":[{"code":"3068749603","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87496","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTOMEGALOVIRUS (CMV) PCR QUAL - ARUP","code_information":[{"code":"3068749604","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87496","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTOMEGALOVIRUS (CMV) PCR QUAL SALIVA - ARUP","code_information":[{"code":"3068749606","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87496","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CMV QUANT PCR","code_information":[{"code":"3068749701","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87497","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.36,"discounted_cash":316.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTOMEGALOVIRUS QUANT NAAT - ARUP","code_information":[{"code":"3068749703","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87497","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.36,"discounted_cash":316.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENTEROVIRUS PROBE&REVRS TRNS - ENTEROVIRUS DNA PROBE, AMPLIFIED","code_information":[{"code":"3068749801","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87498","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENTEROVIRUS PCR FECES","code_information":[{"code":"3068749802","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87498","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENTEROVIRUS PCR QUAL - ARUP","code_information":[{"code":"3068749803","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87498","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENTEROVIRUS PCR QUAL","code_information":[{"code":"3068749805","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87498","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INFLUENZA A & B PCR","code_information":[{"code":"3068750201","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87502","type":"HCPCS"}],"standard_charges":[{"gross_charge":639.98,"discounted_cash":639.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GASTROINTESTINAL PARASITE PANELY BY PCR 5 TARGETS - ARUP","code_information":[{"code":"3068750501","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87505","type":"HCPCS"}],"standard_charges":[{"gross_charge":449.02,"discounted_cash":449.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GASTROINTESTINAL VIRAL PCR PANEL STOOL - 5 TARGETS","code_information":[{"code":"3068750503","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87505","type":"HCPCS"}],"standard_charges":[{"gross_charge":449.02,"discounted_cash":449.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GASTROINTESTINAL PARASITE PANEL PCR 3 TARGETS","code_information":[{"code":"3068750504","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87505","type":"HCPCS"}],"standard_charges":[{"gross_charge":449.02,"discounted_cash":449.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GASTROINTESTINAL BACTERIAL PCR PANEL STOOL - 6 -11 TARGETS","code_information":[{"code":"3068750601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87506","type":"HCPCS"}],"standard_charges":[{"gross_charge":1756.31,"discounted_cash":1756.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IADNA-DNA/RNA PROBE TQ 12-25 - GASTROINTESTINAL PANEL","code_information":[{"code":"3068750701","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87507","type":"HCPCS"}],"standard_charges":[{"gross_charge":1458.73,"discounted_cash":1458.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GASTROINTESTINAL PATHOGENS PANEL PCR STOOL - 21 TARGETS","code_information":[{"code":"3068750702","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87507","type":"HCPCS"}],"standard_charges":[{"gross_charge":1458.73,"discounted_cash":1458.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GARDNER VAG DNA DIR PROBE - GARDNERELLA VAGINALIS DNA PROBE, DIRECT","code_information":[{"code":"3068751001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87510","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.56,"discounted_cash":133.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GARDNER VAG DNA QUANT - GARDNERELLA VAGINALIS DNA PROBE, QUANT","code_information":[{"code":"3068751201","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87512","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.36,"discounted_cash":279.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS B , DNA, QUANT - HEPATITIS B DNA, ULTRAQUANTITATIVE, PCR","code_information":[{"code":"3068751701","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87517","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.36,"discounted_cash":316.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS B , DNA, QUANT - HEPATITIS B DNA PROBE, DIRECT","code_information":[{"code":"3068751702","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87517","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.36,"discounted_cash":316.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS B DNA BY QUANT NAAT - HEPATITIS BE DNA PROBE DIRECT - ARUP","code_information":[{"code":"3068751703","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87517","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.36,"discounted_cash":316.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS B PCR QUANTITATIVE - HEPATITIS B DNA QUATITATIVE PCR","code_information":[{"code":"3068751704","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87517","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.36,"discounted_cash":316.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IADNA HEPATITIS C  AMPLIFIED PROBE&REVERSE TRANSCR","code_information":[{"code":"3068752101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87521","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION - HCV QUANT PCR","code_information":[{"code":"3068752201","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87522","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.36,"discounted_cash":316.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS C QUANT NAAT - ARUP","code_information":[{"code":"3068752205","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87522","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.36,"discounted_cash":316.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS C BY QUANT NAAT WITH REFLEX GENOTYPE - ARUP","code_information":[{"code":"3068752206","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87522","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.36,"discounted_cash":316.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS D DELTA QUANT","code_information":[{"code":"3068752301","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87523","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.94,"discounted_cash":149.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HSV QUAL PCR","code_information":[{"code":"3068752901","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX VIRUS 1 & 2 PCR QUALITATIVE","code_information":[{"code":"3068752902","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SURESWAB, HERPES SIMPLEX VIRUS TYPE 1 AND 2 MRNA, TMA - QDID","code_information":[{"code":"3068752903","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HSV 1 PCR - HSV PCR QUAL NONBLOOD","code_information":[{"code":"3068752904","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HSV 2 PCR - HSV PCR QUAL NONBLOOD","code_information":[{"code":"3068752905","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HSV 1 PCR QUAL - HSV 1 AND 2 SUBTYPE BY PCR - ARUP","code_information":[{"code":"3068752907","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HSV 2 PCR QUAL - HSV 1 AND 2 SUBTYPE BY PCR - ARUP","code_information":[{"code":"3068752908","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HSV 1 PCR QUAL - HSV 1 AND 2 SURESWAB BY TMA - QDID","code_information":[{"code":"3068752909","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HSV 2 PCR QUAL - HSV 1 AND 2 SURESWAB BY TMA - QDID","code_information":[{"code":"3068752910","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HSV-1 - T PALLIDUM, HSV-1, HSV-2 BY PCR - ARUP","code_information":[{"code":"3068752911","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HSV-2 - T PALLIDUM, HSV-1, HSV-2 BY PCR - ARUP","code_information":[{"code":"3068752912","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HSV, DNA, QUANT - HSV DNA, QUANTITATIVE","code_information":[{"code":"3068753001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87530","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.04,"discounted_cash":286.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES SIMPLEX VIRUS (HSV) 1/2 PCR - QDID","code_information":[{"code":"3068753002","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87530","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.04,"discounted_cash":286.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HHV-6, DNA, AMP PROBE - HHV-6 DNA PROBE, AMPLIFIED","code_information":[{"code":"3068753201","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87532","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES VIRUS 6 (HHV-6) DNA PCR QUAL - QDID","code_information":[{"code":"3068753202","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87532","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HHV-6, DNA, QUANT - HHV-6 DNA PROBE, QUANTITATIVE","code_information":[{"code":"3068753301","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87533","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.16,"discounted_cash":146.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES VIRUS 6 PCR QUANT - ARUP","code_information":[{"code":"3068753307","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87533","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.16,"discounted_cash":146.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HIV-1 PROBE&REVERSE TRNSCRPJ - HIV-1 DNA PROBE, AMPLIFIED","code_information":[{"code":"3068753501","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87535","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HIV-1 - HIV-1/HIV-2 QUALITATIVE NAAT - ARUP","code_information":[{"code":"3068753504","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87535","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HIV 1 RNA PCR QUAL TMA - QDID","code_information":[{"code":"3068753505","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87535","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HIV 1 RNA QUANT PCR - QDID","code_information":[{"code":"3068753601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87536","type":"HCPCS"}],"standard_charges":[{"gross_charge":629.03,"discounted_cash":629.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HIV 1 PCR QUANTITATIVE","code_information":[{"code":"3068753604","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87536","type":"HCPCS"}],"standard_charges":[{"gross_charge":629.03,"discounted_cash":629.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HIV 1 BY QUANTITATIVE NAAT, PLASMA (ARUP)","code_information":[{"code":"3068753605","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87536","type":"HCPCS"}],"standard_charges":[{"gross_charge":629.03,"discounted_cash":629.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HIV 1 QUANT PCR - QDID","code_information":[{"code":"3068753606","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87536","type":"HCPCS"}],"standard_charges":[{"gross_charge":629.03,"discounted_cash":629.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HIV-2 PROBE&REVRSE TRNSCRIPJ - HIV-2 DNA PROBE, AMPLIFIED","code_information":[{"code":"3068753801","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87538","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.82,"discounted_cash":122.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HIV-2 - HIV-1/HIV-2 QUALITATIVE NAAT - ARUP","code_information":[{"code":"3068753803","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87538","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.82,"discounted_cash":122.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEGIONELLA SPECIES BY QUALITATIVE PCR","code_information":[{"code":"3068754101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87541","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYCOBACTERIA, DNA, AMP PROBE - MYCOBACTERIA DNA PROBE, AMPLIFIED","code_information":[{"code":"3068755101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87551","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.84,"discounted_cash":168.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC M TUBERCULOSIS COMPLEX, DNA PCR AMPLIFIED","code_information":[{"code":"3068755601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87556","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.25,"discounted_cash":278.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DNA/RNA AMP PROBE - M. TUBERCULOSIS CSF","code_information":[{"code":"3068755602","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87556","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.25,"discounted_cash":278.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC M.AVIUM-INTRA, DNA, DIR PROB - M. AVIUM-INTRA DNA PROBE, DIRECT","code_information":[{"code":"3068756001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87560","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.88,"discounted_cash":201.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC M GENITALIUM AMP PROBE","code_information":[{"code":"3068756301","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87563","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.82,"discounted_cash":122.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYCOPLASMA GENITALIUM - UREAPLASMA AND MYCOPLASMA SPECIES BY PCR - ARUP","code_information":[{"code":"3068756302","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87563","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.82,"discounted_cash":122.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC M GENITALIUM DETECTION - M GENITALIUM & MACROLIDE RESIST, PCR - ARUP","code_information":[{"code":"3068756303","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87563","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.82,"discounted_cash":122.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC M TUBERCULOSIS COMPLEX AND RIFAMPIN RESISTANCE, DNA PCR AMPLIFIED","code_information":[{"code":"3068756401","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87564","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.7,"discounted_cash":268.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC M TUBERCULOSIS COMPLEX AND RIFAMPIN RESISTANCE, DNA PCR AMPLIFIED - ARUP","code_information":[{"code":"3068756402","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87564","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.7,"discounted_cash":268.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYCOPLASMA PNEUMONIAE PCR","code_information":[{"code":"3068758101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87581","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYCOPLASMA PNEUMONIAE PCR - ARUP","code_information":[{"code":"3068758103","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87581","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEISSERIA GONORRHOEAE PCR","code_information":[{"code":"3068759101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GC DNA TMA","code_information":[{"code":"3068759102","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC N.GONORRHOEAE,  DNA,  AMP PROB - GC DNA PCR REFER","code_information":[{"code":"3068759103","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEISSERIA GONORRHEA DNA AMPLIFIED PROBE","code_information":[{"code":"3068759105","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEISSERIA GONORRHOEAE-CHLAMYDIA T & N GONORRHOEAE TMA W/ RFLX - ARUP","code_information":[{"code":"3068759107","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEISSERIA GONORRHOEAE - CHLAMYDIA T & N GONORRHOEAE BY TMA - ARUP","code_information":[{"code":"3068759108","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEISSERIA GONORRHOEAE BY TMA - ARUP","code_information":[{"code":"3068759109","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEISSERIA GONORRHOEAE BY TMA-SEXUALLY TRANSMITTED DISEASE PANEL 1-ARUP","code_information":[{"code":"3068759110","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEISSERIA GONORRHOEAE CONFIRMATION TMA - ARUP","code_information":[{"code":"3068759111","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ORTHOPOXVIRUS AMP PRB EACH","code_information":[{"code":"3068759301","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87593","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":159.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MONKEYPOX (ORTHOPOXVIRUS) DNA PCR - ARUP","code_information":[{"code":"3068759302","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87593","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":159.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMOCYSTIS JIROVECCI DNA PCR AMPLIFIED","code_information":[{"code":"3068759401","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87594","type":"HCPCS"}],"standard_charges":[{"gross_charge":468.57,"discounted_cash":468.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMOCYSTIS JIROVECII DNA PCR AMPLIFIED - ARUP","code_information":[{"code":"3068759402","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87594","type":"HCPCS"}],"standard_charges":[{"gross_charge":468.57,"discounted_cash":468.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES - HPV DNA PROBE, AMP","code_information":[{"code":"3068762401","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87624","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES - HPV HIGH RISK PCR","code_information":[{"code":"3068762402","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87624","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES - HPV DNA PROBE, DIRECT","code_information":[{"code":"3068762403","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87624","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HUMAN PAPILLOMAVIRUS (HPV) PCR HIGH RISK+16/18 GENOTYPE SUREPATH - ARUP","code_information":[{"code":"3068762404","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87624","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HUMAN PAPILLOMAVIRUS (HPV) PCR HIGH RISK+16/18 GENOTYPE THIN PREP- ARUP","code_information":[{"code":"3068762406","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87624","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HUMAN PAPOLLOMAVIRUS (HPV) NUCLEIC ACID AMPLIFICATION HIGH RISK - ARUP","code_information":[{"code":"3068762407","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87624","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HPV HIGH RISK SCREEN BY TMA, THIN PREP, WITH REFLEX - ARUP","code_information":[{"code":"3068762408","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87624","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - AMP PROBE HPV 16/18","code_information":[{"code":"3068762501","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87625","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.46,"discounted_cash":270.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - AMP PROBE RESP 3-5 TARGETS","code_information":[{"code":"3068763101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87631","type":"HCPCS"}],"standard_charges":[{"gross_charge":952.73,"discounted_cash":952.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RESPIRATORY VIRUS MINI PANEL PCR - 3 TARGETS - ARUP","code_information":[{"code":"3068763102","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87631","type":"HCPCS"}],"standard_charges":[{"gross_charge":952.73,"discounted_cash":952.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IADNA RESPIRATRY PROBE & REV TRNSCR 6-11 TARGET - ADDITIONAL CHARGE","code_information":[{"code":"3068763201","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87632","type":"HCPCS"}],"standard_charges":[{"gross_charge":763.21,"discounted_cash":763.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RESPIRATORY VIRAL PANEL PCR - ARUP","code_information":[{"code":"3068763202","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87632","type":"HCPCS"}],"standard_charges":[{"gross_charge":763.21,"discounted_cash":763.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET - ADDITIONAL CHARGE","code_information":[{"code":"3068763301","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87633","type":"HCPCS"}],"standard_charges":[{"gross_charge":2783.61,"discounted_cash":2783.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET - PANEL COMP CHARGE","code_information":[{"code":"3068763302","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87633","type":"HCPCS"}],"standard_charges":[{"gross_charge":2783.61,"discounted_cash":2783.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RESPIRATORY PANEL - 14 TARGETS","code_information":[{"code":"3068763303","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87633","type":"HCPCS"}],"standard_charges":[{"gross_charge":2783.61,"discounted_cash":2783.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - AMP PROBE RSV","code_information":[{"code":"3068763401","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87634","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.7,"discounted_cash":245.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RSV PCR","code_information":[{"code":"3068763402","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87634","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.7,"discounted_cash":245.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COVID-19 SARS-COV-2 AMPLIFIED PROBE","code_information":[{"code":"3068763501","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87635","type":"HCPCS"}],"standard_charges":[{"gross_charge":379.14,"discounted_cash":379.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COVID-19, FLU A, FLU B PCR","code_information":[{"code":"3068763601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87636","type":"HCPCS"}],"standard_charges":[{"gross_charge":952.73,"discounted_cash":952.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC STAPH AUREUS PCR - MRSA AND STAPH AUREUS PCR SCREEN NARES","code_information":[{"code":"3068764001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87640","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.82,"discounted_cash":122.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRSA PCR - MRSA AND STAPH AUREUS PCR SCREEN NARES","code_information":[{"code":"3068764101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87641","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.82,"discounted_cash":122.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRSA RAPID SCREEN PCR NARES","code_information":[{"code":"3068764103","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87641","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.82,"discounted_cash":122.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC STREP A DNA PROBE AMPLIFICATION THROAT","code_information":[{"code":"3068765102","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87651","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.82,"discounted_cash":122.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC STREP B DNA PCR PROBE","code_information":[{"code":"3068765301","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87653","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC STREP B DNA PCR AMPLIFIED PROBE ANTENATAL","code_information":[{"code":"3068765302","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87653","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRICHOMONAS VAGIN, DIR PROBE - TRICHOMONAS VAGINALIS DNA PROBE","code_information":[{"code":"3068766001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87660","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.56,"discounted_cash":133.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRICHOMONAS VAGINALIS PCR","code_information":[{"code":"3068766101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRICHOMONAS VAGINALIS BY TMA","code_information":[{"code":"3068766102","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRICHOMONAS VAGINALIS PCR PROBE","code_information":[{"code":"3068766106","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRICHOMONAS VAGINALIS PCR - VAGINAL PATHOGEN DNA PANEL","code_information":[{"code":"3068766107","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRICHOMONAS VAGINALIS - SEXUALLY TRANSMITTED DISEASE PANEL 1 - ARUP","code_information":[{"code":"3068766108","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRICHOMONAS VAGINALIS BY TMA - ARUP","code_information":[{"code":"3068766109","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRICHOMONAS VAGINALIS - VAGINAL PATHOGEN DNA PANEL - ARUP","code_information":[{"code":"3068766110","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRICHOMONAS VAGINALIS - CANDIDA AND TRICHOMONAS BY TMA - ARUP","code_information":[{"code":"3068766113","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - AMP PROBE ZIKA VIRUS","code_information":[{"code":"3068766201","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87662","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.8,"discounted_cash":342.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DETECT AGENT NOS, DNA, AMP - BORDETELLA PERTUSSIS PCR","code_information":[{"code":"3068779802","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DETECT AGENT NOS, DNA, AMP","code_information":[{"code":"3068779804","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHIKUNGUNYA PCR QUALITATIVE","code_information":[{"code":"3068779806","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYCOBACTERIA TB COMPLEX PCR","code_information":[{"code":"3068779807","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EPSTEIN BARR VIRUS PCR QUALITATIVE","code_information":[{"code":"3068779809","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC JC VIRUS PCR","code_information":[{"code":"3068779810","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOXOPLASMA PCR","code_information":[{"code":"3068779811","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WEST NILE VIRUS PCR","code_information":[{"code":"3068779812","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VARICELLA ZOSTER VIRUS PCR.","code_information":[{"code":"3068779813","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES VIRUS 8 PCR","code_information":[{"code":"3068779816","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANAPLASMA PHAGOCYTOPHILUM PCR","code_information":[{"code":"3068779817","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TROPHERYMA WHIPPLEI PCR","code_information":[{"code":"3068779818","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EHRLICHIA PCR","code_information":[{"code":"3068779819","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NOROVIRUS PCR","code_information":[{"code":"3068779821","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":957.18,"discounted_cash":957.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMPLIFIED NUCLEIC ACID PROBE QUALITATIVE- ADENOVIRUS NONBLOOD PCR","code_information":[{"code":"3068779825","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DNA/RNA AMP PROBE - PARVOVIRUS B19/HUMAN","code_information":[{"code":"3068779827","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.55,"discounted_cash":221.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VARICELLA ZOSTER VIRUS RT-PCR QUAL, NONBLOOD","code_information":[{"code":"3068779830","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NOROVIRUS 1 QUAL - NOROVIRUS GROUPS 1 AND 2 BY PCR - ARUP","code_information":[{"code":"3068779835","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NOROVIRUS 2 QUAL - NOROVIRUS GROUPS 1 AND 2 BY PCR - ARUP","code_information":[{"code":"3068779836","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ADENOVIRUS QUANT/QUAL PCR BLOOD","code_information":[{"code":"3068779837","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMOCYSTIS JIROVECII PCR","code_information":[{"code":"3068779841","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PNEUMOCYSTIS JIROVECII PCR - ARUP","code_information":[{"code":"3068779842","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WEST NILE VIRUS PCR QUAL - ARUP","code_information":[{"code":"3068779843","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ADENOVIRUS BY QUAL PCR - ARUP","code_information":[{"code":"3068779845","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EHRLICHIA EWINGII/CANIS PCR - EHRLICHIA & ANAPLASMA SPECIES PCR - ARUP","code_information":[{"code":"3068779847","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EHRLICHIA MURIS-LIKE PCR - EHRLICHIA & ANAPLASMA SPECIES PCR - ARUP","code_information":[{"code":"3068779848","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EPSTEIN BARR VIRUS PCR QUAL - ARUP","code_information":[{"code":"3068779849","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HERPES VIRUS 8 PCR QUAL - QDID","code_information":[{"code":"3068779850","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC JC VIRUS PCR QUAL - ARUP","code_information":[{"code":"3068779853","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PAROVIRUS B19 PCR QUAL - ARUP","code_information":[{"code":"3068779854","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BABESIA SPECIES PCR - TICK BORNE DISEASE PANEL PCR - ARUP","code_information":[{"code":"3068779855","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EHRLICHIA EWINGII/CANIS PCR - TICK BORNE DISEASE PANEL PCR - ARUP","code_information":[{"code":"3068779856","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EHRLICHIA MURIS LIKE PCR - TICK BORNE DISEASE PANEL PCR - ARUP","code_information":[{"code":"3068779857","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOXOPLASMA GONDII PCR QUAL - ARUP","code_information":[{"code":"3068779858","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TROPHERYMA WHIPPLEI (WHIPPLE DISEASE) PCR QUAL - ARUP","code_information":[{"code":"3068779861","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYCOPLASMA HOMINIS - UREAPLASMA AND MYCOPLASMA SPECIES BY PCR - ARUP","code_information":[{"code":"3068779862","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC UREAPLASMA PARVUM - UREAPLASMA AND MYCOPLASMA SPECIES BY PCR - ARUP","code_information":[{"code":"3068779863","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC UREAPLASMA UREALYTICUM - UREAPLASMA AND MYCOPLASMA SPECIES BY PCR - ARUP","code_information":[{"code":"3068779864","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VARICELLA ZOSTER VIRUS PCR QUAL - ARUP","code_information":[{"code":"3068779865","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MALARIA P. FALCIPARUM PCR QUAL - MALARIA SPECIES ID BY PCR - ARUP","code_information":[{"code":"3068779866","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MALARIA P. KNOWLESI PCR QUAL - MALARIA SPECIES ID BY PCR - ARUP","code_information":[{"code":"3068779867","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MALARIA P. MALARIAE PCR QUAL - MALARIA SPECIES ID BY PCR - ARUP","code_information":[{"code":"3068779868","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MALARIA P. OVALE PCR QUAL - MALARIA SPECIES ID BY PCR - ARUP","code_information":[{"code":"3068779869","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MALARIA P. VIVAX PCR QUAL - MALARIA SPECIES ID BY PCR - ARUP","code_information":[{"code":"3068779870","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MUMPS VIRUS PCR QUAL - ARUP","code_information":[{"code":"3068779871","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BORDETELLA PARAPERTUSSIS PCR-BORDETELLA PERTUSSIS/PARAPERTUSSIS PCR","code_information":[{"code":"3068779874","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BORDETELLA PERTUSSIS PCR -BORDETELLA PERTUSSIS/PARAPERTUSSIS PCR","code_information":[{"code":"3068779875","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BORDETELLA PERTUSSIS PCR","code_information":[{"code":"3068779878","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MEASLES (RUBEOLA) QUALITATIVE PCR, NP/THROAT - QUEST","code_information":[{"code":"3068779879","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MEASLES - MEASLES VIRUS BY QUAL NAAT - ARUP","code_information":[{"code":"3068779880","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MEASLES VACCINE STRAIN - MEASLES VIRUS BY QUAL NAAT - ARUP","code_information":[{"code":"3068779881","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MACROLIDE RESISTANCE - M GENITALIUM & MACROLIDE RESIST, PCR - ARUP","code_information":[{"code":"3068779884","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BK VIRUS PCR QUANT BLOOD","code_information":[{"code":"3068779901","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.36,"discounted_cash":316.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EPSTEIN BARR VIRUS (EBV) PCR QUANTITATIVE/QUALITATIVE","code_information":[{"code":"3068779902","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.36,"discounted_cash":316.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BK VIRUS PCR QUANT/QUAL URINE - ARUP","code_information":[{"code":"3068779903","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.36,"discounted_cash":316.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BK VIRUS PCR QUANT PLASMA - ARUP","code_information":[{"code":"3068779904","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.36,"discounted_cash":316.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EPSTEIN BARR VIRUS (EBV) QUANT NAAT PLASMA - ARUP","code_information":[{"code":"3068779905","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.36,"discounted_cash":316.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NUCLEIC ACID PROBE QUANTITATIVE - ADENOVIRUS PCR BLOOD","code_information":[{"code":"3068779911","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.36,"discounted_cash":316.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ADENOVIRUS QUANT PCR - ARUP","code_information":[{"code":"3068779912","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.36,"discounted_cash":316.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BK VIRUS PCR QUANT URINE","code_information":[{"code":"3068779913","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.04,"discounted_cash":286.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DETECT AGENT, MULT ORGS, DNA, AMP - MULTIPLE ORGANISMS","code_information":[{"code":"3068780102","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87801","type":"HCPCS"}],"standard_charges":[{"gross_charge":518.24,"discounted_cash":518.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BACTERIAL VAGINOSIS PCR - VAGINAL PATHOGEN DNA PANEL","code_information":[{"code":"3068780104","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87801","type":"HCPCS"}],"standard_charges":[{"gross_charge":518.24,"discounted_cash":518.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DETECT AGENT,IMMUN,DIR OBS,INFLUENZA - RAPID FLU","code_information":[{"code":"3068780401","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87804","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.87,"discounted_cash":121.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RAPID HIV ANTIBODY/ANTIGEN SCREEN","code_information":[{"code":"3068780601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87806","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.7,"discounted_cash":114.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - IMMUNOASSAY RSV AG","code_information":[{"code":"3068780701","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87807","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.25,"discounted_cash":97.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC STREP A RAPID SCREEN, DIRECT OPTICAL OBSERVATION","code_information":[{"code":"3068788001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87880","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.19,"discounted_cash":110.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AGENT NOS ASSAY W/OPTIC - CAMPYLOBACTER","code_information":[{"code":"3068789903","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.94,"discounted_cash":84.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AGENT NOS ASSAY W/OPTIC - CRYPTOCOCCAL","code_information":[{"code":"3068789904","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.85,"discounted_cash":106.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AGENT NOS ASSAY W/OPTIC - LEGIONELLA","code_information":[{"code":"3068789906","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.94,"discounted_cash":84.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AGENT NOS ASSAY W/OPTIC - SHIGELLA","code_information":[{"code":"3068789907","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.94,"discounted_cash":84.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AGENT NOS ASSAY W/OPTIC - STREP PNEUMO","code_information":[{"code":"3068789908","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.94,"discounted_cash":84.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AGENT NOS ASSAY W/OPTIC - UNLISTED ORGANISM","code_information":[{"code":"3068789909","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.18,"discounted_cash":118.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC STREPTOCOCCUS PNEUMONIAE ANTIGEN URINE","code_information":[{"code":"3068789910","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.94,"discounted_cash":84.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC STREPTOCOCCUS PNEUMONIAE ANTIGEN CSF","code_information":[{"code":"3068789911","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.04,"discounted_cash":89.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MALARIA SMEAR - RAPID SCREEN (WITH GIEMSA) - ARUP","code_information":[{"code":"3068789913","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.94,"discounted_cash":84.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - SUSCEPTIBILITY PHENOTYPE HIV","code_information":[{"code":"3068790001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87900","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.37,"discounted_cash":870.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - GENOTYPE BY NA - HIV1","code_information":[{"code":"3068790101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87901","type":"HCPCS"}],"standard_charges":[{"gross_charge":1901.87,"discounted_cash":1901.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS C GENOTYPE","code_information":[{"code":"3068790201","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87902","type":"HCPCS"}],"standard_charges":[{"gross_charge":1901.87,"discounted_cash":1901.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HCV NS5A GENOTYPE","code_information":[{"code":"3068790203","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87902","type":"HCPCS"}],"standard_charges":[{"gross_charge":1901.87,"discounted_cash":1901.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS C HIGH RESOLUTION GENOTYPE - ARUP","code_information":[{"code":"3068790204","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87902","type":"HCPCS"}],"standard_charges":[{"gross_charge":1901.87,"discounted_cash":1901.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HCV NS5A DRUG RESISTANCE GENOTYPE - ARUP","code_information":[{"code":"3068790205","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87902","type":"HCPCS"}],"standard_charges":[{"gross_charge":1901.87,"discounted_cash":1901.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS C GENOTYPE - ARUP","code_information":[{"code":"3068790206","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87902","type":"HCPCS"}],"standard_charges":[{"gross_charge":1901.87,"discounted_cash":1901.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - NA PHENOTYPE DRUG RESIST 1-10 HIV1","code_information":[{"code":"3068790301","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87903","type":"HCPCS"}],"standard_charges":[{"gross_charge":3263.32,"discounted_cash":3263.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - NA PHENOTYPE DRUG RESIST EA ADD HIV1","code_information":[{"code":"3068790401","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87904","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.63,"discounted_cash":173.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - NA GENOTYPE HIV1 OTHER REGION","code_information":[{"code":"3068790601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87906","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.56,"discounted_cash":450.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTOMEGALOVIRUS (CMV) ANTIVIRAL RESISTANCE - ARUP","code_information":[{"code":"3068791001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87910","type":"HCPCS"}],"standard_charges":[{"gross_charge":901.08,"discounted_cash":901.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - NA GENOTYPE HEP B VIRUS","code_information":[{"code":"3068791201","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87912","type":"HCPCS"}],"standard_charges":[{"gross_charge":901.08,"discounted_cash":901.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATITIS B GENOTYPE - ARUP","code_information":[{"code":"3068791202","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87912","type":"HCPCS"}],"standard_charges":[{"gross_charge":901.08,"discounted_cash":901.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROBIOLOGY - UNLISTED PROCEDURE","code_information":[{"code":"3068799901","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87999","type":"HCPCS"}],"standard_charges":[{"gross_charge":8.9,"discounted_cash":8.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URINALYSIS W MICROSCOPIC NON-AUTO","code_information":[{"code":"3078100001","type":"CDM"},{"code":"0307","type":"RC"},{"code":"81000","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.54,"discounted_cash":29.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URINALYSIS AUTO WITH MICROSCOPIC","code_information":[{"code":"3078100101","type":"CDM"},{"code":"0307","type":"RC"},{"code":"81001","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.39,"discounted_cash":23.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URINALYSIS, NON-AUTO W/O MICROSCPY","code_information":[{"code":"3078100201","type":"CDM"},{"code":"0307","type":"RC"},{"code":"81002","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.85,"discounted_cash":25.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URINALYSIS, NON-AUTO W/O MICROSCPY - POC","code_information":[{"code":"3078100202","type":"CDM"},{"code":"0307","type":"RC"},{"code":"81002","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.85,"discounted_cash":25.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URINALYSIS, NON-AUTO W/O MICROSCPY - ACETONE QUAL","code_information":[{"code":"3078100203","type":"CDM"},{"code":"0307","type":"RC"},{"code":"81002","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.85,"discounted_cash":25.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URINALYSIS, NON-AUTO W/O MICROSCPY - PROTEIN","code_information":[{"code":"3078100210","type":"CDM"},{"code":"0307","type":"RC"},{"code":"81002","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.85,"discounted_cash":25.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URINALYSIS, NON-AUTO W/O MICROSCPY - SPECIFIC GRAVITY","code_information":[{"code":"3078100211","type":"CDM"},{"code":"0307","type":"RC"},{"code":"81002","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.85,"discounted_cash":25.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PBB URINALYSIS NONAUTO W/O SCOPE","code_information":[{"code":"30781002PB","type":"CDM"},{"code":"0307","type":"RC"},{"code":"81002","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.85,"discounted_cash":25.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URINALYSIS DIPSTICK","code_information":[{"code":"3078100301","type":"CDM"},{"code":"0307","type":"RC"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.23,"discounted_cash":17.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URINALYSIS, AUTO, W/O SCOPE - POCT KETONE, URINE","code_information":[{"code":"3078100302","type":"CDM"},{"code":"0307","type":"RC"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.23,"discounted_cash":17.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URINALYSIS, AUTO, W/O SCOPE - URINALYSIS CHEM ONLY - PH","code_information":[{"code":"3078100303","type":"CDM"},{"code":"0307","type":"RC"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.23,"discounted_cash":17.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URINALYSIS, AUTO, W/O SCOPE - URINALYSIS CHEM ONLY - SPECIFIC GRAVITY","code_information":[{"code":"3078100304","type":"CDM"},{"code":"0307","type":"RC"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.23,"discounted_cash":17.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URINALYSIS, AUTO, W/O SCOPE - URINALYSIS CHEM ONLY - OCCULT BLOOD","code_information":[{"code":"3078100305","type":"CDM"},{"code":"0307","type":"RC"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.23,"discounted_cash":17.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URINALYSIS, AUTO, W/O SCOPE - URINALYSIS CHEM ONLY - ALBUMIN","code_information":[{"code":"3078100306","type":"CDM"},{"code":"0307","type":"RC"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.23,"discounted_cash":17.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URINALYSIS POINT OF CARE","code_information":[{"code":"3078100307","type":"CDM"},{"code":"0307","type":"RC"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.23,"discounted_cash":17.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BILE URINE","code_information":[{"code":"3078100308","type":"CDM"},{"code":"0307","type":"RC"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.23,"discounted_cash":17.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GLUCOSE URINE QUALITATIVE","code_information":[{"code":"3078100309","type":"CDM"},{"code":"0307","type":"RC"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.23,"discounted_cash":17.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC UROBILINOGEN QUALITATIVE","code_information":[{"code":"3078100310","type":"CDM"},{"code":"0307","type":"RC"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.23,"discounted_cash":17.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URINALYSIS, AUTO W/O MICROSCPY - SPECIFIC GRAVITY QUAL","code_information":[{"code":"3078100311","type":"CDM"},{"code":"0307","type":"RC"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.23,"discounted_cash":17.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URINALYSIS REFLEX MICRO REFLEX CULTURE (NO UNITS)","code_information":[{"code":"3078100312","type":"CDM"},{"code":"0307","type":"RC"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.58,"discounted_cash":15.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC UROBILINOGEN QUALITATIVE URINE","code_information":[{"code":"3078100314","type":"CDM"},{"code":"0307","type":"RC"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.23,"discounted_cash":17.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URINALYSIS MICROSCOPIC ONLY","code_information":[{"code":"3078101501","type":"CDM"},{"code":"0307","type":"RC"},{"code":"81015","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URINE PREGNANCY TEST - PREGNANCY URINE","code_information":[{"code":"3078102501","type":"CDM"},{"code":"0307","type":"RC"},{"code":"81025","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.02,"discounted_cash":64.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URINE PREGNANCY TEST - PREGNANCY URINE - POC","code_information":[{"code":"3078102502","type":"CDM"},{"code":"0307","type":"RC"},{"code":"81025","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.02,"discounted_cash":64.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEURO CSF PRION PRTN QUAL","code_information":[{"code":"3100035U01","type":"CDM"},{"code":"0310","type":"RC"},{"code":"0035U","type":"HCPCS"}],"standard_charges":[{"gross_charge":1893.47,"discounted_cash":1893.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEURO PRION PROTEIN - 14 3 3 PROTEIN CSF - ARUP","code_information":[{"code":"3100035U02","type":"CDM"},{"code":"0310","type":"RC"},{"code":"0035U","type":"HCPCS"}],"standard_charges":[{"gross_charge":1893.47,"discounted_cash":1893.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MERKEL POLYOMAVIRUS VP1 CAPSID ANTIBODY - ARUP","code_information":[{"code":"3100059U02","type":"CDM"},{"code":"0310","type":"RC"},{"code":"0059U","type":"HCPCS"}],"standard_charges":[{"gross_charge":1130.36,"discounted_cash":1130.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ORGANISM NGS KARIUS","code_information":[{"code":"3100152U01","type":"CDM"},{"code":"0310","type":"RC"},{"code":"0152U","type":"HCPCS"}],"standard_charges":[{"gross_charge":7441.7,"discounted_cash":7441.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RESPIRATORY PANEL BIOFIRE - 22 TARGETS","code_information":[{"code":"3100202U02","type":"CDM"},{"code":"0310","type":"RC"},{"code":"0202U","type":"HCPCS"}],"standard_charges":[{"gross_charge":1458.73,"discounted_cash":1458.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HPA1 GENOTYPING","code_information":[{"code":"3108110501","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81105","type":"HCPCS"}],"standard_charges":[{"gross_charge":815.83,"discounted_cash":815.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BRCA 1&2 SEQUENCING - ARUP","code_information":[{"code":"3108116202","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81162","type":"HCPCS"}],"standard_charges":[{"gross_charge":12186.24,"discounted_cash":12186.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BCR ABL1 MUTATION ANALYSIS BY NGS - ARUP","code_information":[{"code":"3108117002","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81170","type":"HCPCS"}],"standard_charges":[{"gross_charge":1050.0,"discounted_cash":1050.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - BCR/ABL1 GENE ANALYSIS","code_information":[{"code":"3108120601","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81206","type":"HCPCS"}],"standard_charges":[{"gross_charge":1095.19,"discounted_cash":1095.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - BCR/ABL T(9;22)","code_information":[{"code":"3108120602","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81206","type":"HCPCS"}],"standard_charges":[{"gross_charge":1095.19,"discounted_cash":1095.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BCR/ABL T(9-22) PCR QUANTITATIVE","code_information":[{"code":"3108120604","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81206","type":"HCPCS"}],"standard_charges":[{"gross_charge":1095.19,"discounted_cash":1095.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BCR-ABL1 MAJOR QUANTITATIVE PCR - ARUP","code_information":[{"code":"3108120605","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81206","type":"HCPCS"}],"standard_charges":[{"gross_charge":1095.19,"discounted_cash":1095.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BCR-ABL1 MAJOR - BCR-ABL1 QUAL W/ REFLEX TO MAJOR OR MINOR QUANT - ARUP","code_information":[{"code":"3108120607","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81206","type":"HCPCS"}],"standard_charges":[{"gross_charge":1095.19,"discounted_cash":1095.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - BCR/ABL1 T922 GENE ANALYSIS","code_information":[{"code":"3108120701","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81207","type":"HCPCS"}],"standard_charges":[{"gross_charge":967.2,"discounted_cash":967.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BCR-ABL1 MINOR - BCR-ABL1 QUAL W/ REFLEX TO MAJOR OR MINOR QUANT - ARUP","code_information":[{"code":"3108120702","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81207","type":"HCPCS"}],"standard_charges":[{"gross_charge":967.2,"discounted_cash":967.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BCR/ABL T922 QNT MINOR BREAKPOINT","code_information":[{"code":"3108120703","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81207","type":"HCPCS"}],"standard_charges":[{"gross_charge":967.2,"discounted_cash":967.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - BCR/ABL1 (T(9;22)), QUAL OR QUANT","code_information":[{"code":"3108120801","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81208","type":"HCPCS"}],"standard_charges":[{"gross_charge":1433.54,"discounted_cash":1433.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BCR-ABL1 MICRO - BCR-ABL1 QUAL W/ REFLEX TO MAJOR OR MINOR QUANT - ARUP","code_information":[{"code":"3108120802","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81208","type":"HCPCS"}],"standard_charges":[{"gross_charge":1433.54,"discounted_cash":1433.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BRAF MUTATIONAL ANALYSIS","code_information":[{"code":"3108121002","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81210","type":"HCPCS"}],"standard_charges":[{"gross_charge":1170.88,"discounted_cash":1170.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - CEBPA FULL GENE SEQUENCE","code_information":[{"code":"3108121801","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81218","type":"HCPCS"}],"standard_charges":[{"gross_charge":1614.96,"discounted_cash":1614.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CALR GENE ANALYSIS, COMMON, EXON 9 - MPN JAK2 REFLEX PANEL","code_information":[{"code":"3108121901","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81219","type":"HCPCS"}],"standard_charges":[{"gross_charge":812.49,"discounted_cash":812.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - CFTR COMMON VARIANTS - CYSTIC FIBROSIS DIAG STDY","code_information":[{"code":"3108122001","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81220","type":"HCPCS"}],"standard_charges":[{"gross_charge":3717.42,"discounted_cash":3717.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - CYP2C19 ANALYSIS, COMMON VARIANTS","code_information":[{"code":"3108122501","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81225","type":"HCPCS"}],"standard_charges":[{"gross_charge":1945.52,"discounted_cash":1945.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - CYP2D9 VARIANTS","code_information":[{"code":"3108122701","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81227","type":"HCPCS"}],"standard_charges":[{"gross_charge":1167.54,"discounted_cash":1167.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - CYTOGENOMIC MICROARRAY ANALYSIS, CNV & SNP","code_information":[{"code":"3108122901","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81229","type":"HCPCS"}],"standard_charges":[{"gross_charge":8567.61,"discounted_cash":8567.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTOGENOMIC INV PRB ARRAYFFPE TISSUE POC - ARUP","code_information":[{"code":"3108122902","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81229","type":"HCPCS"}],"standard_charges":[{"gross_charge":7746.48,"discounted_cash":7746.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - DPYD GENE ANALYSIS","code_information":[{"code":"3108123201","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81232","type":"HCPCS"}],"standard_charges":[{"gross_charge":1291.3,"discounted_cash":1291.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIHYDROPYRIMIDINE DEHYDROGENASE (DPYD) - ARUP","code_information":[{"code":"3108123202","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81232","type":"HCPCS"}],"standard_charges":[{"gross_charge":1291.3,"discounted_cash":1291.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - EGFR GENE ANALYSIS","code_information":[{"code":"3108123501","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81235","type":"HCPCS"}],"standard_charges":[{"gross_charge":2396.71,"discounted_cash":2396.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EGFR GENE ANALYSIS","code_information":[{"code":"3108123502","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81235","type":"HCPCS"}],"standard_charges":[{"gross_charge":2396.71,"discounted_cash":2396.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - 20210G F2 >A VARIANT - PROTHROMBIN GENE MUTATION","code_information":[{"code":"3108124001","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81240","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":485.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FACTOR 2 GENE MUTATION","code_information":[{"code":"3108124004","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81240","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":485.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FACTOR 5 LEIDEN","code_information":[{"code":"3108124102","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81241","type":"HCPCS"}],"standard_charges":[{"gross_charge":541.63,"discounted_cash":541.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - FMR1 ANALYSIS, ABNORMAL ALLELE DETECTION","code_information":[{"code":"3108124301","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81243","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.65,"discounted_cash":380.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - FLT3 GENE ANALYSIS","code_information":[{"code":"3108124501","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81245","type":"HCPCS"}],"standard_charges":[{"gross_charge":1105.21,"discounted_cash":1105.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLT3 ITD AND TKD MUTATION DETECTION - ARUP","code_information":[{"code":"3108124602","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81246","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.27,"discounted_cash":554.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - G6PC GENE ANALYSIS, COMMON VARIANTS","code_information":[{"code":"3108125001","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81250","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.66,"discounted_cash":390.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - HFE HEMOCHROMATOSIS CMN VAR - HEMOCHROMATOSIS MUT","code_information":[{"code":"3108125601","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81256","type":"HCPCS"}],"standard_charges":[{"gross_charge":482.55,"discounted_cash":482.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEMOCHROMATOSIS (HFE) 3 MUTATION - ARUP","code_information":[{"code":"3108125602","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81256","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.3,"discounted_cash":436.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - HBA2/HBA2 ANALYSIS, COMMON DELETIONS/VARIANT","code_information":[{"code":"3108125701","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81257","type":"HCPCS"}],"standard_charges":[{"gross_charge":683.38,"discounted_cash":683.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - IGH GENE ANALYSIS","code_information":[{"code":"3108126101","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81261","type":"HCPCS"}],"standard_charges":[{"gross_charge":1322.24,"discounted_cash":1322.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC B CELL CLONALITY NGS","code_information":[{"code":"3108126102","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81261","type":"HCPCS"}],"standard_charges":[{"gross_charge":1322.24,"discounted_cash":1322.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - IGH@ VARIABLE REGION SOMATIC MUTATION ANAL","code_information":[{"code":"3108126301","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81263","type":"HCPCS"}],"standard_charges":[{"gross_charge":1966.67,"discounted_cash":1966.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IGK GENE REARRANGEMENT ANALYSIS","code_information":[{"code":"3108126401","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81264","type":"HCPCS"}],"standard_charges":[{"gross_charge":1153.07,"discounted_cash":1153.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - JAK2 / V617F MUTATION GENE ANALYSIS","code_information":[{"code":"3108127001","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.15,"discounted_cash":612.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC JAK2 GENE V617F MUTATION QUANTITATIVE - ARUP","code_information":[{"code":"3108127002","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.15,"discounted_cash":612.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC JAK2 GENE V617F QUALITATIVE WITH REFLEX JAK2 EXON 12 - ARUP","code_information":[{"code":"3108127003","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.15,"discounted_cash":612.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC JAK2 GENE V617F QUALITATIVE WITH REFLEX CALR AND MPL - ARUP","code_information":[{"code":"3108127004","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.15,"discounted_cash":612.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC JAK2 GENE V617F MUTATION QUALITATIVE - ARUP","code_information":[{"code":"3108127005","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.15,"discounted_cash":612.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC JAK2 EXON 14 V617F POINT MUTATION","code_information":[{"code":"3108127006","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.15,"discounted_cash":612.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HUNTINGTON DISEASE (HD) MUTATION BY PCR - ARUP","code_information":[{"code":"3108127102","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81271","type":"HCPCS"}],"standard_charges":[{"gross_charge":914.89,"discounted_cash":914.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - KIT SEQUENCE","code_information":[{"code":"3108127201","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81272","type":"HCPCS"}],"standard_charges":[{"gross_charge":2200.4,"discounted_cash":2200.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - KIT D816 VARIANT(S)","code_information":[{"code":"3108127301","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81273","type":"HCPCS"}],"standard_charges":[{"gross_charge":833.64,"discounted_cash":833.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC KRAS GENE ANALYSIS","code_information":[{"code":"3108127503","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81275","type":"HCPCS"}],"standard_charges":[{"gross_charge":1291.08,"discounted_cash":1291.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - KRAS ADDITIONAL VAR GENE ANALYSIS","code_information":[{"code":"3108127601","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81276","type":"HCPCS"}],"standard_charges":[{"gross_charge":1291.08,"discounted_cash":1291.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC JAK2 TARGETED SEQUENCE EXONS 12-15 - MPN JAK2 REFLEX PANEL","code_information":[{"code":"3108127901","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81279","type":"HCPCS"}],"standard_charges":[{"gross_charge":1236.54,"discounted_cash":1236.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC JAK2 EXON 12 MUTATION PCR - ARUP","code_information":[{"code":"3108127902","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81279","type":"HCPCS"}],"standard_charges":[{"gross_charge":1236.54,"discounted_cash":1236.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - MGMT PROMOTER METHYLATION ANALYSIS","code_information":[{"code":"3108128701","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81287","type":"HCPCS"}],"standard_charges":[{"gross_charge":832.52,"discounted_cash":832.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - MLH1 GENE ANALYSIS","code_information":[{"code":"3108128801","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81288","type":"HCPCS"}],"standard_charges":[{"gross_charge":1284.4,"discounted_cash":1284.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - MTHFR VARIANTS","code_information":[{"code":"3108129101","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81291","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.3,"discounted_cash":436.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MLH1 GENE ANALYSIS FULL SEQUENCE - ARUP","code_information":[{"code":"3108129202","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81292","type":"HCPCS"}],"standard_charges":[{"gross_charge":4509.88,"discounted_cash":4509.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MLH1 GENE ANALYSIS DUP/DELETE VARIANTS - ARUP","code_information":[{"code":"3108129402","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81294","type":"HCPCS"}],"standard_charges":[{"gross_charge":1351.18,"discounted_cash":1351.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MSH2 GENE ANALYSIS FULL SEQUENCE - ARUP","code_information":[{"code":"3108129502","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81295","type":"HCPCS"}],"standard_charges":[{"gross_charge":2548.77,"discounted_cash":2548.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MSH2 GENE ANALYSIS DUP/DELETE VARIANTS - ARUP","code_information":[{"code":"3108129702","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81297","type":"HCPCS"}],"standard_charges":[{"gross_charge":1424.64,"discounted_cash":1424.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MSH6 GENE FULL SEQ","code_information":[{"code":"3108129801","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81298","type":"HCPCS"}],"standard_charges":[{"gross_charge":4286.16,"discounted_cash":4286.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MSH6 GENE DUP/DELETE VARIANT","code_information":[{"code":"3108130001","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81300","type":"HCPCS"}],"standard_charges":[{"gross_charge":1589.36,"discounted_cash":1589.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - MICROSATELLITE INSTABILITY GENE ANALYSIS","code_information":[{"code":"3108130101","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81301","type":"HCPCS"}],"standard_charges":[{"gross_charge":2327.28,"discounted_cash":2327.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NUDT15 VARIANTS - TPMT AND NUDT15 GENETICS - ARUP","code_information":[{"code":"3108130601","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81306","type":"HCPCS"}],"standard_charges":[{"gross_charge":1019.76,"discounted_cash":1019.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - NPM1 ANALYSIS, EXON 12 VARIANTS","code_information":[{"code":"3108131001","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81310","type":"HCPCS"}],"standard_charges":[{"gross_charge":1646.13,"discounted_cash":1646.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - NRAS / VAR EXON 2&3 GENE ANALYSIS","code_information":[{"code":"3108131101","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81311","type":"HCPCS"}],"standard_charges":[{"gross_charge":1975.58,"discounted_cash":1975.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - PDGFRA (GIST) GENE ANAL, TARGET SEQ ANAL","code_information":[{"code":"3108131401","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81314","type":"HCPCS"}],"standard_charges":[{"gross_charge":2200.4,"discounted_cash":2200.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - PMR/RARALPHA COMMON BREAKPOINTS","code_information":[{"code":"3108131501","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81315","type":"HCPCS"}],"standard_charges":[{"gross_charge":1384.57,"discounted_cash":1384.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PML-RARA DETECTION BY RT-PCR QUANTITATIVE - ARUP","code_information":[{"code":"3108131502","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81315","type":"HCPCS"}],"standard_charges":[{"gross_charge":1384.57,"discounted_cash":1384.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PMS2 GENE ANALYSIS FULL SEQUENCE - ARUP","code_information":[{"code":"3108131702","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81317","type":"HCPCS"}],"standard_charges":[{"gross_charge":4517.67,"discounted_cash":4517.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PMS2 GENE ANALYSIS DUP/DELETE VARIANTS - ARUP","code_information":[{"code":"3108131902","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81319","type":"HCPCS"}],"standard_charges":[{"gross_charge":1358.97,"discounted_cash":1358.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - SMN1/SMN2 GENE ANALYSIS","code_information":[{"code":"3108132901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"81329","type":"HCPCS"}],"standard_charges":[{"gross_charge":914.89,"discounted_cash":914.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SPINAL MUSCULAR ATROPHY (SMA), COPY NUMBER ANALYSIS- ARUP","code_information":[{"code":"3108132902","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81329","type":"HCPCS"}],"standard_charges":[{"gross_charge":914.89,"discounted_cash":914.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALPHA 1 ANTITRYPSIN GENOTYPE (SERPINA1) - A1A GENOTYPE - ARUP","code_information":[{"code":"3108133202","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81332","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.61,"discounted_cash":291.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - TPMT COMMON VARIANTS","code_information":[{"code":"3108133501","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81335","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.0,"discounted_cash":699.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MPL MUTATION DETECTION BY CAPILLARY ELECTROPHORESIS - ARUP","code_information":[{"code":"3108133803","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81338","type":"HCPCS"}],"standard_charges":[{"gross_charge":526.16,"discounted_cash":526.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MPL GENE SEQUENCE ANALYSIS, EXON 10 - MPN JAK2 REFLEX PANEL","code_information":[{"code":"3108133901","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81339","type":"HCPCS"}],"standard_charges":[{"gross_charge":1236.54,"discounted_cash":1236.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - TRB GENE ANALYSIS","code_information":[{"code":"3108134001","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81340","type":"HCPCS"}],"standard_charges":[{"gross_charge":1395.7,"discounted_cash":1395.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - GENE ANALYSIS - TRG T CELL VARIANTS","code_information":[{"code":"3108134201","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81342","type":"HCPCS"}],"standard_charges":[{"gross_charge":1345.62,"discounted_cash":1345.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - UGT1A1 ANALYSIS, COMMON VARIANTS","code_information":[{"code":"3108135001","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81350","type":"HCPCS"}],"standard_charges":[{"gross_charge":1562.65,"discounted_cash":1562.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC UGT1A1 GENOTYPING - ARUP","code_information":[{"code":"3108135002","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81350","type":"HCPCS"}],"standard_charges":[{"gross_charge":1562.65,"discounted_cash":1562.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEMOGLOBIN SUBUNIT BETA - HBB FULL GENE SEQUENCE","code_information":[{"code":"3108136401","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81364","type":"HCPCS"}],"standard_charges":[{"gross_charge":1136.03,"discounted_cash":1136.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANKLYOSING SPONDYLITIS (HLAB27) GENOTYPING - ARUP","code_information":[{"code":"3108137403","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81374","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.16,"discounted_cash":260.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HLA-B27 ANTIGEN","code_information":[{"code":"3108137404","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81374","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.16,"discounted_cash":260.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HLA DR TYPING MISC","code_information":[{"code":"3108137501","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81375","type":"HCPCS"}],"standard_charges":[{"gross_charge":772.59,"discounted_cash":772.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HLA CLASS II LOCUS, LOW RESOLUTION","code_information":[{"code":"3108137601","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81376","type":"HCPCS"}],"standard_charges":[{"gross_charge":815.83,"discounted_cash":815.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HLA II TYPE 1 AG EQUIV LR","code_information":[{"code":"3108137701","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81377","type":"HCPCS"}],"standard_charges":[{"gross_charge":632.18,"discounted_cash":632.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HLA CLASS I ONE LOCUS, HIGH RESOLUTION","code_information":[{"code":"3108138001","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81380","type":"HCPCS"}],"standard_charges":[{"gross_charge":620.38,"discounted_cash":620.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HLA CLASS I TYPING ALLELE, HIGH RESOLUTION","code_information":[{"code":"3108138101","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81381","type":"HCPCS"}],"standard_charges":[{"gross_charge":1134.15,"discounted_cash":1134.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HLA CLASS II ONE LOCUS, HIGH RESOLUTION","code_information":[{"code":"3108138201","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81382","type":"HCPCS"}],"standard_charges":[{"gross_charge":825.85,"discounted_cash":825.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HLA CLASS II TYPING, 1 ALLELE, HIGH RESOLUTION","code_information":[{"code":"3108138301","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81383","type":"HCPCS"}],"standard_charges":[{"gross_charge":729.02,"discounted_cash":729.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - SERPINE1 4G VARIANT","code_information":[{"code":"3108140003","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81400","type":"HCPCS"}],"standard_charges":[{"gross_charge":427.39,"discounted_cash":427.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APOLIPOPROTEIN E (APOE) MUTATION","code_information":[{"code":"3108140101","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81401","type":"HCPCS"}],"standard_charges":[{"gross_charge":914.89,"discounted_cash":914.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APOLIPOPROTEIN E (APOE) GENOTYPING, CARDIOVASCULAR RISK - ARUP","code_information":[{"code":"3108140102","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81401","type":"HCPCS"}],"standard_charges":[{"gross_charge":914.89,"discounted_cash":914.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - EML4/ALK TRANSLOCATION/INVERSION ANALYSIS","code_information":[{"code":"3108140103","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81401","type":"HCPCS"}],"standard_charges":[{"gross_charge":914.89,"discounted_cash":914.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APOLIPOPROTEIN E (APOE) GENOTYPING, ALZHEIMER DISEASE RISK - ARUP","code_information":[{"code":"3108140107","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81401","type":"HCPCS"}],"standard_charges":[{"gross_charge":914.89,"discounted_cash":914.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - TIER 2 LEVEL 3","code_information":[{"code":"3108140201","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81402","type":"HCPCS"}],"standard_charges":[{"gross_charge":1003.93,"discounted_cash":1003.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MPL CODON 515 MUTATION - ARUP","code_information":[{"code":"3108140202","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81402","type":"HCPCS"}],"standard_charges":[{"gross_charge":1003.93,"discounted_cash":1003.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - TIER 2 LEVEL 4","code_information":[{"code":"3108140301","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81403","type":"HCPCS"}],"standard_charges":[{"gross_charge":1236.54,"discounted_cash":1236.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - RBC GENOTYPE","code_information":[{"code":"3108140303","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81403","type":"HCPCS"}],"standard_charges":[{"gross_charge":1236.54,"discounted_cash":1236.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - DNMT3A MUTATION ANALYSIS","code_information":[{"code":"3108140305","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81403","type":"HCPCS"}],"standard_charges":[{"gross_charge":1236.54,"discounted_cash":1236.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RBC GENOTYPE - CARDIOMYOPATHY AND ARRHYTHMIA PANEL - ARUP","code_information":[{"code":"3108140306","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81403","type":"HCPCS"}],"standard_charges":[{"gross_charge":1236.54,"discounted_cash":1236.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - TIER 2 LEVEL 5","code_information":[{"code":"3108140401","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81404","type":"HCPCS"}],"standard_charges":[{"gross_charge":1835.34,"discounted_cash":1835.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TIER 2 LEVEL 5 - CARDIOMYOPATHY AND ARRHYTHMIA PANEL - ARUP","code_information":[{"code":"3108140402","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81404","type":"HCPCS"}],"standard_charges":[{"gross_charge":1835.34,"discounted_cash":1835.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - MEN TYPE 2A","code_information":[{"code":"3108140501","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81405","type":"HCPCS"}],"standard_charges":[{"gross_charge":2012.3,"discounted_cash":2012.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MEN TYPE 2A - CARDIOMYOPATHY AND ARRHYTHMIA PANEL - ARUP","code_information":[{"code":"3108140502","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81405","type":"HCPCS"}],"standard_charges":[{"gross_charge":2012.3,"discounted_cash":2012.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SPRED1 FULL GENE SEQUENCE - NEUROFIBROMATOSIS 1, LS PANEL - ARUP","code_information":[{"code":"3108140503","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81405","type":"HCPCS"}],"standard_charges":[{"gross_charge":2012.3,"discounted_cash":2012.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - TIER 2 LEVEL 7","code_information":[{"code":"3108140601","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":1888.76,"discounted_cash":1888.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC UBE3A GENE ANALYSIS - CARDIOMYOPATHY AND ARRHYTHMIA PANEL - ARUP","code_information":[{"code":"3108140604","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":1888.76,"discounted_cash":1888.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - LEVEL 8 - CARDIOMYOPATHY AND ARRHYTHMIA PANEL - ARUP","code_information":[{"code":"3108140702","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81407","type":"HCPCS"}],"standard_charges":[{"gross_charge":5651.81,"discounted_cash":5651.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY LEVEL 9","code_information":[{"code":"3108140802","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81408","type":"HCPCS"}],"standard_charges":[{"gross_charge":13356.0,"discounted_cash":13356.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENE ANALYSIS - LEVEL 9 - CARDIOMYOPATHY AND ARRHYTHMIA PANEL - ARUP","code_information":[{"code":"3108140803","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81408","type":"HCPCS"}],"standard_charges":[{"gross_charge":13356.0,"discounted_cash":13356.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIAC ION KCNH2 KCNQ1 - CARDIOMYOPATHY AND ARRHYTHMIA PANEL - ARUP","code_information":[{"code":"3108141402","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81414","type":"HCPCS"}],"standard_charges":[{"gross_charge":2047.15,"discounted_cash":2047.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - FETAL CHROMOSOME ANEUPLOIDY","code_information":[{"code":"3108142001","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81420","type":"HCPCS"}],"standard_charges":[{"gross_charge":5068.6,"discounted_cash":5068.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FETAL ANEUPLOIDY -NIPT FETAL ANEUPLOIDY SCREENING W MICRODELETIONS -ARUP","code_information":[{"code":"3108142002","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81420","type":"HCPCS"}],"standard_charges":[{"gross_charge":5068.6,"discounted_cash":5068.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - FETAL CHROMOSOME MICRODELETIONS","code_information":[{"code":"3108142201","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81422","type":"HCPCS"}],"standard_charges":[{"gross_charge":2656.68,"discounted_cash":2656.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FETAL MICRODELETIONS -NIPT FETAL ANEUPLOIDY SCREEN W MICRODELETIONS-ARUP","code_information":[{"code":"3108142202","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81422","type":"HCPCS"}],"standard_charges":[{"gross_charge":2656.68,"discounted_cash":2656.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - SEVERE DISORDER","code_information":[{"code":"3108144301","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81443","type":"HCPCS"}],"standard_charges":[{"gross_charge":8569.96,"discounted_cash":8569.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - SOLID ORGAN SEQUENCE VARIANTS","code_information":[{"code":"3108144501","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81445","type":"HCPCS"}],"standard_charges":[{"gross_charge":3992.33,"discounted_cash":3992.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SOLID TUMOR PROFILING BY NGS 50 GENES LUNG DNA ANALYSIS","code_information":[{"code":"3108144503","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81445","type":"HCPCS"}],"standard_charges":[{"gross_charge":3992.33,"discounted_cash":3992.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - HEMATOLYMPHOID SEQUENCE VARIANTS","code_information":[{"code":"3108145001","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81450","type":"HCPCS"}],"standard_charges":[{"gross_charge":5071.94,"discounted_cash":5071.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - NEOPLASM SEQUENCE VARIANTS","code_information":[{"code":"3108145501","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81455","type":"HCPCS"}],"standard_charges":[{"gross_charge":19497.53,"discounted_cash":19497.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY - TIER 2 UNLISTED","code_information":[{"code":"3108147901","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":1446.9,"discounted_cash":1446.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TIER 2 UNLISTED - CARDIOMYOPATHY AND ARRHYTHMIA PANEL - ARUP","code_information":[{"code":"3108147913","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":1446.9,"discounted_cash":1446.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MALIGNANCY RISK ASSESSMENT PELVIC MASS OVA1 PLUS - ARUP","code_information":[{"code":"3108150302","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81503","type":"HCPCS"}],"standard_charges":[{"gross_charge":3139.5,"discounted_cash":3139.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MATERNAL SCREENING SEQUENTIAL 1 - ARUP","code_information":[{"code":"3108150802","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81508","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.05,"discounted_cash":190.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FETAL CONGENITAL ABNORM PANEL, MATERNAL SERUM","code_information":[{"code":"3108151101","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81511","type":"HCPCS"}],"standard_charges":[{"gross_charge":537.25,"discounted_cash":537.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MATERNAL SERUM SCREEN QUAD TEST - ARUP","code_information":[{"code":"3108151102","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81511","type":"HCPCS"}],"standard_charges":[{"gross_charge":537.25,"discounted_cash":537.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BACTERIAL VAGINOSIS/VAGINITIS, CANDIDA SPP, TRICHOMONAS VAGINALIS PCR","code_information":[{"code":"3108151501","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81515","type":"HCPCS"}],"standard_charges":[{"gross_charge":920.47,"discounted_cash":920.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOLECULAR PATHOLOGY MAAA - PROSTATE ONCOLOGY","code_information":[{"code":"3108153901","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81539","type":"HCPCS"}],"standard_charges":[{"gross_charge":2660.0,"discounted_cash":2660.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PROSTATE SPECIFIC KALLIKREIN 4K SCORE - ARUP","code_information":[{"code":"3108153902","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81539","type":"HCPCS"}],"standard_charges":[{"gross_charge":2660.0,"discounted_cash":2660.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NFCT DS CHRNC HCV 6 ASSAYS","code_information":[{"code":"3108159601","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81596","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.01,"discounted_cash":533.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUK/LYMPH 16 OR MORE MARKERS - ARUP","code_information":[{"code":"3108818901","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88189","type":"HCPCS"}],"standard_charges":[{"gross_charge":620.22,"discounted_cash":620.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TISSUE CULTURE, LYMPHOCYTE - CHROMOSOME ANALYSIS","code_information":[{"code":"3108823001","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88230","type":"HCPCS"}],"standard_charges":[{"gross_charge":777.99,"discounted_cash":777.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TISSUE CULTURE LYMPHOCYTE - CHROMOS WHOLE BLD CONSTITUTIONAL - ARUP","code_information":[{"code":"3108823003","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88230","type":"HCPCS"}],"standard_charges":[{"gross_charge":777.99,"discounted_cash":777.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TISSUE CULTURE, SKIN OR SOLID TISSUE BIOPSY - CHROMOSOME ANALYSIS","code_information":[{"code":"3108823301","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88233","type":"HCPCS"}],"standard_charges":[{"gross_charge":939.37,"discounted_cash":939.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHROMOSOME PRODUCTS OF CONCEPTION","code_information":[{"code":"3108823302","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88233","type":"HCPCS"}],"standard_charges":[{"gross_charge":939.37,"discounted_cash":939.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TISSUE CULTURE, AMNIOTIC FLD OR CVS - CHROMOSOME ANALYSIS","code_information":[{"code":"3108823501","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88235","type":"HCPCS"}],"standard_charges":[{"gross_charge":1003.93,"discounted_cash":1003.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TISSUE CULTURE NEOPLASTIC DISORDER - CHROMOSOME ANALYSIS - BONE MARROW, BLOOD CELLS","code_information":[{"code":"3108823701","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88237","type":"HCPCS"}],"standard_charges":[{"gross_charge":1062.34,"discounted_cash":1062.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHROMOSOME LEUKEMIC BLOOD","code_information":[{"code":"3108823702","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88237","type":"HCPCS"}],"standard_charges":[{"gross_charge":960.52,"discounted_cash":960.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TISSUE CULTURE NEOPLASTIC DISORDER - CHROMOSOME ANALYSIS - SOLID TUMOR","code_information":[{"code":"3108823901","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88239","type":"HCPCS"}],"standard_charges":[{"gross_charge":985.01,"discounted_cash":985.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY - CHROM ANALYSIS 5 CELL KAROTYPE BANDING","code_information":[{"code":"3108826101","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88261","type":"HCPCS"}],"standard_charges":[{"gross_charge":1765.22,"discounted_cash":1765.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY - 15 - 20 CELL 2 KAROTYPE BANDING","code_information":[{"code":"3108826201","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88262","type":"HCPCS"}],"standard_charges":[{"gross_charge":926.93,"discounted_cash":926.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC 15-20 CELL 2 KARYO BAND -CHROMOSOME WHOLE BLD CONSTITUTIONAL - ARUP","code_information":[{"code":"3108826202","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88262","type":"HCPCS"}],"standard_charges":[{"gross_charge":926.93,"discounted_cash":926.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY - CHROM ANALYSIS 15 CELLS 1 KARYOTYPE WITH BANDING AMNIOTIC FLD OR CVS","code_information":[{"code":"3108826701","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88267","type":"HCPCS"}],"standard_charges":[{"gross_charge":1258.8,"discounted_cash":1258.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTOGENETICS, DNA PROBE - ALK, FISH","code_information":[{"code":"3108827101","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.58,"discounted_cash":143.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTOGENETICS, DNA PROBE - FISH","code_information":[{"code":"3108827103","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.58,"discounted_cash":143.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTOGENETICS, DNA PROBE - CHROM IN SITU HYBRID 3-5 CELLS","code_information":[{"code":"3108827201","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88272","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.45,"discounted_cash":142.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTOGENETICS, DNA PROBE - CHROM IN SITU HYBRID 10-30 CELLS","code_information":[{"code":"3108827301","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88273","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.62,"discounted_cash":232.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY - INTERPHASE IN SITU HYBRID 25 - 99 CELL ANALYSIS","code_information":[{"code":"3108827401","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88274","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.7,"discounted_cash":282.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY - INTERPHASE IN SITU HYBRID 100-300 CELL ANALYSIS","code_information":[{"code":"3108827502","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.69,"discounted_cash":341.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY - CHROM ANALYSIS ADDITIONAL KARYOTYPE","code_information":[{"code":"3108828001","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88280","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.42,"discounted_cash":247.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY - CHROM ANALYSIS ADDITIONAL CELLS COUNTED","code_information":[{"code":"3108828501","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88285","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.19,"discounted_cash":179.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY - CHROM ANALYSIS ADDITIONAL HIGH RES","code_information":[{"code":"3108828901","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88289","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.39,"discounted_cash":230.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SURGICAL PATHOLOGY HISTOCHEMICAL STAIN ON FROZEN TISSUE","code_information":[{"code":"3108831401","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88314","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.68,"discounted_cash":75.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY - INTRAOP CONSULT","code_information":[{"code":"3108832901","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88329","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.89,"discounted_cash":249.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY - INTRAOP CONSULT INITIAL SITE PREP EXAM","code_information":[{"code":"3108833301","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88333","type":"HCPCS"}],"standard_charges":[{"gross_charge":2921.63,"discounted_cash":2921.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY - IMMUNOCYTOCHEM MULTIPLEX ABY STAIN","code_information":[{"code":"3108834401","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88344","type":"HCPCS"}],"standard_charges":[{"gross_charge":1945.52,"discounted_cash":1945.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY - ELECTRON MICROSCOPY","code_information":[{"code":"3108834801","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88348","type":"HCPCS"}],"standard_charges":[{"gross_charge":4381.88,"discounted_cash":4381.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY - IMMUNOFLUOR ADDITIONAL SINGLE ABY STAIN","code_information":[{"code":"3108835001","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88350","type":"HCPCS"}],"standard_charges":[{"gross_charge":972.76,"discounted_cash":972.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOHISTOCHEMISTRY (IHC) MANUAL MORPHOMETRIC ANALYSIS EACH ANTIBODY","code_information":[{"code":"3108836001","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88360","type":"HCPCS"}],"standard_charges":[{"gross_charge":1101.73,"discounted_cash":1101.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY - MORPH ANALYSIS IHC STAIN SINGLE ABY QUANT/QUAL COMPUTER ASSIST","code_information":[{"code":"3108836101","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88361","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY - MORPH ANALYSIS  IHC STAIN SINGLE ABY QUANT/QUAL COMPTR TUMOR","code_information":[{"code":"3108836106","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88361","type":"HCPCS"}],"standard_charges":[{"gross_charge":1945.52,"discounted_cash":1945.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXAMINATION AND SELECTION OF ARCHIVED TISSUE FOR MOLECULAR ANALYSIS","code_information":[{"code":"3108836301","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88363","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.72,"discounted_cash":164.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IN SITU HYBRIDIZATION EACH ADDITIONAL SINGLE PROBE STAIN","code_information":[{"code":"3108836401","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88364","type":"HCPCS"}],"standard_charges":[{"gross_charge":551.47,"discounted_cash":551.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IN SITU HYBRIDIZATION INITIAL SINGLE PROBE STAIN","code_information":[{"code":"3108836501","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88365","type":"HCPCS"}],"standard_charges":[{"gross_charge":1101.73,"discounted_cash":1101.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY - INSITU HYB INITIAL STAIN - HPV","code_information":[{"code":"3108836503","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88365","type":"HCPCS"}],"standard_charges":[{"gross_charge":1101.73,"discounted_cash":1101.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY - MORPH ANALYSIS IN SITU HYB INITIAL STAIN COMPUTER ASSIST","code_information":[{"code":"3108836701","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88367","type":"HCPCS"}],"standard_charges":[{"gross_charge":1945.52,"discounted_cash":1945.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY - MORPH ANALYSIS IN SITU HYB INITIAL STAIN MANUAL","code_information":[{"code":"3108836801","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88368","type":"HCPCS"}],"standard_charges":[{"gross_charge":1945.52,"discounted_cash":1945.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY - MORPH ANALYSIS IN SITU HYB ADDITIONAL STAIN MANUAL","code_information":[{"code":"3108836901","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88369","type":"HCPCS"}],"standard_charges":[{"gross_charge":972.76,"discounted_cash":972.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY-MORPH ANALYSIS IN SITU,PER SPCMN,EA ADDL PROBE STAIN COMP ASST","code_information":[{"code":"3108837301","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88373","type":"HCPCS"}],"standard_charges":[{"gross_charge":972.76,"discounted_cash":972.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY - MORPH ANALYSIS IN SITU HYB MULTIPLX STAIN COMPUTER ASSIST","code_information":[{"code":"3108837401","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88374","type":"HCPCS"}],"standard_charges":[{"gross_charge":1101.73,"discounted_cash":1101.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY - MORPH ANALYSIS IN SITU HYB MANUAL EACH MULTIPLEX STAIN PROCEDURE","code_information":[{"code":"3108837702","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88377","type":"HCPCS"}],"standard_charges":[{"gross_charge":1101.73,"discounted_cash":1101.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY - MICRODISSECTION MANUAL","code_information":[{"code":"3108838101","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88381","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.37,"discounted_cash":545.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CTYOPATHOLOGY SMEARS AND INTERPRETATION, FLUIDS","code_information":[{"code":"3118810401","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88104","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.19,"discounted_cash":166.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTOPATHOLOGY CONCENTRATION, SMEARS, AND INTERPRETATION, FLUIDS","code_information":[{"code":"3118810801","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88108","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.19,"discounted_cash":166.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAB CYTOPATH CELL ENHANCEMENT TECHNIQUE","code_information":[{"code":"3118811201","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88112","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.79,"discounted_cash":332.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTO-WASHING","code_information":[{"code":"3118811202","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88112","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.79,"discounted_cash":332.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTO-BRUSH WASHINGS","code_information":[{"code":"3118811203","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88112","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.49,"discounted_cash":221.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTOPATH CELL ENHANCE TECH - LAB CYTOPATH,  CELL ENHANCE TECH INTERM","code_information":[{"code":"3118811204","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88112","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.79,"discounted_cash":332.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTOPATH CELL ENHANCE TECH - LAB CYTOPATH,  CELL ENHANCE TECH CMPLX","code_information":[{"code":"3118811205","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88112","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.79,"discounted_cash":332.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTP URNE 3-5 PROBES EA SPEC - LAB CYTOPATH, INSITU HYB URINE SPEC","code_information":[{"code":"3118812001","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88120","type":"HCPCS"}],"standard_charges":[{"gross_charge":996.14,"discounted_cash":996.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PAP SMEAR PATHOLOGIST INTERPRETATION NO ALT CODE","code_information":[{"code":"3118814101","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88141","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.15,"discounted_cash":90.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PAP SMEAR SCREENING MANUAL PATHOLOGIST INTERPRETATION ALT CODE G0124","code_information":[{"code":"3118814102","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88141","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.15,"discounted_cash":90.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PAP SMEAR SCREENING IMAGED PATHOLOGIST INTERPRETATION ALT CODE G0141","code_information":[{"code":"3118814103","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88141","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.15,"discounted_cash":90.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PAP SMEAR DIAGNOSTIC MANUAL NO ALT CODE","code_information":[{"code":"3118814201","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88142","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.79,"discounted_cash":135.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PAP SMEAR SCREENING MANUAL ALT CODE G0123","code_information":[{"code":"3118814202","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88142","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.79,"discounted_cash":135.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTOPATHOLOGY  SMEARS, INTERPRETATION, ANY OTHER SOURCE","code_information":[{"code":"3118816001","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88160","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.19,"discounted_cash":110.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTOPATHOLOGY  SMEARS, PREPARATION AND INTERPRETATION, ANY OTHER SOURCE","code_information":[{"code":"3118816101","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88161","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.72,"discounted_cash":164.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTOPATH PAPSM - PAP MAN SCRN PHY SPV BETHES DIAG","code_information":[{"code":"3118816402","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88164","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.67,"discounted_cash":63.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FINE NEEDLE ASPIRATION IMMEDIATE EVALUATION FOR ADEQUACY FIRST SITE","code_information":[{"code":"3118817201","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88172","type":"HCPCS"}],"standard_charges":[{"gross_charge":664.46,"discounted_cash":664.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FINE NEEDLE ASPIRATION INTERPRETATION AND REPORT","code_information":[{"code":"3118817301","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88173","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.97,"discounted_cash":244.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CYTOPATH C/V AUTO FLUID - PAPSM THIN LAYER,INTER DIAG NO ALT CODE","code_information":[{"code":"3118817501","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88175","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.08,"discounted_cash":178.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PAP SMEAR DIAGNOSTIC IMAGED NO ALT CODE","code_information":[{"code":"3118817502","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88175","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.08,"discounted_cash":178.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PAP SMEAR SCREENING IMAGED ALT CODE G0145","code_information":[{"code":"3118817503","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88175","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.08,"discounted_cash":178.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FINE NEEDLE ASPIRATION IMMEDIATE EVALUATION FOR ADEQUACY EACH ADDL SITE","code_information":[{"code":"3118817701","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88177","type":"HCPCS"}],"standard_charges":[{"gross_charge":498.62,"discounted_cash":498.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOWCYTOMETRY/ TECH COMPONENT, CELL CYCLE OR DNA ANALYSIS","code_information":[{"code":"3118818201","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88182","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.79,"discounted_cash":332.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY FIRST MARKER","code_information":[{"code":"3118818405","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REFERENCE FETAL HEMOGLOBIN QUANTITATIVE","code_information":[{"code":"3118818406","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NATURAL KILLER CELL FUNCTION ASSAY","code_information":[{"code":"3118818407","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LYMPHOCYTE SUBSETS","code_information":[{"code":"3118818408","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOWCYTOMETRY/ TECH COMPONENT, 1 MARKER - FLOWCYTOMETRY","code_information":[{"code":"3118818415","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC B CELL CD20 EXPRESSION FIRST MARKER - ARUP","code_information":[{"code":"3118818419","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LYMPHOCYTE SUBSETS FIRST MARKER","code_information":[{"code":"3118818421","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PAROXYSMAL NOCTURNAL HEMOGLOBINURIA (PNH) FIRST MARKER","code_information":[{"code":"3118818422","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 35 MARKERS - ARUP","code_information":[{"code":"3118818423","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 10 MARKERS - ARUP","code_information":[{"code":"3118818424","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 11 MARKERS - ARUP","code_information":[{"code":"3118818425","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 12 MARKERS - ARUP","code_information":[{"code":"3118818426","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 13 MARKERS - ARUP","code_information":[{"code":"3118818427","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 14 MARKERS - ARUP","code_information":[{"code":"3118818428","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 15 MARKERS - ARUP","code_information":[{"code":"3118818429","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 16 MARKERS - ARUP","code_information":[{"code":"3118818430","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 17 MARKERS - ARUP","code_information":[{"code":"3118818431","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 18 MARKERS - ARUP","code_information":[{"code":"3118818432","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 19 MARKERS - ARUP","code_information":[{"code":"3118818433","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 20 MARKERS - ARUP","code_information":[{"code":"3118818434","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 21 MARKERS - ARUP","code_information":[{"code":"3118818435","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 22 MARKERS - ARUP","code_information":[{"code":"3118818436","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 23 MARKERS - ARUP","code_information":[{"code":"3118818437","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 24 MARKERS - ARUP","code_information":[{"code":"3118818438","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 25 MARKERS - ARUP","code_information":[{"code":"3118818439","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 26 MARKERS - ARUP","code_information":[{"code":"3118818440","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 27 MARKERS - ARUP","code_information":[{"code":"3118818441","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 28 MARKERS - ARUP","code_information":[{"code":"3118818442","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 29 MARKERS - ARUP","code_information":[{"code":"3118818443","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 30 MARKERS - ARUP","code_information":[{"code":"3118818444","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 31 MARKERS - ARUP","code_information":[{"code":"3118818445","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 32 MARKERS - ARUP","code_information":[{"code":"3118818446","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 33 MARKERS - ARUP","code_information":[{"code":"3118818447","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 34 MARKERS - ARUP","code_information":[{"code":"3118818448","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 5 MARKERS - ARUP","code_information":[{"code":"3118818449","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 6 MARKERS - ARUP","code_information":[{"code":"3118818450","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 7 MARKERS - ARUP","code_information":[{"code":"3118818451","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 8 MARKERS - ARUP","code_information":[{"code":"3118818452","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 9 MARKERS - ARUP","code_information":[{"code":"3118818453","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.75,"discounted_cash":2151.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOWCYTOMETRY/TECH COMPONENT, ADD-ON - LAB FLOWCYTOMETRY/TECH CMP","code_information":[{"code":"3118818501","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.87,"discounted_cash":1075.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOWCYTOMETRY/TECH COMPONENT, ADD-ON - BUNDLED CHARGE","code_information":[{"code":"3118818502","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.87,"discounted_cash":1075.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LYMPHOCYTE SUBSETS ADDITIONAL MARKERS","code_information":[{"code":"3118818504","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.87,"discounted_cash":1075.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY  EACH ADDITIONAL MARKER","code_information":[{"code":"3118818505","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.87,"discounted_cash":1075.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LYMPHOCYTE SUBSETS ADDITIONAL MARKERS","code_information":[{"code":"3118818507","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.87,"discounted_cash":1075.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PAROXYSMAL NOCTURNAL HEMOGLOBINURIA (PNH) ADDITIONAL MARKERS","code_information":[{"code":"3118818508","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.87,"discounted_cash":1075.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC B CELL CD20 EXPRESSION ADDITIONAL MARKER - ARUP","code_information":[{"code":"3118818509","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.87,"discounted_cash":1075.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 34 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818510","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.87,"discounted_cash":1075.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 9 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818511","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.87,"discounted_cash":1075.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 10 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818512","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.87,"discounted_cash":1075.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 11 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818513","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.87,"discounted_cash":1075.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 12 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818514","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.87,"discounted_cash":1075.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 13 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818515","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.87,"discounted_cash":1075.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 14 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818516","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.87,"discounted_cash":1075.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 15 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818517","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.87,"discounted_cash":1075.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 16 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818518","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.87,"discounted_cash":1075.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 17 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818519","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.87,"discounted_cash":1075.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 18 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818520","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.87,"discounted_cash":1075.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 19 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818521","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.87,"discounted_cash":1075.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 20 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818522","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.87,"discounted_cash":1075.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 21 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818523","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.87,"discounted_cash":1075.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 22 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818524","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.87,"discounted_cash":1075.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 23 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818525","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.87,"discounted_cash":1075.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 24 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818526","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.87,"discounted_cash":1075.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 25 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818527","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.87,"discounted_cash":1075.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 26 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818528","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.87,"discounted_cash":1075.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 27 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818529","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.87,"discounted_cash":1075.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 28 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818530","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.87,"discounted_cash":1075.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 29 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818531","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.87,"discounted_cash":1075.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 30 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818532","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.87,"discounted_cash":1075.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 31 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818533","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.87,"discounted_cash":1075.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 32 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818534","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.87,"discounted_cash":1075.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 33 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818535","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.87,"discounted_cash":1075.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 4 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818536","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.87,"discounted_cash":1075.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 5 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818537","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.87,"discounted_cash":1075.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 6 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818538","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.87,"discounted_cash":1075.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 7 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818539","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.87,"discounted_cash":1075.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 8 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818540","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.87,"discounted_cash":1075.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHROMOSOME COUNT - CHROMOSOME ANALYSIS PRODUCTS OF CONCEPTION - ARUP","code_information":[{"code":"3118826202","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88262","type":"HCPCS"}],"standard_charges":[{"gross_charge":926.93,"discounted_cash":926.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY - CHROM ANALYSIS 20 - 25 CELL","code_information":[{"code":"3118826401","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88264","type":"HCPCS"}],"standard_charges":[{"gross_charge":1068.48,"discounted_cash":1068.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SURGICAL PATHOLOGY LEVEL I GROSS ONLY","code_information":[{"code":"3128830001","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88300","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.87,"discounted_cash":121.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SURGICAL PATHOLOGY LEVEL II","code_information":[{"code":"3128830201","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88302","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":215.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SURG PATH,LEVEL III - LAB SURG PATH,LEVEL III","code_information":[{"code":"3128830401","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88304","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":329.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SURGICAL PATHOLOGY LEVEL IV","code_information":[{"code":"3128830501","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88305","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":405.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SURGICAL PATHOLOGY LEVEL V","code_information":[{"code":"3128830701","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88307","type":"HCPCS"}],"standard_charges":[{"gross_charge":1434.09,"discounted_cash":1434.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SURGICAL PATHOLOGY LEVEL VI","code_information":[{"code":"3128830901","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88309","type":"HCPCS"}],"standard_charges":[{"gross_charge":3231.32,"discounted_cash":3231.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SURGICAL PATHOLOGY DECALCIFY TISSUE","code_information":[{"code":"3128831105","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88311","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.52,"discounted_cash":338.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SPECIAL STAINS,GROUP I - LAB SPECIAL STAINS,GROUP I","code_information":[{"code":"3128831201","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88312","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.97,"discounted_cash":244.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SURGICAL PATHOLOGY SPECIAL STAIN GROUP I MICROORGANISMS","code_information":[{"code":"3128831202","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88312","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.97,"discounted_cash":244.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SPECIAL STAINS,GROUP II - LAB SPECIAL STAINS,GROUP II","code_information":[{"code":"3128831301","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88313","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.19,"discounted_cash":166.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SURGICAL PATHOLOGY SPECIAL STAIN GROUP II EXCEPT MICROORGANISMS","code_information":[{"code":"3128831302","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88313","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.19,"discounted_cash":166.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IRON STAIN","code_information":[{"code":"3128831303","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88313","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.19,"discounted_cash":166.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SURGICAL PATHOLOGY CONSULT ON SLIDES PREPARED ELSEWHERE","code_information":[{"code":"3128832101","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88321","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.94,"discounted_cash":225.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MICROSLIDE CONSULT W SLIDE PREP - LAB MICROSLIDE CONSULT W SLD PREP","code_information":[{"code":"3128832301","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88323","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.07,"discounted_cash":368.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COMPREHENSIVE PATHOLOGY CONSULT","code_information":[{"code":"3128832501","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88325","type":"HCPCS"}],"standard_charges":[{"gross_charge":996.14,"discounted_cash":996.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY CONSULT IN SURGERY, FROZEN SECTION BLOCK","code_information":[{"code":"3128833101","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88331","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.89,"discounted_cash":734.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY CONSULT IN SURGERY, EACH ADDITIONAL FROZEN SECTION BLOCK","code_information":[{"code":"3128833201","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88332","type":"HCPCS"}],"standard_charges":[{"gross_charge":551.47,"discounted_cash":551.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PATHOLOGY CONSULT IN SURGERY, EACH ADDITIONAL CYTOLOGIC EXAMINATION","code_information":[{"code":"3128833401","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88334","type":"HCPCS"}],"standard_charges":[{"gross_charge":498.62,"discounted_cash":498.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOHISTOCHEMISTRY (IHC) EACH ADDITIONAL ANTIBODY","code_information":[{"code":"3128834101","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88341","type":"HCPCS"}],"standard_charges":[{"gross_charge":551.47,"discounted_cash":551.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOHISTOCHEMISTRY (IHC) FIRST ANTIBODY","code_information":[{"code":"3128834201","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88342","type":"HCPCS"}],"standard_charges":[{"gross_charge":1101.73,"discounted_cash":1101.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOHISTOCHEMISTRY - INITIAL SINGLE ANTIBODY STAIN PROCEDURE - ARKANA","code_information":[{"code":"3128834202","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88342","type":"HCPCS"}],"standard_charges":[{"gross_charge":1101.73,"discounted_cash":1101.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMHISTOCHEM/CYTCHM INIT ANTIBODY STAIN PROCEDURE - SINGLE ABY","code_information":[{"code":"3128834203","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88342","type":"HCPCS"}],"standard_charges":[{"gross_charge":1101.73,"discounted_cash":1101.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMHISTOCHEM/CYTCHM INIT ANTIBODY STAIN PROCEDURE - HER2/NEU","code_information":[{"code":"3128834204","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88342","type":"HCPCS"}],"standard_charges":[{"gross_charge":1101.73,"discounted_cash":1101.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOFLUORESCENT STUDY,INDIRECT - ANTIBODY EACH","code_information":[{"code":"3128834602","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88346","type":"HCPCS"}],"standard_charges":[{"gross_charge":1945.52,"discounted_cash":1945.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNOFLUORESCENT STUDY,INDIRECT ADDITIONAL SINGLE ABY STAIN","code_information":[{"code":"3128835001","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88350","type":"HCPCS"}],"standard_charges":[{"gross_charge":972.76,"discounted_cash":972.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PDL1 22C3 IMMUNOHISTOCHEMISTRY (IHC) WITH TUMOR PROPORTION SCORE - ARUP","code_information":[{"code":"3128836005","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88360","type":"HCPCS"}],"standard_charges":[{"gross_charge":1101.73,"discounted_cash":1101.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HER2NEU FISH, BREAST TISSUE","code_information":[{"code":"3128837701","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88377","type":"HCPCS"}],"standard_charges":[{"gross_charge":1101.73,"discounted_cash":1101.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ALK1 GENE REARRANGEMENT BY FISH","code_information":[{"code":"3128837703","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88377","type":"HCPCS"}],"standard_charges":[{"gross_charge":1101.73,"discounted_cash":1101.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SURGICAL PATHOLOGY PROSTATE NEEDLE BIOPSY, ANY NUMBER OF SPECIMENS","code_information":[{"code":"312G041601","type":"CDM"},{"code":"0312","type":"RC"},{"code":"G0416","type":"HCPCS"}],"standard_charges":[{"gross_charge":1296.65,"discounted_cash":1296.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CISTERNOGRAPHY,POS CONTRAST - FL CISTERNOGRAM","code_information":[{"code":"3207001501","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70015","type":"HCPCS"}],"standard_charges":[{"gross_charge":6841.46,"discounted_cash":6841.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY EYE FOR FOREIGN BODY","code_information":[{"code":"3207003001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70030","type":"HCPCS"}],"standard_charges":[{"gross_charge":944.94,"discounted_cash":944.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY JAW <4 VW","code_information":[{"code":"3207010001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70100","type":"HCPCS"}],"standard_charges":[{"gross_charge":902.31,"discounted_cash":902.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY JAW 4+ VW","code_information":[{"code":"3207011001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70110","type":"HCPCS"}],"standard_charges":[{"gross_charge":1925.49,"discounted_cash":1925.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY MASTOIDS 3+ VW","code_information":[{"code":"3207013001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70130","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.27,"discounted_cash":485.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY FACIAL BONES <3 VW","code_information":[{"code":"3207014001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70140","type":"HCPCS"}],"standard_charges":[{"gross_charge":1047.56,"discounted_cash":1047.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY FACIAL BONES 3+ VW","code_information":[{"code":"3207015001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70150","type":"HCPCS"}],"standard_charges":[{"gross_charge":1574.42,"discounted_cash":1574.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY NASAL BONES","code_information":[{"code":"3207016001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70160","type":"HCPCS"}],"standard_charges":[{"gross_charge":1262.99,"discounted_cash":1262.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY ORBITS","code_information":[{"code":"3207020001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1845.35,"discounted_cash":1845.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY SINUSES <3 VW - XR SINUSES WATERS VIEW ONLY","code_information":[{"code":"3207021001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70210","type":"HCPCS"}],"standard_charges":[{"gross_charge":907.1,"discounted_cash":907.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY SINUSES <3 VW - XR PARANASAL SINUSES 1-2 VIEWS","code_information":[{"code":"3207021002","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70210","type":"HCPCS"}],"standard_charges":[{"gross_charge":907.1,"discounted_cash":907.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY SINUSES 3+ VW","code_information":[{"code":"3207022001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1823.09,"discounted_cash":1823.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY EXAM SELLA - XR SELLA TURCICA","code_information":[{"code":"3207024001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70240","type":"HCPCS"}],"standard_charges":[{"gross_charge":1823.09,"discounted_cash":1823.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY SKULL <4 VW","code_information":[{"code":"3207025001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70250","type":"HCPCS"}],"standard_charges":[{"gross_charge":1025.41,"discounted_cash":1025.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY SKULL 4+ VW","code_information":[{"code":"3207026001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70260","type":"HCPCS"}],"standard_charges":[{"gross_charge":2005.27,"discounted_cash":2005.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FULL MOUTH X-RAY OF TEETH - XR TEETH FULL MOUTH","code_information":[{"code":"3207032001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70320","type":"HCPCS"}],"standard_charges":[{"gross_charge":1047.21,"discounted_cash":1047.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY TMJ UNILAT","code_information":[{"code":"3207032802","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70328","type":"HCPCS"}],"standard_charges":[{"gross_charge":977.21,"discounted_cash":977.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY TMJ BILAT","code_information":[{"code":"3207033001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70330","type":"HCPCS"}],"standard_charges":[{"gross_charge":1303.32,"discounted_cash":1303.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY NECK SOFT TISSUE","code_information":[{"code":"3207036001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70360","type":"HCPCS"}],"standard_charges":[{"gross_charge":1391.01,"discounted_cash":1391.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY RIBS 2 VW UNILAT","code_information":[{"code":"3207110001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"71100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1276.52,"discounted_cash":1276.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY RIBS 3 VW BILAT","code_information":[{"code":"3207111001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"71110","type":"HCPCS"}],"standard_charges":[{"gross_charge":1511.64,"discounted_cash":1511.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY STERNUM 2+ VW","code_information":[{"code":"3207112001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"71120","type":"HCPCS"}],"standard_charges":[{"gross_charge":1571.96,"discounted_cash":1571.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY STERNO-CLAVICLUAR JT","code_information":[{"code":"3207113001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"71130","type":"HCPCS"}],"standard_charges":[{"gross_charge":1268.82,"discounted_cash":1268.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY SPINE ONE VIEW","code_information":[{"code":"3207202001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72020","type":"HCPCS"}],"standard_charges":[{"gross_charge":1016.79,"discounted_cash":1016.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADEX SPINE CERVICAL 2 OR 3 VIEWS","code_information":[{"code":"3207204002","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1826.77,"discounted_cash":1826.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADEX SPINE CERVICAL 4 OR 5 VIEWS","code_information":[{"code":"3207205001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72050","type":"HCPCS"}],"standard_charges":[{"gross_charge":2725.38,"discounted_cash":2725.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADEX SPINE CERVICAL 6 OR MORE VIEWS","code_information":[{"code":"3207205201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72052","type":"HCPCS"}],"standard_charges":[{"gross_charge":1976.69,"discounted_cash":1976.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY THORACIC SPINE 2 VW","code_information":[{"code":"3207207001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72070","type":"HCPCS"}],"standard_charges":[{"gross_charge":1654.43,"discounted_cash":1654.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY THORACIC SPINE+SWIM 3 VW","code_information":[{"code":"3207207201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72072","type":"HCPCS"}],"standard_charges":[{"gross_charge":2672.45,"discounted_cash":2672.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY THORACIC SPINE 4 VW","code_information":[{"code":"3207207401","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72074","type":"HCPCS"}],"standard_charges":[{"gross_charge":3779.75,"discounted_cash":3779.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS","code_information":[{"code":"3207208001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72080","type":"HCPCS"}],"standard_charges":[{"gross_charge":1228.75,"discounted_cash":1228.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 1 VW","code_information":[{"code":"3207208101","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72081","type":"HCPCS"}],"standard_charges":[{"gross_charge":3948.92,"discounted_cash":3948.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW","code_information":[{"code":"3207208202","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72082","type":"HCPCS"}],"standard_charges":[{"gross_charge":2001.17,"discounted_cash":2001.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 4/5 VW","code_information":[{"code":"3207208301","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72083","type":"HCPCS"}],"standard_charges":[{"gross_charge":3222.14,"discounted_cash":3222.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 6/> VW","code_information":[{"code":"3207208401","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72084","type":"HCPCS"}],"standard_charges":[{"gross_charge":4027.95,"discounted_cash":4027.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY LUMBAR SPINE 2/3 VW","code_information":[{"code":"3207210001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72100","type":"HCPCS"}],"standard_charges":[{"gross_charge":2066.82,"discounted_cash":2066.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY LUMBAR SPINE 4 VW","code_information":[{"code":"3207211001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72110","type":"HCPCS"}],"standard_charges":[{"gross_charge":3190.7,"discounted_cash":3190.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY LUMBAR SPINE 6+ VW","code_information":[{"code":"3207211401","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72114","type":"HCPCS"}],"standard_charges":[{"gross_charge":1663.94,"discounted_cash":1663.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY LUMBAR SPINE FLEX/EXTEN","code_information":[{"code":"3207212001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72120","type":"HCPCS"}],"standard_charges":[{"gross_charge":1247.67,"discounted_cash":1247.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY PELVIS 1/2 VW","code_information":[{"code":"3207217001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72170","type":"HCPCS"}],"standard_charges":[{"gross_charge":1431.63,"discounted_cash":1431.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY PELVIS 3+ VW","code_information":[{"code":"3207219001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72190","type":"HCPCS"}],"standard_charges":[{"gross_charge":1320.02,"discounted_cash":1320.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY SACROILIAC JTS <3 VW","code_information":[{"code":"3207220001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1045.11,"discounted_cash":1045.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY SACROILIAC JTS 3+ VW","code_information":[{"code":"3207220201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72202","type":"HCPCS"}],"standard_charges":[{"gross_charge":1086.95,"discounted_cash":1086.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY SACRUM/COCCYX 2+ VW","code_information":[{"code":"3207222001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1619.97,"discounted_cash":1619.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYELOGRAPHY CERV SPINE","code_information":[{"code":"3207224001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72240","type":"HCPCS"}],"standard_charges":[{"gross_charge":4774.77,"discounted_cash":4774.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY C/T DISK SUPERV/INTERPRET - CERVICAL SPINE DISCOGRAM","code_information":[{"code":"3207228501","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72285","type":"HCPCS"}],"standard_charges":[{"gross_charge":7811.03,"discounted_cash":7811.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DISCOGRAPHY LUMBAR SPINE","code_information":[{"code":"3207229501","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72295","type":"HCPCS"}],"standard_charges":[{"gross_charge":7811.03,"discounted_cash":7811.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY CLAVICLE","code_information":[{"code":"3207300001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1238.37,"discounted_cash":1238.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY SCAPULA","code_information":[{"code":"3207301001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73010","type":"HCPCS"}],"standard_charges":[{"gross_charge":1469.79,"discounted_cash":1469.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY SHOULDER 1 VW","code_information":[{"code":"3207302002","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73020","type":"HCPCS"}],"standard_charges":[{"gross_charge":719.0,"discounted_cash":719.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY SHOULDER 2+ VW","code_information":[{"code":"3207303002","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73030","type":"HCPCS"}],"standard_charges":[{"gross_charge":1564.93,"discounted_cash":1564.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY AC JTS","code_information":[{"code":"3207305001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73050","type":"HCPCS"}],"standard_charges":[{"gross_charge":752.39,"discounted_cash":752.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY HUMERUS","code_information":[{"code":"3207306002","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73060","type":"HCPCS"}],"standard_charges":[{"gross_charge":1555.67,"discounted_cash":1555.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY ELBOW 2 VW","code_information":[{"code":"3207307002","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73070","type":"HCPCS"}],"standard_charges":[{"gross_charge":1056.17,"discounted_cash":1056.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY ELBOW 3+ VW","code_information":[{"code":"3207308002","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73080","type":"HCPCS"}],"standard_charges":[{"gross_charge":1621.2,"discounted_cash":1621.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY FOREARM 2 VW","code_information":[{"code":"3207309001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73090","type":"HCPCS"}],"standard_charges":[{"gross_charge":1519.42,"discounted_cash":1519.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY ARM, INFANT","code_information":[{"code":"3207309201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73092","type":"HCPCS"}],"standard_charges":[{"gross_charge":1286.38,"discounted_cash":1286.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY WRIST 2 VW","code_information":[{"code":"3207310001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1004.2,"discounted_cash":1004.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY WRIST 3+ VW","code_information":[{"code":"3207311001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73110","type":"HCPCS"}],"standard_charges":[{"gross_charge":1628.88,"discounted_cash":1628.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY HAND 2 VW","code_information":[{"code":"3207312001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":1238.77,"discounted_cash":1238.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY HAND 3+ VW","code_information":[{"code":"3207313001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73130","type":"HCPCS"}],"standard_charges":[{"gross_charge":1874.68,"discounted_cash":1874.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY EXAM OF FINGER(S)","code_information":[{"code":"3207314002","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73140","type":"HCPCS"}],"standard_charges":[{"gross_charge":1159.59,"discounted_cash":1159.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADEX HIP UNILATERAL WITH PELVIS 1 VIEW","code_information":[{"code":"3207350101","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73501","type":"HCPCS"}],"standard_charges":[{"gross_charge":1013.1,"discounted_cash":1013.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS","code_information":[{"code":"3207350201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73502","type":"HCPCS"}],"standard_charges":[{"gross_charge":2229.84,"discounted_cash":2229.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS","code_information":[{"code":"3207350301","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73503","type":"HCPCS"}],"standard_charges":[{"gross_charge":2069.27,"discounted_cash":2069.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS","code_information":[{"code":"3207352101","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73521","type":"HCPCS"}],"standard_charges":[{"gross_charge":4459.68,"discounted_cash":4459.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY EXAM HIPS BI 3-4 VWS - XR HIPS BILAT 3-4 VW W/ OR W/O PELVIS","code_information":[{"code":"3207352201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73522","type":"HCPCS"}],"standard_charges":[{"gross_charge":1603.97,"discounted_cash":1603.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADEX HIPS BILATERAL WITH PELVIS MINIMUM 5 VIEWS","code_information":[{"code":"3207352301","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73523","type":"HCPCS"}],"standard_charges":[{"gross_charge":2512.42,"discounted_cash":2512.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIOLOGIC EXAMINATION FEMUR 1 VIEW","code_information":[{"code":"3207355101","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73551","type":"HCPCS"}],"standard_charges":[{"gross_charge":1099.64,"discounted_cash":1099.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS","code_information":[{"code":"3207355201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73552","type":"HCPCS"}],"standard_charges":[{"gross_charge":1432.74,"discounted_cash":1432.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY KNEE 1 OR 2 VIEW","code_information":[{"code":"3207356001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":951.77,"discounted_cash":951.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY KNEE 3 VIEW","code_information":[{"code":"3207356201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73562","type":"HCPCS"}],"standard_charges":[{"gross_charge":1402.0,"discounted_cash":1402.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY KNEE 4+ VIEW","code_information":[{"code":"3207356401","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":2121.23,"discounted_cash":2121.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY KNEE BILAT STANDING","code_information":[{"code":"3207356501","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73565","type":"HCPCS"}],"standard_charges":[{"gross_charge":1529.26,"discounted_cash":1529.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY TIB + FIB, 2VW","code_information":[{"code":"3207359001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73590","type":"HCPCS"}],"standard_charges":[{"gross_charge":1526.05,"discounted_cash":1526.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY LEG, INFANT","code_information":[{"code":"3207359201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73592","type":"HCPCS"}],"standard_charges":[{"gross_charge":1131.27,"discounted_cash":1131.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY ANKLE 2 VW","code_information":[{"code":"3207360001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1287.76,"discounted_cash":1287.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY ANKLE 3+ VW","code_information":[{"code":"3207361001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73610","type":"HCPCS"}],"standard_charges":[{"gross_charge":1956.69,"discounted_cash":1956.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY FOOT 2 VW","code_information":[{"code":"3207362001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":854.92,"discounted_cash":854.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY FOOT 3+ VW","code_information":[{"code":"3207363001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73630","type":"HCPCS"}],"standard_charges":[{"gross_charge":1706.91,"discounted_cash":1706.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY HEEL","code_information":[{"code":"3207365001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73650","type":"HCPCS"}],"standard_charges":[{"gross_charge":809.98,"discounted_cash":809.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY TOE(S)","code_information":[{"code":"3207366001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73660","type":"HCPCS"}],"standard_charges":[{"gross_charge":945.39,"discounted_cash":945.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIOLOGIC EXAM ABDOMEN 1 VIEW","code_information":[{"code":"3207401802","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74018","type":"HCPCS"}],"standard_charges":[{"gross_charge":1082.03,"discounted_cash":1082.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIOLOGIC EXAM ABDOMEN 2 VIEWS","code_information":[{"code":"3207401901","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74019","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.98,"discounted_cash":1699.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIOLOGIC EXAM ABDOMEN 3+ VIEWS","code_information":[{"code":"3207402101","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74021","type":"HCPCS"}],"standard_charges":[{"gross_charge":1701.22,"discounted_cash":1701.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIOLOGIC EXAM COMPLETE ACUTE ABD SERIES W/CHEST","code_information":[{"code":"3207402201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74022","type":"HCPCS"}],"standard_charges":[{"gross_charge":2320.4,"discounted_cash":2320.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY PERITONEUM - XR GUIDED PERITONEOGRAM W CONTRAST","code_information":[{"code":"3207419001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74190","type":"HCPCS"}],"standard_charges":[{"gross_charge":2150.32,"discounted_cash":2150.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIOLOGIC EXAM ESOPHAGUS SINGLE CONTRAST STUDY","code_information":[{"code":"3207422001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1672.9,"discounted_cash":1672.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ESOPHAGRAM DOUBLE CONTRAST","code_information":[{"code":"3207422101","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74221","type":"HCPCS"}],"standard_charges":[{"gross_charge":2355.11,"discounted_cash":2355.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY","code_information":[{"code":"3207423001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74230","type":"HCPCS"}],"standard_charges":[{"gross_charge":2621.98,"discounted_cash":2621.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY","code_information":[{"code":"3207424001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74240","type":"HCPCS"}],"standard_charges":[{"gross_charge":1530.38,"discounted_cash":1530.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIOLOGIC EXAM UPR GI TRC DOUBLE CONTRAST STUDY","code_information":[{"code":"3207424601","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74246","type":"HCPCS"}],"standard_charges":[{"gross_charge":2373.32,"discounted_cash":2373.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CXR SM BOWEL W/MLT IMG","code_information":[{"code":"3207424801","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74248","type":"HCPCS"}],"standard_charges":[{"gross_charge":914.55,"discounted_cash":914.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIOLOGIC EXAM SMALL INT SINGLE CONTRAST STUDY","code_information":[{"code":"3207425001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74250","type":"HCPCS"}],"standard_charges":[{"gross_charge":1814.46,"discounted_cash":1814.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY EXAM OF SMALL BOWEL - FL SMALL BOWEL SERIES ENTEROCLYSIS TUBE","code_information":[{"code":"3207425101","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74251","type":"HCPCS"}],"standard_charges":[{"gross_charge":794.68,"discounted_cash":794.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIOLOGIC EXAM COLON SINGLE CONTRAST STUDY","code_information":[{"code":"3207427001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1849.81,"discounted_cash":1849.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIOLOGIC EXAM COLON DOUBLE CONTRAST STUDY","code_information":[{"code":"3207428001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74280","type":"HCPCS"}],"standard_charges":[{"gross_charge":3179.84,"discounted_cash":3179.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY OPER CHOLANGIOGRAM","code_information":[{"code":"3207430001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74300","type":"HCPCS"}],"standard_charges":[{"gross_charge":3313.8,"discounted_cash":3313.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY OPER CHOLANGIO ADDNL SET","code_information":[{"code":"3207430101","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74301","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.3,"discounted_cash":1413.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY FOR BILE DUCT ENDOSCOPY","code_information":[{"code":"3207432801","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74328","type":"HCPCS"}],"standard_charges":[{"gross_charge":3114.37,"discounted_cash":3114.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY FOR PANCREAS ENDOSCOPY","code_information":[{"code":"3207432901","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74329","type":"HCPCS"}],"standard_charges":[{"gross_charge":4355.2,"discounted_cash":4355.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY BILE/PANCREAS ENDOSCOPY","code_information":[{"code":"3207433001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74330","type":"HCPCS"}],"standard_charges":[{"gross_charge":5248.89,"discounted_cash":5248.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I","code_information":[{"code":"3207434002","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74340","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.27,"discounted_cash":1007.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY GUIDE, GI DILATION","code_information":[{"code":"3207436001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74360","type":"HCPCS"}],"standard_charges":[{"gross_charge":2066.4,"discounted_cash":2066.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY IV PYELOGRAM (IVP)","code_information":[{"code":"3207440001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74400","type":"HCPCS"}],"standard_charges":[{"gross_charge":794.68,"discounted_cash":794.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC XR IVP INFUS/DRIP/BOLUS","code_information":[{"code":"3207441001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74410","type":"HCPCS"}],"standard_charges":[{"gross_charge":794.68,"discounted_cash":794.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY IV PYELOGRAM+TOMOGRAPHY","code_information":[{"code":"3207441501","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74415","type":"HCPCS"}],"standard_charges":[{"gross_charge":794.68,"discounted_cash":794.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY RETROGRADE PYELOGRAM","code_information":[{"code":"3207442001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74420","type":"HCPCS"}],"standard_charges":[{"gross_charge":2778.32,"discounted_cash":2778.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY CYSTOGRAM, MIN 3 VIEW","code_information":[{"code":"3207443001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74430","type":"HCPCS"}],"standard_charges":[{"gross_charge":2005.27,"discounted_cash":2005.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY URETHROCYSTOGRAM","code_information":[{"code":"3207445001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74450","type":"HCPCS"}],"standard_charges":[{"gross_charge":2000.06,"discounted_cash":2000.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY URETHROCYSTOGRAM+VOIDING","code_information":[{"code":"3207445501","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74455","type":"HCPCS"}],"standard_charges":[{"gross_charge":1133.73,"discounted_cash":1133.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY RENAL CYST XLUMBAR+CONTRST","code_information":[{"code":"3207447001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74470","type":"HCPCS"}],"standard_charges":[{"gross_charge":537.45,"discounted_cash":537.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY HYSTEROSALPINGOGRAM","code_information":[{"code":"3207474001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74740","type":"HCPCS"}],"standard_charges":[{"gross_charge":2573.26,"discounted_cash":2573.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NONVASCULAR SHUNTOGRAM","code_information":[{"code":"3207580901","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75809","type":"HCPCS"}],"standard_charges":[{"gross_charge":1318.37,"discounted_cash":1318.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC XR VENOGRAM EXTREM UNILAT","code_information":[{"code":"3207582007","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75820","type":"HCPCS"}],"standard_charges":[{"gross_charge":4874.46,"discounted_cash":4874.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC XR VENOGRAM EXTREM BILAT","code_information":[{"code":"3207582201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75822","type":"HCPCS"}],"standard_charges":[{"gross_charge":9748.91,"discounted_cash":9748.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC XR VENOGRAM INFER VENA CAVA","code_information":[{"code":"3207582501","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75825","type":"HCPCS"}],"standard_charges":[{"gross_charge":14780.98,"discounted_cash":14780.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC XR VENOGRAM SUPER VENA CAVA","code_information":[{"code":"3207582701","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75827","type":"HCPCS"}],"standard_charges":[{"gross_charge":7801.24,"discounted_cash":7801.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC XR VENOGRAM RENAL UNILAT","code_information":[{"code":"3207583101","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75831","type":"HCPCS"}],"standard_charges":[{"gross_charge":12921.93,"discounted_cash":12921.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC XR VENOGRAM RENAL BILAT","code_information":[{"code":"3207583301","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75833","type":"HCPCS"}],"standard_charges":[{"gross_charge":12740.51,"discounted_cash":12740.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC XR VENOGRAM SINUS/JUGULAR","code_information":[{"code":"3207586001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75860","type":"HCPCS"}],"standard_charges":[{"gross_charge":12920.8,"discounted_cash":12920.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC XR VENOGRAM SUPER SAG SINUS","code_information":[{"code":"3207587001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75870","type":"HCPCS"}],"standard_charges":[{"gross_charge":21237.15,"discounted_cash":21237.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC XR TRANSHEPATIC PORTO W HEMO EVL","code_information":[{"code":"3207588501","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75885","type":"HCPCS"}],"standard_charges":[{"gross_charge":16139.61,"discounted_cash":16139.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRANSCATHETER RX EMBOLIZATN","code_information":[{"code":"3207589401","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75894","type":"HCPCS"}],"standard_charges":[{"gross_charge":6567.75,"discounted_cash":6567.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC XR REMOVE CVA DEVICE OBSTRUCT","code_information":[{"code":"3207590101","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75901","type":"HCPCS"}],"standard_charges":[{"gross_charge":7912.8,"discounted_cash":7912.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMOVAL INTRALUM OBSTR MATERIAL","code_information":[{"code":"3207590201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75902","type":"HCPCS"}],"standard_charges":[{"gross_charge":7912.8,"discounted_cash":7912.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VASCULAR BIOPSY","code_information":[{"code":"3207597001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75970","type":"HCPCS"}],"standard_charges":[{"gross_charge":4736.24,"discounted_cash":4736.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLUOROSCOPY UP TO 1 HOUR PHYSICIAN/QHP TIME","code_information":[{"code":"3207600004","type":"CDM"},{"code":"0320","type":"RC"},{"code":"76000","type":"HCPCS"}],"standard_charges":[{"gross_charge":974.94,"discounted_cash":974.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY NOSE-RECTUM CHILD F.B.","code_information":[{"code":"3207601002","type":"CDM"},{"code":"0320","type":"RC"},{"code":"76010","type":"HCPCS"}],"standard_charges":[{"gross_charge":796.91,"discounted_cash":796.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY FISTULA,ABSCESS,SINUS TRACT","code_information":[{"code":"3207608005","type":"CDM"},{"code":"0320","type":"RC"},{"code":"76080","type":"HCPCS"}],"standard_charges":[{"gross_charge":1378.2,"discounted_cash":1378.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC XR EXAM  BREAST SPECIMEN","code_information":[{"code":"3207609801","type":"CDM"},{"code":"0320","type":"RC"},{"code":"76098","type":"HCPCS"}],"standard_charges":[{"gross_charge":3221.47,"discounted_cash":3221.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY TOMOGRAM","code_information":[{"code":"3207610001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"76100","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.27,"discounted_cash":485.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC UNLISTED FLUOROSCOPIC PROCEDURE","code_information":[{"code":"3207649601","type":"CDM"},{"code":"0320","type":"RC"},{"code":"76496","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.61,"discounted_cash":360.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLUOROGUIDE CNTRL VEN ACCESS,PLACE,REPLACE,REMOVE","code_information":[{"code":"3207700101","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77001","type":"HCPCS"}],"standard_charges":[{"gross_charge":930.62,"discounted_cash":930.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT","code_information":[{"code":"3207700201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77002","type":"HCPCS"}],"standard_charges":[{"gross_charge":2276.69,"discounted_cash":2276.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEEDLE LOCALIZATION BY XRAY - FL GUIDED BIOPSY/ASP/INJ","code_information":[{"code":"3207700293","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77002","type":"HCPCS"}],"standard_charges":[{"gross_charge":2276.69,"discounted_cash":2276.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FLUORSCOPIC GUIDANCE SPINAL INJECTION","code_information":[{"code":"3207700301","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77003","type":"HCPCS"}],"standard_charges":[{"gross_charge":1427.98,"discounted_cash":1427.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MAMMARY DUCTOGRAM  SINGLE - MAMMO BREAST DUCTOGRAM","code_information":[{"code":"3207705301","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77053","type":"HCPCS"}],"standard_charges":[{"gross_charge":1025.07,"discounted_cash":1025.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MAMMARY DUCTOGRAM  MULTIPLE - MAMMO BREAST DUCTOGRAM MULTIPLE","code_information":[{"code":"3207705402","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77054","type":"HCPCS"}],"standard_charges":[{"gross_charge":1025.07,"discounted_cash":1025.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAYS FOR BONE AGE","code_information":[{"code":"3207707201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77072","type":"HCPCS"}],"standard_charges":[{"gross_charge":1189.8,"discounted_cash":1189.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAYS, BONE LENGTH STUDIES","code_information":[{"code":"3207707301","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77073","type":"HCPCS"}],"standard_charges":[{"gross_charge":800.25,"discounted_cash":800.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAYS, BONE SURVEY, LIMITED","code_information":[{"code":"3207707401","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77074","type":"HCPCS"}],"standard_charges":[{"gross_charge":1056.24,"discounted_cash":1056.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAYS, BONE SURVEY COMPLETE","code_information":[{"code":"3207707501","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77075","type":"HCPCS"}],"standard_charges":[{"gross_charge":2189.91,"discounted_cash":2189.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAYS, BONE SURVEY, INFANT","code_information":[{"code":"3207707601","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77076","type":"HCPCS"}],"standard_charges":[{"gross_charge":1009.49,"discounted_cash":1009.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEXA,BONE DENSITY, 1 + SITE, AXIAL SKELETON","code_information":[{"code":"3207708002","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77080","type":"HCPCS"}],"standard_charges":[{"gross_charge":967.2,"discounted_cash":967.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEXA,BONE DENSITY, 1 + SITE, APPENDICULR SKELTN","code_information":[{"code":"3207708101","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77081","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.79,"discounted_cash":332.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DXA BONE DENSITY STUDY AXIAL SKELETON","code_information":[{"code":"3207708501","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77085","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.37,"discounted_cash":870.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VERTEBRAL FRACTURE ASSESSMENT VIA DXA","code_information":[{"code":"3207708601","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77086","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.61,"discounted_cash":360.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC XR EXAM TMJ ARTHROGRAM","code_information":[{"code":"3227033202","type":"CDM"},{"code":"0322","type":"RC"},{"code":"70332","type":"HCPCS"}],"standard_charges":[{"gross_charge":1025.07,"discounted_cash":1025.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARTHROGRAM OF SHOULDER","code_information":[{"code":"3227304001","type":"CDM"},{"code":"0322","type":"RC"},{"code":"73040","type":"HCPCS"}],"standard_charges":[{"gross_charge":2035.68,"discounted_cash":2035.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARTHROGRAM OF ELBOW","code_information":[{"code":"3227308501","type":"CDM"},{"code":"0322","type":"RC"},{"code":"73085","type":"HCPCS"}],"standard_charges":[{"gross_charge":1638.34,"discounted_cash":1638.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARTHROGRAM OF WRIST","code_information":[{"code":"3227311502","type":"CDM"},{"code":"0322","type":"RC"},{"code":"73115","type":"HCPCS"}],"standard_charges":[{"gross_charge":1638.34,"discounted_cash":1638.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARTHROGRAM OF HIP","code_information":[{"code":"3227352501","type":"CDM"},{"code":"0322","type":"RC"},{"code":"73525","type":"HCPCS"}],"standard_charges":[{"gross_charge":1659.48,"discounted_cash":1659.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARTHROGRAM OF KNEE JOINT","code_information":[{"code":"3227358001","type":"CDM"},{"code":"0322","type":"RC"},{"code":"73580","type":"HCPCS"}],"standard_charges":[{"gross_charge":1638.34,"discounted_cash":1638.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERCUT TRANSHEPAT DILAT,BILE DUCT STRICT","code_information":[{"code":"3237436301","type":"CDM"},{"code":"0323","type":"RC"},{"code":"74363","type":"HCPCS"}],"standard_charges":[{"gross_charge":4211.55,"discounted_cash":4211.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY ANTEGRADE PYELOGRAM TUBE","code_information":[{"code":"3237442504","type":"CDM"},{"code":"0323","type":"RC"},{"code":"74425","type":"HCPCS"}],"standard_charges":[{"gross_charge":1909.85,"discounted_cash":1909.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DILATION URETERS/URETHRA RS&I","code_information":[{"code":"3237448503","type":"CDM"},{"code":"0323","type":"RC"},{"code":"74485","type":"HCPCS"}],"standard_charges":[{"gross_charge":5359.1,"discounted_cash":5359.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SP ANGIO THORACIC AORTA","code_information":[{"code":"3237560001","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75600","type":"HCPCS"}],"standard_charges":[{"gross_charge":14290.4,"discounted_cash":14290.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANGIO AORTOGRAM THOR SERIAL","code_information":[{"code":"3237560501","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75605","type":"HCPCS"}],"standard_charges":[{"gross_charge":21537.68,"discounted_cash":21537.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANGIO AORTOGRAM ABD SERIAL","code_information":[{"code":"3237562501","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75625","type":"HCPCS"}],"standard_charges":[{"gross_charge":17287.81,"discounted_cash":17287.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANGIO AORTOBIFEMORAL W CATH","code_information":[{"code":"3237563001","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75630","type":"HCPCS"}],"standard_charges":[{"gross_charge":17345.71,"discounted_cash":17345.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANGIO SPINAL SELECTV","code_information":[{"code":"3237570501","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75705","type":"HCPCS"}],"standard_charges":[{"gross_charge":21237.15,"discounted_cash":21237.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANGIO EXTREMITY UNILAT","code_information":[{"code":"3237571001","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75710","type":"HCPCS"}],"standard_charges":[{"gross_charge":11575.1,"discounted_cash":11575.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANGIO EXTERMITY BILAT","code_information":[{"code":"3237571601","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75716","type":"HCPCS"}],"standard_charges":[{"gross_charge":23150.2,"discounted_cash":23150.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANGIO VISCERAL SELECTV/SUBSELEC","code_information":[{"code":"3237572601","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75726","type":"HCPCS"}],"standard_charges":[{"gross_charge":18699.75,"discounted_cash":18699.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANGIO ADRENAL UNILAT SELECT - IR ANGIOGRAM ADRENAL SELECTIVE LT CHG","code_information":[{"code":"3237573102","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75731","type":"HCPCS"}],"standard_charges":[{"gross_charge":3185.02,"discounted_cash":3185.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANGIO ADRENAL BILAT SELECT","code_information":[{"code":"3237573302","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75733","type":"HCPCS"}],"standard_charges":[{"gross_charge":3185.02,"discounted_cash":3185.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANGIO PELVIS","code_information":[{"code":"3237573601","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75736","type":"HCPCS"}],"standard_charges":[{"gross_charge":17658.58,"discounted_cash":17658.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANGIO PULMON UNILAT SELECT","code_information":[{"code":"3237574101","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75741","type":"HCPCS"}],"standard_charges":[{"gross_charge":12757.85,"discounted_cash":12757.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANGIO PULMON BILAT SELECT","code_information":[{"code":"3237574302","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75743","type":"HCPCS"}],"standard_charges":[{"gross_charge":18103.01,"discounted_cash":18103.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PULMONARY ANGIOGRAPHY NONSELECTIVE","code_information":[{"code":"3237574601","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75746","type":"HCPCS"}],"standard_charges":[{"gross_charge":12740.51,"discounted_cash":12740.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANGIO INTERN MAMMARY","code_information":[{"code":"3237575601","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75756","type":"HCPCS"}],"standard_charges":[{"gross_charge":12920.8,"discounted_cash":12920.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANGIO EA ADDNL SELECTV VESSEL","code_information":[{"code":"3237577401","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75774","type":"HCPCS"}],"standard_charges":[{"gross_charge":8153.29,"discounted_cash":8153.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VENOGRAM EXTREM UNILAT","code_information":[{"code":"3237582007","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75820","type":"HCPCS"}],"standard_charges":[{"gross_charge":4874.46,"discounted_cash":4874.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VENOGRAM INFER VENA CAVA","code_information":[{"code":"3237582501","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75825","type":"HCPCS"}],"standard_charges":[{"gross_charge":14780.98,"discounted_cash":14780.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VENOGRAM SUPER VENA CAVA","code_information":[{"code":"3237582701","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75827","type":"HCPCS"}],"standard_charges":[{"gross_charge":7801.24,"discounted_cash":7801.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VENOGRAM SUPER SAG SINUS","code_information":[{"code":"3237587001","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75870","type":"HCPCS"}],"standard_charges":[{"gross_charge":21237.15,"discounted_cash":21237.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VENOGRAM EPIDURAL","code_information":[{"code":"3237587201","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75872","type":"HCPCS"}],"standard_charges":[{"gross_charge":2410.76,"discounted_cash":2410.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VENOGRAM HEPATIC W HEMODYNAMICS","code_information":[{"code":"3237588901","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75889","type":"HCPCS"}],"standard_charges":[{"gross_charge":12920.8,"discounted_cash":12920.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VENOGRAM HEPATIC","code_information":[{"code":"3237589101","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75891","type":"HCPCS"}],"standard_charges":[{"gross_charge":12740.51,"discounted_cash":12740.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VENOUS SAMPLING BY CATHETER","code_information":[{"code":"3237589301","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75893","type":"HCPCS"}],"standard_charges":[{"gross_charge":21237.15,"discounted_cash":21237.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANGRPH CATH F-UP STD TCAT OTHER THAN THROMBYLSIS","code_information":[{"code":"3237589801","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75898","type":"HCPCS"}],"standard_charges":[{"gross_charge":5789.29,"discounted_cash":5789.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHANGE PERCUT TUBE/DRAIN CATH W CONTRAST MONIT","code_information":[{"code":"3237598401","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75984","type":"HCPCS"}],"standard_charges":[{"gross_charge":1933.05,"discounted_cash":1933.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIOLOGIC EXAM CHEST SINGLE VIEW","code_information":[{"code":"3247104502","type":"CDM"},{"code":"0324","type":"RC"},{"code":"71045","type":"HCPCS"}],"standard_charges":[{"gross_charge":829.68,"discounted_cash":829.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIOLOGIC EXAM CHEST 2 VIEWS","code_information":[{"code":"3247104606","type":"CDM"},{"code":"0324","type":"RC"},{"code":"71046","type":"HCPCS"}],"standard_charges":[{"gross_charge":1018.02,"discounted_cash":1018.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC XR CHEST 2V W AP LORDOTIC","code_information":[{"code":"3247104701","type":"CDM"},{"code":"0324","type":"RC"},{"code":"71047","type":"HCPCS"}],"standard_charges":[{"gross_charge":1138.66,"discounted_cash":1138.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIOLOGIC EXAM CHEST 4+ VIEWS","code_information":[{"code":"3247104803","type":"CDM"},{"code":"0324","type":"RC"},{"code":"71048","type":"HCPCS"}],"standard_charges":[{"gross_charge":678.93,"discounted_cash":678.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY RIBS, CHEST 3+ VW","code_information":[{"code":"3247110101","type":"CDM"},{"code":"0324","type":"RC"},{"code":"71101","type":"HCPCS"}],"standard_charges":[{"gross_charge":1908.39,"discounted_cash":1908.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC X-RAY RIBS, CHEST 4+ VW","code_information":[{"code":"3247111101","type":"CDM"},{"code":"0324","type":"RC"},{"code":"71111","type":"HCPCS"}],"standard_charges":[{"gross_charge":3816.78,"discounted_cash":3816.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJ CHEMO, NON-HORMONAL ANTI-NEOPL, SUBQ/IM","code_information":[{"code":"3319640101","type":"CDM"},{"code":"0331","type":"RC"},{"code":"96401","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.31,"discounted_cash":446.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJ CHEMO, HORMONAL ANTI-NEOPL, SUBQ/IM","code_information":[{"code":"3319640201","type":"CDM"},{"code":"0331","type":"RC"},{"code":"96402","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.31,"discounted_cash":446.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJ CHEMO, IV PUSH, SGL/INITIAL DRUG","code_information":[{"code":"3319640901","type":"CDM"},{"code":"0331","type":"RC"},{"code":"96409","type":"HCPCS"}],"standard_charges":[{"gross_charge":905.98,"discounted_cash":905.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJ CHEMO, IV PUSH, EA ADDL DRUG","code_information":[{"code":"3319641101","type":"CDM"},{"code":"0331","type":"RC"},{"code":"96411","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.02,"discounted_cash":276.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJ CHEMO, IA PUSH","code_information":[{"code":"3319642001","type":"CDM"},{"code":"0331","type":"RC"},{"code":"96420","type":"HCPCS"}],"standard_charges":[{"gross_charge":1383.46,"discounted_cash":1383.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJ CHEMO, PERITONEAL CAVITY, VIA PORT/CATH","code_information":[{"code":"3319644601","type":"CDM"},{"code":"0331","type":"RC"},{"code":"96446","type":"HCPCS"}],"standard_charges":[{"gross_charge":1383.46,"discounted_cash":1383.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJ CHEMO, CNS, W/ SPINAL PUNCTURE","code_information":[{"code":"3319645001","type":"CDM"},{"code":"0331","type":"RC"},{"code":"96450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1294.42,"discounted_cash":1294.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TR SIMULATION SIMPLE","code_information":[{"code":"3337728001","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77280","type":"HCPCS"}],"standard_charges":[{"gross_charge":564.29,"discounted_cash":564.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TR SIMULATION INTERMEDIATE","code_information":[{"code":"3337728501","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77285","type":"HCPCS"}],"standard_charges":[{"gross_charge":1508.12,"discounted_cash":1508.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TR SIMULATION COMPLEX","code_information":[{"code":"3337729001","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77290","type":"HCPCS"}],"standard_charges":[{"gross_charge":1508.12,"discounted_cash":1508.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC 3D RXTHPY PLAN W/ HISTOGM","code_information":[{"code":"3337729501","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77295","type":"HCPCS"}],"standard_charges":[{"gross_charge":5619.54,"discounted_cash":5619.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIATION THERAPY,DOSIMETRY PLAN","code_information":[{"code":"3337730002","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77300","type":"HCPCS"}],"standard_charges":[{"gross_charge":564.29,"discounted_cash":564.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIATION THERAPY INTENSITY MODULATED THERAPY PLAN - IMRT","code_information":[{"code":"3337730101","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77301","type":"HCPCS"}],"standard_charges":[{"gross_charge":16618.24,"discounted_cash":16618.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIATION THERAPY - TELETHERAPY ISODOSE PLAN SIMPLE","code_information":[{"code":"3337730601","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77306","type":"HCPCS"}],"standard_charges":[{"gross_charge":1508.12,"discounted_cash":1508.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIATION THERAPY - TELETHERAPY ISODOSE PLAN COMPLEX","code_information":[{"code":"3337730701","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77307","type":"HCPCS"}],"standard_charges":[{"gross_charge":1508.12,"discounted_cash":1508.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RADIATION THERAPY - BRACHYTHERAPY ISODOSE PLAN COMPLEX","code_information":[{"code":"3337731801","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77318","type":"HCPCS"}],"standard_charges":[{"gross_charge":1508.12,"discounted_cash":1508.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TR SPECIAL DOSIMETRY W DEVICE","code_information":[{"code":"3337733101","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77331","type":"HCPCS"}],"standard_charges":[{"gross_charge":564.29,"discounted_cash":564.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TR TREATMENT DEVICE SIMPLE","code_information":[{"code":"3337733201","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77332","type":"HCPCS"}],"standard_charges":[{"gross_charge":564.29,"discounted_cash":564.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TR TREATMENT DEVICE INTERMEDIATE","code_information":[{"code":"3337733301","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77333","type":"HCPCS"}],"standard_charges":[{"gross_charge":564.29,"discounted_cash":564.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TR TREATMENT DEVICE COMPLEX","code_information":[{"code":"3337733401","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77334","type":"HCPCS"}],"standard_charges":[{"gross_charge":1508.12,"discounted_cash":1508.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TR PHYSICS CONSULT PER WEEK","code_information":[{"code":"3337733601","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77336","type":"HCPCS"}],"standard_charges":[{"gross_charge":564.29,"discounted_cash":564.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TR TREATMENT DEVICE MLC FOR IMRT PER PLAN","code_information":[{"code":"3337733801","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77338","type":"HCPCS"}],"standard_charges":[{"gross_charge":1508.12,"discounted_cash":1508.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TR PHYSICS CONSULT SPECIAL","code_information":[{"code":"3337737001","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77370","type":"HCPCS"}],"standard_charges":[{"gross_charge":564.29,"discounted_cash":564.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TR SBRT PER SESSION MAX OF 5","code_information":[{"code":"3337737301","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77373","type":"HCPCS"}],"standard_charges":[{"gross_charge":10119.58,"discounted_cash":10119.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TR IMRT SIMPLE","code_information":[{"code":"3337738501","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77385","type":"HCPCS"}],"standard_charges":[{"gross_charge":2716.71,"discounted_cash":2716.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GUIDANCE FOR LOCLZJ TARGET VOL FOR RADJ TX DLVR","code_information":[{"code":"3337738701","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77387","type":"HCPCS"}],"standard_charges":[{"gross_charge":993.91,"discounted_cash":993.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TR DELIVERY LEVEL 3 W/ IMG","code_information":[{"code":"3337741201","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77412","type":"HCPCS"}],"standard_charges":[{"gross_charge":1516.22,"discounted_cash":1516.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TR PORT FILM PER 5 FRACTIONS","code_information":[{"code":"3337741701","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77417","type":"HCPCS"}],"standard_charges":[{"gross_charge":508.64,"discounted_cash":508.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SPECIAL RADIATION TREATMENT","code_information":[{"code":"3337747001","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77470","type":"HCPCS"}],"standard_charges":[{"gross_charge":2415.21,"discounted_cash":2415.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CB INTERSTITIAL APPLICATION COMPLEX","code_information":[{"code":"3337777801","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77778","type":"HCPCS"}],"standard_charges":[{"gross_charge":10491.27,"discounted_cash":10491.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REFILL/MAINT IMPLANTED PUMP, SPINE/BRAIN, BY PHYSICIAN","code_information":[{"code":"3359599101","type":"CDM"},{"code":"0335","type":"RC"},{"code":"95991","type":"HCPCS"}],"standard_charges":[{"gross_charge":1612.0,"discounted_cash":1612.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IV INF, CHEMO, SGL/INITIAL DRUG, TO 1 HR","code_information":[{"code":"3359641301","type":"CDM"},{"code":"0335","type":"RC"},{"code":"96413","type":"HCPCS"}],"standard_charges":[{"gross_charge":1537.05,"discounted_cash":1537.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IV INF, CHEMO, SGL/INITIAL DRUG, EA ADDL HR","code_information":[{"code":"3359641501","type":"CDM"},{"code":"0335","type":"RC"},{"code":"96415","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.02,"discounted_cash":276.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IV INF BY PUMP, CHEMO, 8+ HOURS W/O FOLLOW-UP","code_information":[{"code":"3359641601","type":"CDM"},{"code":"0335","type":"RC"},{"code":"96416","type":"HCPCS"}],"standard_charges":[{"gross_charge":1383.46,"discounted_cash":1383.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IV INF, CHEMO, EA SEQUENTIAL, TO 1 HR","code_information":[{"code":"3359641701","type":"CDM"},{"code":"0335","type":"RC"},{"code":"96417","type":"HCPCS"}],"standard_charges":[{"gross_charge":477.48,"discounted_cash":477.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT","code_information":[{"code":"3417801201","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78012","type":"HCPCS"}],"standard_charges":[{"gross_charge":1678.4,"discounted_cash":1678.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROID IMAGING WITH VASCULAR FLOW","code_information":[{"code":"3417801301","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78013","type":"HCPCS"}],"standard_charges":[{"gross_charge":745.71,"discounted_cash":745.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN MEAS","code_information":[{"code":"3417801401","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78014","type":"HCPCS"}],"standard_charges":[{"gross_charge":1877.63,"discounted_cash":1877.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THYROID MET IMAGING BODY","code_information":[{"code":"3417801801","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78018","type":"HCPCS"}],"standard_charges":[{"gross_charge":3977.86,"discounted_cash":3977.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PARATHYROID PLANAR IMAGING","code_information":[{"code":"3417807001","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78070","type":"HCPCS"}],"standard_charges":[{"gross_charge":1882.08,"discounted_cash":1882.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PARATHYROID PLANAR IMAGING W/WO SUBTRACTION","code_information":[{"code":"3417807101","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78071","type":"HCPCS"}],"standard_charges":[{"gross_charge":1882.08,"discounted_cash":1882.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BONE MARROW IMAGING, LTD","code_information":[{"code":"3417810201","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78102","type":"HCPCS"}],"standard_charges":[{"gross_charge":1678.4,"discounted_cash":1678.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LYMPHATICS & LYMPH GLANDS IMAGING","code_information":[{"code":"3417819502","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78195","type":"HCPCS"}],"standard_charges":[{"gross_charge":4250.57,"discounted_cash":4250.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIVER IMAGING - NM LIVER","code_information":[{"code":"3417820101","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78201","type":"HCPCS"}],"standard_charges":[{"gross_charge":2179.25,"discounted_cash":2179.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIVER IMAGING WITH FLOW","code_information":[{"code":"3417820201","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78202","type":"HCPCS"}],"standard_charges":[{"gross_charge":2179.25,"discounted_cash":2179.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIVER AND SPLEEN IMAGING","code_information":[{"code":"3417821501","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78215","type":"HCPCS"}],"standard_charges":[{"gross_charge":3297.82,"discounted_cash":3297.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIVER & SPLEEN IMAGE, FLOW","code_information":[{"code":"3417821601","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78216","type":"HCPCS"}],"standard_charges":[{"gross_charge":3390.2,"discounted_cash":3390.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER","code_information":[{"code":"3417822601","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78226","type":"HCPCS"}],"standard_charges":[{"gross_charge":3408.58,"discounted_cash":3408.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ","code_information":[{"code":"3417822702","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78227","type":"HCPCS"}],"standard_charges":[{"gross_charge":3665.85,"discounted_cash":3665.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SALIVARY GLAND IMG W/SERIAL IMG","code_information":[{"code":"3417823101","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78231","type":"HCPCS"}],"standard_charges":[{"gross_charge":1678.4,"discounted_cash":1678.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GASTROESOPHAGEAL REFLUX EXAM","code_information":[{"code":"3417826201","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78262","type":"HCPCS"}],"standard_charges":[{"gross_charge":1678.4,"discounted_cash":1678.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GASTRIC EMPTYING IMAGING STUDY","code_information":[{"code":"3417826401","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78264","type":"HCPCS"}],"standard_charges":[{"gross_charge":3140.22,"discounted_cash":3140.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ACUTE GI BLOOD LOSS IMAGING","code_information":[{"code":"3417827801","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78278","type":"HCPCS"}],"standard_charges":[{"gross_charge":3205.46,"discounted_cash":3205.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BOWEL IMAGING","code_information":[{"code":"3417829001","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78290","type":"HCPCS"}],"standard_charges":[{"gross_charge":3500.39,"discounted_cash":3500.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEVEEN/SHUNT PATENCY EXAM","code_information":[{"code":"3417829101","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78291","type":"HCPCS"}],"standard_charges":[{"gross_charge":3500.39,"discounted_cash":3500.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BONE IMAGING, LIMITED AREA","code_information":[{"code":"3417830001","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78300","type":"HCPCS"}],"standard_charges":[{"gross_charge":2772.48,"discounted_cash":2772.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BONE IMAGING, MULTIPLE AREAS","code_information":[{"code":"3417830501","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78305","type":"HCPCS"}],"standard_charges":[{"gross_charge":2772.48,"discounted_cash":2772.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BONE IMAGING, WHOLE BODY","code_information":[{"code":"3417830601","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78306","type":"HCPCS"}],"standard_charges":[{"gross_charge":4835.28,"discounted_cash":4835.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BONE IMAGING, 3 PHASE","code_information":[{"code":"3417831501","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78315","type":"HCPCS"}],"standard_charges":[{"gross_charge":3740.95,"discounted_cash":3740.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VASCULAR FLOW IMAGING,NONCARDIAC - NM VESSELS FLOW","code_information":[{"code":"3417844501","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78445","type":"HCPCS"}],"standard_charges":[{"gross_charge":3382.41,"discounted_cash":3382.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HT MUSCLE IMAGE SPECT SING - NM HEART PERFUSION SPECT STRESS","code_information":[{"code":"3417845108","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78451","type":"HCPCS"}],"standard_charges":[{"gross_charge":6102.02,"discounted_cash":6102.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYOCARDIAL SPECT MULTIPLE STUDIES","code_information":[{"code":"3417845201","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78452","type":"HCPCS"}],"standard_charges":[{"gross_charge":12121.65,"discounted_cash":12121.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYOCARDIAL PERFUSION PLANAR MULTIPLE STUDIES","code_information":[{"code":"3417845401","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78454","type":"HCPCS"}],"standard_charges":[{"gross_charge":11952.51,"discounted_cash":11952.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEART INFARCT IMAGE","code_information":[{"code":"3417846601","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78466","type":"HCPCS"}],"standard_charges":[{"gross_charge":4267.24,"discounted_cash":4267.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GATED HEART, PLANAR SINGLE","code_information":[{"code":"3417847201","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78472","type":"HCPCS"}],"standard_charges":[{"gross_charge":4267.24,"discounted_cash":4267.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GATED HEART, MULTIPLE","code_information":[{"code":"3417847301","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78473","type":"HCPCS"}],"standard_charges":[{"gross_charge":4267.24,"discounted_cash":4267.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEART FIRST PASS SINGLE - NM HEART BLOOD POOL FIRST PASS","code_information":[{"code":"3417848101","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78481","type":"HCPCS"}],"standard_charges":[{"gross_charge":4267.24,"discounted_cash":4267.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEART FIRST PASS ADD-ON","code_information":[{"code":"3417849601","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78496","type":"HCPCS"}],"standard_charges":[{"gross_charge":2133.62,"discounted_cash":2133.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LUNG VENTILATION IMAGING - NM LUNG VENTILATION","code_information":[{"code":"3417857906","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78579","type":"HCPCS"}],"standard_charges":[{"gross_charge":1381.23,"discounted_cash":1381.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LUNG PERFUSION IMAGING","code_information":[{"code":"3417858001","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78580","type":"HCPCS"}],"standard_charges":[{"gross_charge":2437.34,"discounted_cash":2437.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PULMONARY VENTILATION & PERFUSION IMAGING","code_information":[{"code":"3417858201","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78582","type":"HCPCS"}],"standard_charges":[{"gross_charge":3594.46,"discounted_cash":3594.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING","code_information":[{"code":"3417859701","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78597","type":"HCPCS"}],"standard_charges":[{"gross_charge":6649.75,"discounted_cash":6649.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC QUANT DIFF PULM PRFUSION & VENTLAJ W/WO IMAGING","code_information":[{"code":"3417859801","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78598","type":"HCPCS"}],"standard_charges":[{"gross_charge":6500.79,"discounted_cash":6500.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BRAIN IMAGING MIN 4 STATIC VIEWS W VASCULAR FLOW","code_information":[{"code":"3417860601","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78606","type":"HCPCS"}],"standard_charges":[{"gross_charge":4003.46,"discounted_cash":4003.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CSF FLUID SCAN CISTERNOGRAPHY","code_information":[{"code":"3417863001","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78630","type":"HCPCS"}],"standard_charges":[{"gross_charge":6431.87,"discounted_cash":6431.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CSF SHUNT EVALUATION","code_information":[{"code":"3417864501","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78645","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.44,"discounted_cash":2092.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CSF LEAKAGE IMAGING - NM BRAIN CEREBROSPINAL FLUID LEAK","code_information":[{"code":"3417865001","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78650","type":"HCPCS"}],"standard_charges":[{"gross_charge":5814.31,"discounted_cash":5814.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RENAL IMAGING WITH FLOW","code_information":[{"code":"3417870101","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78701","type":"HCPCS"}],"standard_charges":[{"gross_charge":2952.79,"discounted_cash":2952.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RENAL FLOW/FUNCT IMAGING","code_information":[{"code":"3417870701","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78707","type":"HCPCS"}],"standard_charges":[{"gross_charge":2863.26,"discounted_cash":2863.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RENAL FLOW/FUNCT IMAGE,PHARM RX","code_information":[{"code":"3417870803","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78708","type":"HCPCS"}],"standard_charges":[{"gross_charge":3578.3,"discounted_cash":3578.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RENAL FLOW/FUNCT IMAGE,COMBO,PHARM","code_information":[{"code":"3417870901","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78709","type":"HCPCS"}],"standard_charges":[{"gross_charge":5565.25,"discounted_cash":5565.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC URETERAL REFLUX STUDY - NM CYSTOGRAM REFLUX","code_information":[{"code":"3417874001","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78740","type":"HCPCS"}],"standard_charges":[{"gross_charge":1678.4,"discounted_cash":1678.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NM TESTICULAR IMG W/ VASCULAR FLOW","code_information":[{"code":"3417876101","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78761","type":"HCPCS"}],"standard_charges":[{"gross_charge":1678.4,"discounted_cash":1678.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RP LOCLZJ TUM PLNR 1 AREA SINGLE DAY IMAGING","code_information":[{"code":"3417880001","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78800","type":"HCPCS"}],"standard_charges":[{"gross_charge":4093.01,"discounted_cash":4093.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RP LOCLZJ TUM PLNR 2+AREA 1+D IMG/1 AREA IMG>2+D","code_information":[{"code":"3417880102","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78801","type":"HCPCS"}],"standard_charges":[{"gross_charge":7566.82,"discounted_cash":7566.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RP LOCLZJ TUM PLNR WHOLE BODY SINGLE DAY IMAGING","code_information":[{"code":"3417880203","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78802","type":"HCPCS"}],"standard_charges":[{"gross_charge":5887.77,"discounted_cash":5887.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RP LOCLZJ TUM SPECT 1 AREA SINGLE DAY IMAGING","code_information":[{"code":"3417880301","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78803","type":"HCPCS"}],"standard_charges":[{"gross_charge":7572.85,"discounted_cash":7572.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RP LOCLZJ TUM PLNR WHOLE BODY 2+ DAYS IMAGING","code_information":[{"code":"3417880401","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78804","type":"HCPCS"}],"standard_charges":[{"gross_charge":4024.61,"discounted_cash":4024.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LOCATE TUMOR SPECT USING CT IMAGE SINGLE DAY IMAGING","code_information":[{"code":"3417883001","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78830","type":"HCPCS"}],"standard_charges":[{"gross_charge":5814.31,"discounted_cash":5814.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NM INJ ISOTOPE LOCALIZATION ONLY","code_information":[{"code":"3427880801","type":"CDM"},{"code":"0342","type":"RC"},{"code":"78808","type":"HCPCS"}],"standard_charges":[{"gross_charge":1789.84,"discounted_cash":1789.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NUCLEAR THERAPY, ORAL","code_information":[{"code":"3427900503","type":"CDM"},{"code":"0342","type":"RC"},{"code":"79005","type":"HCPCS"}],"standard_charges":[{"gross_charge":1744.07,"discounted_cash":1744.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NUCLEAR THERAPY, IV","code_information":[{"code":"3427910101","type":"CDM"},{"code":"0342","type":"RC"},{"code":"79101","type":"HCPCS"}],"standard_charges":[{"gross_charge":1744.07,"discounted_cash":1744.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION","code_information":[{"code":"3507637601","type":"CDM"},{"code":"0350","type":"RC"},{"code":"76376","type":"HCPCS"}],"standard_charges":[{"gross_charge":830.55,"discounted_cash":830.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION","code_information":[{"code":"3507637701","type":"CDM"},{"code":"0350","type":"RC"},{"code":"76377","type":"HCPCS"}],"standard_charges":[{"gross_charge":1106.7,"discounted_cash":1106.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN,LIMITED/LOCALIZED F/U STUDY","code_information":[{"code":"3507638001","type":"CDM"},{"code":"0350","type":"RC"},{"code":"76380","type":"HCPCS"}],"standard_charges":[{"gross_charge":3130.38,"discounted_cash":3130.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT GUIDANCE STEREOTACTIC LOCALIZATION","code_information":[{"code":"3507701101","type":"CDM"},{"code":"0350","type":"RC"},{"code":"77011","type":"HCPCS"}],"standard_charges":[{"gross_charge":3766.35,"discounted_cash":3766.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT GUIDANCE NEEDLE PLACEMENT","code_information":[{"code":"3507701243","type":"CDM"},{"code":"0350","type":"RC"},{"code":"77012","type":"HCPCS"}],"standard_charges":[{"gross_charge":3766.35,"discounted_cash":3766.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT GUIDANCE TISSUE ABLATION","code_information":[{"code":"3507701310","type":"CDM"},{"code":"0350","type":"RC"},{"code":"77013","type":"HCPCS"}],"standard_charges":[{"gross_charge":3358.95,"discounted_cash":3358.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","code_information":[{"code":"3517045001","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70450","type":"HCPCS"}],"standard_charges":[{"gross_charge":8449.43,"discounted_cash":8449.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN HEAD CONTRAST","code_information":[{"code":"3517046001","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70460","type":"HCPCS"}],"standard_charges":[{"gross_charge":8109.68,"discounted_cash":8109.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN HEAD COMBO","code_information":[{"code":"3517047001","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70470","type":"HCPCS"}],"standard_charges":[{"gross_charge":9698.88,"discounted_cash":9698.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CTA HEAD/NECK W/ CONT AND NON-CONT IMG W/ POST-PROC","code_information":[{"code":"3517047101","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70471","type":"HCPCS"}],"standard_charges":[{"gross_charge":21139.06,"discounted_cash":21139.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN,ORBIT/SELLA/POST FOSSA/EAR,W/O","code_information":[{"code":"3517048001","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70480","type":"HCPCS"}],"standard_charges":[{"gross_charge":6911.95,"discounted_cash":6911.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN ORBIT/SELLA/POST FOSSA/EAR CONTRAST","code_information":[{"code":"3517048101","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70481","type":"HCPCS"}],"standard_charges":[{"gross_charge":5776.47,"discounted_cash":5776.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN SKULL COMBO","code_information":[{"code":"3517048201","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70482","type":"HCPCS"}],"standard_charges":[{"gross_charge":7672.69,"discounted_cash":7672.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN,MAXILLOFACIAL AREA,W/O CONTRAST","code_information":[{"code":"3517048602","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70486","type":"HCPCS"}],"standard_charges":[{"gross_charge":8353.42,"discounted_cash":8353.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN, FACE/JAW CONTRAST","code_information":[{"code":"3517048702","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70487","type":"HCPCS"}],"standard_charges":[{"gross_charge":9108.01,"discounted_cash":9108.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCANS FACE/JAW COMBO","code_information":[{"code":"3517048802","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70488","type":"HCPCS"}],"standard_charges":[{"gross_charge":7097.6,"discounted_cash":7097.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN,SOFT TISSUE NECK,W/O CONTRAST","code_information":[{"code":"3517049001","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70490","type":"HCPCS"}],"standard_charges":[{"gross_charge":7341.55,"discounted_cash":7341.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT NECK TISSUE CONTRAST","code_information":[{"code":"3517049101","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70491","type":"HCPCS"}],"standard_charges":[{"gross_charge":9269.26,"discounted_cash":9269.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT NECK TISSUE COMBO","code_information":[{"code":"3517049201","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70492","type":"HCPCS"}],"standard_charges":[{"gross_charge":9135.08,"discounted_cash":9135.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT ANGIO,HEAD COMBO,INCL IMAGE PROCESS","code_information":[{"code":"3517049602","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70496","type":"HCPCS"}],"standard_charges":[{"gross_charge":8284.48,"discounted_cash":8284.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT ANGIO,NECK COMBO,INCL IMAGE PROCESS","code_information":[{"code":"3517049802","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70498","type":"HCPCS"}],"standard_charges":[{"gross_charge":8284.48,"discounted_cash":8284.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN,THORAX,W/O CONTRAST","code_information":[{"code":"3527125001","type":"CDM"},{"code":"0352","type":"RC"},{"code":"71250","type":"HCPCS"}],"standard_charges":[{"gross_charge":6515.57,"discounted_cash":6515.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CAT SCAN OF CHEST CONTRAST","code_information":[{"code":"3527126002","type":"CDM"},{"code":"0352","type":"RC"},{"code":"71260","type":"HCPCS"}],"standard_charges":[{"gross_charge":9908.15,"discounted_cash":9908.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CAT SCAN OF CHEST COMBO","code_information":[{"code":"3527127001","type":"CDM"},{"code":"0352","type":"RC"},{"code":"71270","type":"HCPCS"}],"standard_charges":[{"gross_charge":9953.69,"discounted_cash":9953.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LDCT FOR LUNG CA SCREEN","code_information":[{"code":"3527127101","type":"CDM"},{"code":"0352","type":"RC"},{"code":"71271","type":"HCPCS"}],"standard_charges":[{"gross_charge":6569.73,"discounted_cash":6569.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT ANGIO, CHEST, COMBO, INCL IMAGE PROC","code_information":[{"code":"3527127501","type":"CDM"},{"code":"0352","type":"RC"},{"code":"71275","type":"HCPCS"}],"standard_charges":[{"gross_charge":10549.48,"discounted_cash":10549.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN,CERVICAL SPINE,W/O CONTRAST","code_information":[{"code":"3527212501","type":"CDM"},{"code":"0352","type":"RC"},{"code":"72125","type":"HCPCS"}],"standard_charges":[{"gross_charge":9413.29,"discounted_cash":9413.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN CERV SPINE CONTRAST","code_information":[{"code":"3527212601","type":"CDM"},{"code":"0352","type":"RC"},{"code":"72126","type":"HCPCS"}],"standard_charges":[{"gross_charge":8262.33,"discounted_cash":8262.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN CERV SP COMBO","code_information":[{"code":"3527212701","type":"CDM"},{"code":"0352","type":"RC"},{"code":"72127","type":"HCPCS"}],"standard_charges":[{"gross_charge":9563.47,"discounted_cash":9563.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN,THORACIC SPINE,W/O CONTRAST","code_information":[{"code":"3527212801","type":"CDM"},{"code":"0352","type":"RC"},{"code":"72128","type":"HCPCS"}],"standard_charges":[{"gross_charge":8899.97,"discounted_cash":8899.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN DORSAL SP CONTRAST","code_information":[{"code":"3527212901","type":"CDM"},{"code":"0352","type":"RC"},{"code":"72129","type":"HCPCS"}],"standard_charges":[{"gross_charge":9270.49,"discounted_cash":9270.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN DORSAL SP COMBO","code_information":[{"code":"3527213001","type":"CDM"},{"code":"0352","type":"RC"},{"code":"72130","type":"HCPCS"}],"standard_charges":[{"gross_charge":9953.56,"discounted_cash":9953.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN,LUMBAR SPINE,W/O CONTRAST","code_information":[{"code":"3527213101","type":"CDM"},{"code":"0352","type":"RC"},{"code":"72131","type":"HCPCS"}],"standard_charges":[{"gross_charge":9000.92,"discounted_cash":9000.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN LUMBAR SP CONTRAST","code_information":[{"code":"3527213201","type":"CDM"},{"code":"0352","type":"RC"},{"code":"72132","type":"HCPCS"}],"standard_charges":[{"gross_charge":8035.82,"discounted_cash":8035.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN LUMBAR SP COMBO","code_information":[{"code":"3527213301","type":"CDM"},{"code":"0352","type":"RC"},{"code":"72133","type":"HCPCS"}],"standard_charges":[{"gross_charge":7725.33,"discounted_cash":7725.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT ANGIO, PELVIS, COMBO, INCL IMAGE PROC","code_information":[{"code":"3527219101","type":"CDM"},{"code":"0352","type":"RC"},{"code":"72191","type":"HCPCS"}],"standard_charges":[{"gross_charge":9533.96,"discounted_cash":9533.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN,PELVIS,W/O CONTRAST","code_information":[{"code":"3527219201","type":"CDM"},{"code":"0352","type":"RC"},{"code":"72192","type":"HCPCS"}],"standard_charges":[{"gross_charge":6417.09,"discounted_cash":6417.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN OF PELVIS CONTRAST","code_information":[{"code":"3527219301","type":"CDM"},{"code":"0352","type":"RC"},{"code":"72193","type":"HCPCS"}],"standard_charges":[{"gross_charge":8999.68,"discounted_cash":8999.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN OF PELVIS COMBO","code_information":[{"code":"3527219401","type":"CDM"},{"code":"0352","type":"RC"},{"code":"72194","type":"HCPCS"}],"standard_charges":[{"gross_charge":9636.09,"discounted_cash":9636.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN,UPPER EXTREMITY,W/O CONTRAST","code_information":[{"code":"3527320010","type":"CDM"},{"code":"0352","type":"RC"},{"code":"73200","type":"HCPCS"}],"standard_charges":[{"gross_charge":5852.07,"discounted_cash":5852.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN OF ARM CONTRAST","code_information":[{"code":"3527320112","type":"CDM"},{"code":"0352","type":"RC"},{"code":"73201","type":"HCPCS"}],"standard_charges":[{"gross_charge":6734.68,"discounted_cash":6734.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN OF ARM COMBO","code_information":[{"code":"3527320209","type":"CDM"},{"code":"0352","type":"RC"},{"code":"73202","type":"HCPCS"}],"standard_charges":[{"gross_charge":10934.11,"discounted_cash":10934.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT ANGIO,UPPER EXTREM,COMBO","code_information":[{"code":"3527320601","type":"CDM"},{"code":"0352","type":"RC"},{"code":"73206","type":"HCPCS"}],"standard_charges":[{"gross_charge":6739.61,"discounted_cash":6739.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST - LOWER EXTREMITY WO IV CONTRAST","code_information":[{"code":"3527370013","type":"CDM"},{"code":"0352","type":"RC"},{"code":"73700","type":"HCPCS"}],"standard_charges":[{"gross_charge":5358.54,"discounted_cash":5358.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN OF LEG CONTRAST","code_information":[{"code":"3527370107","type":"CDM"},{"code":"0352","type":"RC"},{"code":"73701","type":"HCPCS"}],"standard_charges":[{"gross_charge":6604.2,"discounted_cash":6604.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN OF LEG COMBO","code_information":[{"code":"3527370205","type":"CDM"},{"code":"0352","type":"RC"},{"code":"73702","type":"HCPCS"}],"standard_charges":[{"gross_charge":7966.89,"discounted_cash":7966.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT ANGIO,LOWER EXTREM,COMBO,IMAGE PRC","code_information":[{"code":"3527370601","type":"CDM"},{"code":"0352","type":"RC"},{"code":"73706","type":"HCPCS"}],"standard_charges":[{"gross_charge":8579.92,"discounted_cash":8579.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN,ABDOMEN,W/O CONTRAST","code_information":[{"code":"3527415001","type":"CDM"},{"code":"0352","type":"RC"},{"code":"74150","type":"HCPCS"}],"standard_charges":[{"gross_charge":7696.08,"discounted_cash":7696.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN OF ABDOMEN CONTRAST","code_information":[{"code":"3527416001","type":"CDM"},{"code":"0352","type":"RC"},{"code":"74160","type":"HCPCS"}],"standard_charges":[{"gross_charge":10089.1,"discounted_cash":10089.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN OF ABDOMEN W/WO CONT","code_information":[{"code":"3527417001","type":"CDM"},{"code":"0352","type":"RC"},{"code":"74170","type":"HCPCS"}],"standard_charges":[{"gross_charge":10534.71,"discounted_cash":10534.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMGES","code_information":[{"code":"3527417401","type":"CDM"},{"code":"0352","type":"RC"},{"code":"74174","type":"HCPCS"}],"standard_charges":[{"gross_charge":10711.97,"discounted_cash":10711.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT ANGIO, ABD, COMBO,INCL IMAGE PROC","code_information":[{"code":"3527417501","type":"CDM"},{"code":"0352","type":"RC"},{"code":"74175","type":"HCPCS"}],"standard_charges":[{"gross_charge":10711.97,"discounted_cash":10711.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN,ABDOMEN AND PELVIS,W/O CONTRAST","code_information":[{"code":"3527417601","type":"CDM"},{"code":"0352","type":"RC"},{"code":"74176","type":"HCPCS"}],"standard_charges":[{"gross_charge":12543.67,"discounted_cash":12543.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN,ABDOMEN AND PELVIS,W CONTRAST","code_information":[{"code":"3527417701","type":"CDM"},{"code":"0352","type":"RC"},{"code":"74177","type":"HCPCS"}],"standard_charges":[{"gross_charge":15681.43,"discounted_cash":15681.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT SCAN,ABDOMEN AND PELVIS,COMBO","code_information":[{"code":"3527417801","type":"CDM"},{"code":"0352","type":"RC"},{"code":"74178","type":"HCPCS"}],"standard_charges":[{"gross_charge":14724.96,"discounted_cash":14724.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT COLONOGRAPHY DX - CT COLONOGRAPHY DIAGNOSTIC WO CONTRAST","code_information":[{"code":"3527426101","type":"CDM"},{"code":"0352","type":"RC"},{"code":"74261","type":"HCPCS"}],"standard_charges":[{"gross_charge":3560.49,"discounted_cash":3560.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT COLONOGRAPHY INC IMAGE PROCESS, SCREENING","code_information":[{"code":"3527426301","type":"CDM"},{"code":"0352","type":"RC"},{"code":"74263","type":"HCPCS"}],"standard_charges":[{"gross_charge":3560.49,"discounted_cash":3560.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT HEART W/O CONTRAST QUANT EVAL CORONARY CALCIUM","code_information":[{"code":"3527557101","type":"CDM"},{"code":"0352","type":"RC"},{"code":"75571","type":"HCPCS"}],"standard_charges":[{"gross_charge":6213.88,"discounted_cash":6213.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT HEART CONTRAST EVAL CARDIAC STRUCT/MORPH","code_information":[{"code":"3527557201","type":"CDM"},{"code":"0352","type":"RC"},{"code":"75572","type":"HCPCS"}],"standard_charges":[{"gross_charge":12965.89,"discounted_cash":12965.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT HRT W/3D IMAGE CONGEN - CT HRT STRUCT MORPH CONG HRT DIS W/ CONT","code_information":[{"code":"3527557301","type":"CDM"},{"code":"0352","type":"RC"},{"code":"75573","type":"HCPCS"}],"standard_charges":[{"gross_charge":11723.23,"discounted_cash":11723.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT ANGIO HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST","code_information":[{"code":"3527557401","type":"CDM"},{"code":"0352","type":"RC"},{"code":"75574","type":"HCPCS"}],"standard_charges":[{"gross_charge":2372.05,"discounted_cash":2372.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CT ANGIO AORTOBIFEMORAL, COMBO","code_information":[{"code":"3527563501","type":"CDM"},{"code":"0352","type":"RC"},{"code":"75635","type":"HCPCS"}],"standard_charges":[{"gross_charge":9386.21,"discounted_cash":9386.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR CARD - LEVEL 1 FIRST 30 MINUTES","code_information":[{"code":"3600000020","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000020","type":"HCPCS"}],"standard_charges":[{"gross_charge":17945.69,"discounted_cash":17945.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR CARD - LEVEL 1 EACH ADDL MINUTE","code_information":[{"code":"3600000021","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000021","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.13,"discounted_cash":287.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR CARD - LEVEL 2 FIRST 30 MINUTES","code_information":[{"code":"3600000022","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000022","type":"HCPCS"}],"standard_charges":[{"gross_charge":20898.15,"discounted_cash":20898.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR CARD - LEVEL 2 EACH ADDL MINUTE","code_information":[{"code":"3600000023","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000023","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.25,"discounted_cash":388.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR CARD - LEVEL 3 FIRST 30 MINUTES","code_information":[{"code":"3600000024","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000024","type":"HCPCS"}],"standard_charges":[{"gross_charge":23195.11,"discounted_cash":23195.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR CARD - LEVEL 3 EACH ADDL MINUTE","code_information":[{"code":"3600000025","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000025","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.67,"discounted_cash":445.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR CARD - LEVEL 4 FIRST 30 MINUTES","code_information":[{"code":"3600000026","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000026","type":"HCPCS"}],"standard_charges":[{"gross_charge":29256.26,"discounted_cash":29256.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR CARD - LEVEL 4 EACH ADDL MINUTE","code_information":[{"code":"3600000027","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000027","type":"HCPCS"}],"standard_charges":[{"gross_charge":610.47,"discounted_cash":610.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR CARD - LEVEL 5 FIRST 30 MINUTES","code_information":[{"code":"3600000028","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000028","type":"HCPCS"}],"standard_charges":[{"gross_charge":33388.46,"discounted_cash":33388.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR CARD - LEVEL 5 EACH ADDL MINUTE","code_information":[{"code":"3600000029","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000029","type":"HCPCS"}],"standard_charges":[{"gross_charge":790.24,"discounted_cash":790.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ENT - LEVEL 1 FIRST 30 MINUTES","code_information":[{"code":"3600000030","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000030","type":"HCPCS"}],"standard_charges":[{"gross_charge":17945.69,"discounted_cash":17945.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ENT - LEVEL 1 EACH ADDL MINUTE","code_information":[{"code":"3600000031","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000031","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.13,"discounted_cash":287.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ENT - LEVEL 2 FIRST 30 MINUTES","code_information":[{"code":"3600000032","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000032","type":"HCPCS"}],"standard_charges":[{"gross_charge":20898.15,"discounted_cash":20898.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ENT - LEVEL 2 EACH ADDL MINUTE","code_information":[{"code":"3600000033","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000033","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.25,"discounted_cash":388.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ENT - LEVEL 3 FIRST 30 MINUTES","code_information":[{"code":"3600000034","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000034","type":"HCPCS"}],"standard_charges":[{"gross_charge":23195.11,"discounted_cash":23195.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ENT - LEVEL 3 EACH ADDL MINUTE","code_information":[{"code":"3600000035","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000035","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.67,"discounted_cash":445.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ENT - LEVEL 4 FIRST 30 MINUTES","code_information":[{"code":"3600000036","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000036","type":"HCPCS"}],"standard_charges":[{"gross_charge":26016.61,"discounted_cash":26016.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ENT - LEVEL 4 EACH ADDL MINUTE","code_information":[{"code":"3600000037","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000037","type":"HCPCS"}],"standard_charges":[{"gross_charge":538.06,"discounted_cash":538.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ENT - LEVEL 5 FIRST 30 MINUTES","code_information":[{"code":"3600000038","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000038","type":"HCPCS"}],"standard_charges":[{"gross_charge":29256.26,"discounted_cash":29256.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ENT - LEVEL 5 EACH ADDL MINUTE","code_information":[{"code":"3600000039","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000039","type":"HCPCS"}],"standard_charges":[{"gross_charge":610.47,"discounted_cash":610.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GENERAL - LEVEL 1 FIRST 30 MINUTES","code_information":[{"code":"3600000040","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000040","type":"HCPCS"}],"standard_charges":[{"gross_charge":17945.69,"discounted_cash":17945.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GENERAL - LEVEL 1 EACH ADDL MINUTE","code_information":[{"code":"3600000041","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000041","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.13,"discounted_cash":287.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GENERAL - LEVEL 2 FIRST 30 MINUTES","code_information":[{"code":"3600000042","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000042","type":"HCPCS"}],"standard_charges":[{"gross_charge":20898.15,"discounted_cash":20898.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GENERAL - LEVEL 2 EACH ADDL MINUTE","code_information":[{"code":"3600000043","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000043","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.25,"discounted_cash":388.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GENERAL - LEVEL 3 FIRST 30 MINUTES","code_information":[{"code":"3600000044","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000044","type":"HCPCS"}],"standard_charges":[{"gross_charge":23195.11,"discounted_cash":23195.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GENERAL - LEVEL 3 EACH ADDL MINUTE","code_information":[{"code":"3600000045","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000045","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.67,"discounted_cash":445.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GENERAL - LEVEL 4 FIRST 30 MINUTES","code_information":[{"code":"3600000046","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000046","type":"HCPCS"}],"standard_charges":[{"gross_charge":26016.61,"discounted_cash":26016.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GENERAL - LEVEL 4 EACH ADDL MINUTE","code_information":[{"code":"3600000047","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000047","type":"HCPCS"}],"standard_charges":[{"gross_charge":538.06,"discounted_cash":538.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GENERAL - LEVEL 5 FIRST 30 MINUTES","code_information":[{"code":"3600000048","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000048","type":"HCPCS"}],"standard_charges":[{"gross_charge":29256.26,"discounted_cash":29256.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GENERAL - LEVEL 5 EACH ADDL MINUTE","code_information":[{"code":"3600000049","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000049","type":"HCPCS"}],"standard_charges":[{"gross_charge":610.47,"discounted_cash":610.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GYN - LEVEL 1 FIRST 30 MINUTES","code_information":[{"code":"3600000050","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000050","type":"HCPCS"}],"standard_charges":[{"gross_charge":17945.69,"discounted_cash":17945.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GYN - LEVEL 1 EACH ADDL MINUTE","code_information":[{"code":"3600000051","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000051","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.13,"discounted_cash":287.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GYN - LEVEL 2 FIRST 30 MINUTES","code_information":[{"code":"3600000052","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000052","type":"HCPCS"}],"standard_charges":[{"gross_charge":20898.15,"discounted_cash":20898.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GYN - LEVEL 2 EACH ADDL MINUTE","code_information":[{"code":"3600000053","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000053","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.25,"discounted_cash":388.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GYN - LEVEL 3 FIRST 30 MINUTES","code_information":[{"code":"3600000054","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000054","type":"HCPCS"}],"standard_charges":[{"gross_charge":23195.11,"discounted_cash":23195.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GYN - LEVEL 3 EACH ADDL MINUTE","code_information":[{"code":"3600000055","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000055","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.67,"discounted_cash":445.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GYN - LEVEL 4 FIRST 30 MINUTES","code_information":[{"code":"3600000056","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000056","type":"HCPCS"}],"standard_charges":[{"gross_charge":26016.61,"discounted_cash":26016.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GYN - LEVEL 4 EACH ADDL MINUTE","code_information":[{"code":"3600000057","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000057","type":"HCPCS"}],"standard_charges":[{"gross_charge":538.06,"discounted_cash":538.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GYN - LEVEL 5 FIRST 30 MINUTES","code_information":[{"code":"3600000058","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000058","type":"HCPCS"}],"standard_charges":[{"gross_charge":29256.26,"discounted_cash":29256.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR GYN - LEVEL 5 EACH ADDL MINUTE","code_information":[{"code":"3600000059","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000059","type":"HCPCS"}],"standard_charges":[{"gross_charge":610.47,"discounted_cash":610.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR NEURO - LEVEL 1 FIRST 30 MINUTES","code_information":[{"code":"3600000060","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000060","type":"HCPCS"}],"standard_charges":[{"gross_charge":17945.69,"discounted_cash":17945.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR NEURO - LEVEL 1 EACH ADDL MINUTE","code_information":[{"code":"3600000061","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000061","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.13,"discounted_cash":287.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR NEURO - LEVEL 2 FIRST 30 MINUTES","code_information":[{"code":"3600000062","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000062","type":"HCPCS"}],"standard_charges":[{"gross_charge":20898.15,"discounted_cash":20898.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR NEURO - LEVEL 2 EACH ADDL MINUTE","code_information":[{"code":"3600000063","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000063","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.25,"discounted_cash":388.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR NEURO - LEVEL 3 FIRST 30 MINUTES","code_information":[{"code":"3600000064","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000064","type":"HCPCS"}],"standard_charges":[{"gross_charge":23195.11,"discounted_cash":23195.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR NEURO - LEVEL 3 EACH ADDL MINUTE","code_information":[{"code":"3600000065","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000065","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.67,"discounted_cash":445.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR NEURO - LEVEL 4 FIRST 30 MINUTES","code_information":[{"code":"3600000066","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000066","type":"HCPCS"}],"standard_charges":[{"gross_charge":26016.61,"discounted_cash":26016.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR NEURO - LEVEL 4 EACH ADDL MINUTE","code_information":[{"code":"3600000067","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000067","type":"HCPCS"}],"standard_charges":[{"gross_charge":538.06,"discounted_cash":538.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR NEURO - LEVEL 5 FIRST 30 MINUTES","code_information":[{"code":"3600000068","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":29256.26,"discounted_cash":29256.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR NEURO - LEVEL 5 EACH ADDL MINUTE","code_information":[{"code":"3600000069","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000069","type":"HCPCS"}],"standard_charges":[{"gross_charge":610.47,"discounted_cash":610.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OPTH - LEVEL 1 FIRST 30 MINUTES","code_information":[{"code":"3600000070","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000070","type":"HCPCS"}],"standard_charges":[{"gross_charge":17945.69,"discounted_cash":17945.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OPTH - LEVEL 1 EACH ADDL MINUTE","code_information":[{"code":"3600000071","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000071","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.13,"discounted_cash":287.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OPTH - LEVEL 2 FIRST 30 MINUTES","code_information":[{"code":"3600000072","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000072","type":"HCPCS"}],"standard_charges":[{"gross_charge":20898.15,"discounted_cash":20898.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OPTH - LEVEL 2 EACH ADDL MINUTE","code_information":[{"code":"3600000073","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000073","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.25,"discounted_cash":388.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OPTH - LEVEL 3 FIRST 30 MINUTES","code_information":[{"code":"3600000074","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000074","type":"HCPCS"}],"standard_charges":[{"gross_charge":23195.11,"discounted_cash":23195.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OPTH - LEVEL 3 EACH ADDL MINUTE","code_information":[{"code":"3600000075","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000075","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.67,"discounted_cash":445.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OPTH - LEVEL 4 FIRST 30 MINUTES","code_information":[{"code":"3600000076","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000076","type":"HCPCS"}],"standard_charges":[{"gross_charge":26016.61,"discounted_cash":26016.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OPTH - LEVEL 4 EACH ADDL MINUTE","code_information":[{"code":"3600000077","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000077","type":"HCPCS"}],"standard_charges":[{"gross_charge":538.06,"discounted_cash":538.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OPTH - LEVEL 5 FIRST 30 MINUTES","code_information":[{"code":"3600000078","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000078","type":"HCPCS"}],"standard_charges":[{"gross_charge":29256.26,"discounted_cash":29256.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OPTH - LEVEL 5 EACH ADDL MINUTE","code_information":[{"code":"3600000079","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000079","type":"HCPCS"}],"standard_charges":[{"gross_charge":610.47,"discounted_cash":610.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ORTHO - LEVEL 1 FIRST 30 MINUTES","code_information":[{"code":"3600000080","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000080","type":"HCPCS"}],"standard_charges":[{"gross_charge":17945.69,"discounted_cash":17945.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ORTHO - LEVEL 1 EACH ADDL MINUTE","code_information":[{"code":"3600000081","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000081","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.13,"discounted_cash":287.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ORTHO - LEVEL 2 FIRST 30 MINUTES","code_information":[{"code":"3600000082","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000082","type":"HCPCS"}],"standard_charges":[{"gross_charge":20898.15,"discounted_cash":20898.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ORTHO - LEVEL 2 EACH ADDL MINUTE","code_information":[{"code":"3600000083","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000083","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.25,"discounted_cash":388.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ORTHO - LEVEL 3 FIRST 30 MINUTES","code_information":[{"code":"3600000084","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000084","type":"HCPCS"}],"standard_charges":[{"gross_charge":23195.11,"discounted_cash":23195.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ORTHO - LEVEL 3 EACH ADDL MINUTE","code_information":[{"code":"3600000085","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000085","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.67,"discounted_cash":445.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ORTHO - LEVEL 4 FIRST 30 MINUTES","code_information":[{"code":"3600000086","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000086","type":"HCPCS"}],"standard_charges":[{"gross_charge":26016.61,"discounted_cash":26016.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ORTHO - LEVEL 4 EACH ADDL MINUTE","code_information":[{"code":"3600000087","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000087","type":"HCPCS"}],"standard_charges":[{"gross_charge":538.06,"discounted_cash":538.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ORTHO - LEVEL 5 FIRST 30 MINUTES","code_information":[{"code":"3600000088","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000088","type":"HCPCS"}],"standard_charges":[{"gross_charge":29256.26,"discounted_cash":29256.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ORTHO - LEVEL 5 EACH ADDL MINUTE","code_information":[{"code":"3600000089","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000089","type":"HCPCS"}],"standard_charges":[{"gross_charge":610.47,"discounted_cash":610.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ROBOT - LEVEL 1 FIRST 30 MINUTES","code_information":[{"code":"3600000090","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000090","type":"HCPCS"}],"standard_charges":[{"gross_charge":17945.69,"discounted_cash":17945.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ROBOT - LEVEL 1 EACH ADDL MINUTE","code_information":[{"code":"3600000091","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000091","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.13,"discounted_cash":287.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ROBOT - LEVEL 2 FIRST 30 MINUTES","code_information":[{"code":"3600000092","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000092","type":"HCPCS"}],"standard_charges":[{"gross_charge":20898.15,"discounted_cash":20898.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ROBOT - LEVEL 2 EACH ADDL MINUTE","code_information":[{"code":"3600000093","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000093","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.25,"discounted_cash":388.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ROBOT - LEVEL 3 FIRST 30 MINUTES","code_information":[{"code":"3600000094","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000094","type":"HCPCS"}],"standard_charges":[{"gross_charge":23195.11,"discounted_cash":23195.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ROBOT - LEVEL 3 EACH ADDL MINUTE","code_information":[{"code":"3600000095","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000095","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.67,"discounted_cash":445.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ROBOT - LEVEL 4 FIRST 30 MINUTES","code_information":[{"code":"3600000096","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000096","type":"HCPCS"}],"standard_charges":[{"gross_charge":29256.26,"discounted_cash":29256.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ROBOT - LEVEL 4 EACH ADDL MINUTE","code_information":[{"code":"3600000097","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000097","type":"HCPCS"}],"standard_charges":[{"gross_charge":610.47,"discounted_cash":610.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ROBOT - LEVEL 5 FIRST 30 MINUTES","code_information":[{"code":"3600000098","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000098","type":"HCPCS"}],"standard_charges":[{"gross_charge":33388.46,"discounted_cash":33388.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR ROBOT - LEVEL 5 EACH ADDL MINUTE","code_information":[{"code":"3600000099","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600000099","type":"HCPCS"}],"standard_charges":[{"gross_charge":790.24,"discounted_cash":790.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR UROL - LEVEL 1 FIRST 30 MINUTES","code_information":[{"code":"36000000A1","type":"CDM"},{"code":"0360","type":"RC"},{"code":"36000000A1","type":"HCPCS"}],"standard_charges":[{"gross_charge":17945.69,"discounted_cash":17945.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR UROL - LEVEL 1 EACH ADDL MINUTE","code_information":[{"code":"36000000A2","type":"CDM"},{"code":"0360","type":"RC"},{"code":"36000000A2","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.13,"discounted_cash":287.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR UROL - LEVEL 2 FIRST 30 MINUTES","code_information":[{"code":"36000000A3","type":"CDM"},{"code":"0360","type":"RC"},{"code":"36000000A3","type":"HCPCS"}],"standard_charges":[{"gross_charge":20898.15,"discounted_cash":20898.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR UROL - LEVEL 2 EACH ADDL MINUTE","code_information":[{"code":"36000000A4","type":"CDM"},{"code":"0360","type":"RC"},{"code":"36000000A4","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.25,"discounted_cash":388.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR UROL - LEVEL 3 FIRST 30 MINUTES","code_information":[{"code":"36000000A5","type":"CDM"},{"code":"0360","type":"RC"},{"code":"36000000A5","type":"HCPCS"}],"standard_charges":[{"gross_charge":23195.11,"discounted_cash":23195.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR UROL - LEVEL 3 EACH ADDL MINUTE","code_information":[{"code":"36000000A6","type":"CDM"},{"code":"0360","type":"RC"},{"code":"36000000A6","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.67,"discounted_cash":445.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR UROL - LEVEL 4 FIRST 30 MINUTES","code_information":[{"code":"36000000A7","type":"CDM"},{"code":"0360","type":"RC"},{"code":"36000000A7","type":"HCPCS"}],"standard_charges":[{"gross_charge":26016.61,"discounted_cash":26016.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR UROL - LEVEL 4 EACH ADDL MINUTE","code_information":[{"code":"36000000A8","type":"CDM"},{"code":"0360","type":"RC"},{"code":"36000000A8","type":"HCPCS"}],"standard_charges":[{"gross_charge":538.06,"discounted_cash":538.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR UROL - LEVEL 5 FIRST 30 MINUTES","code_information":[{"code":"36000000A9","type":"CDM"},{"code":"0360","type":"RC"},{"code":"36000000A9","type":"HCPCS"}],"standard_charges":[{"gross_charge":29256.26,"discounted_cash":29256.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR UROL - LEVEL 5 EACH ADDL MINUTE","code_information":[{"code":"36000000B1","type":"CDM"},{"code":"0360","type":"RC"},{"code":"36000000B1","type":"HCPCS"}],"standard_charges":[{"gross_charge":610.47,"discounted_cash":610.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OB - LEVEL 1 FIRST 30 MINUTES","code_information":[{"code":"36000000C3","type":"CDM"},{"code":"0360","type":"RC"},{"code":"36000000C3","type":"HCPCS"}],"standard_charges":[{"gross_charge":5492.67,"discounted_cash":5492.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OB - LEVEL 1 EACH ADDL MINUTE","code_information":[{"code":"36000000C4","type":"CDM"},{"code":"0360","type":"RC"},{"code":"36000000C4","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.55,"discounted_cash":192.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OB - LEVEL 2 FIRST 30 MINUTES","code_information":[{"code":"36000000C5","type":"CDM"},{"code":"0360","type":"RC"},{"code":"36000000C5","type":"HCPCS"}],"standard_charges":[{"gross_charge":6801.05,"discounted_cash":6801.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OB - LEVEL 2 EACH ADDL MINUTE","code_information":[{"code":"36000000C6","type":"CDM"},{"code":"0360","type":"RC"},{"code":"36000000C6","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.42,"discounted_cash":247.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OB - LEVEL 3 FIRST 30 MINUTES","code_information":[{"code":"36000000C7","type":"CDM"},{"code":"0360","type":"RC"},{"code":"36000000C7","type":"HCPCS"}],"standard_charges":[{"gross_charge":18119.0,"discounted_cash":18119.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OB - LEVEL 3 EACH ADDL MINUTE","code_information":[{"code":"36000000C8","type":"CDM"},{"code":"0360","type":"RC"},{"code":"36000000C8","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":404.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OB - LEVEL 4 FIRST 30 MINUTES","code_information":[{"code":"36000000C9","type":"CDM"},{"code":"0360","type":"RC"},{"code":"36000000C9","type":"HCPCS"}],"standard_charges":[{"gross_charge":20000.0,"discounted_cash":20000.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OB - LEVEL 4 EACH ADDL MINUTE","code_information":[{"code":"36000000D1","type":"CDM"},{"code":"0360","type":"RC"},{"code":"36000000D1","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":425.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OB - LEVEL 5 FIRST 30 MINUTES","code_information":[{"code":"36000000D2","type":"CDM"},{"code":"0360","type":"RC"},{"code":"36000000D2","type":"HCPCS"}],"standard_charges":[{"gross_charge":22000.0,"discounted_cash":22000.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OR OB - LEVEL 5 EACH ADDL MINUTE","code_information":[{"code":"36000000D3","type":"CDM"},{"code":"0360","type":"RC"},{"code":"36000000D3","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.0,"discounted_cash":450.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ECMO/ECLS DAILY MANAGEMENT VENOUS","code_information":[{"code":"3603394801","type":"CDM"},{"code":"0360","type":"RC"},{"code":"33948","type":"HCPCS"}],"standard_charges":[{"gross_charge":2432.64,"discounted_cash":2432.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ECMO/ECLS DAILY MANAGEMENT ARTERIAL","code_information":[{"code":"3603394901","type":"CDM"},{"code":"0360","type":"RC"},{"code":"33949","type":"HCPCS"}],"standard_charges":[{"gross_charge":2432.64,"discounted_cash":2432.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSJ PERQ VAD W/IMAGING ARTERY ACCESS ONLY","code_information":[{"code":"3603399001","type":"CDM"},{"code":"0360","type":"RC"},{"code":"33990","type":"HCPCS"}],"standard_charges":[{"gross_charge":17153.48,"discounted_cash":17153.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERT PERQ VAD R HRT VENOUS","code_information":[{"code":"3603399501","type":"CDM"},{"code":"0360","type":"RC"},{"code":"33995","type":"HCPCS"}],"standard_charges":[{"gross_charge":18341.03,"discounted_cash":18341.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT","code_information":[{"code":"3603470501","type":"CDM"},{"code":"0360","type":"RC"},{"code":"34705","type":"HCPCS"}],"standard_charges":[{"gross_charge":19369.48,"discounted_cash":19369.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EVASC RPR DPLMNT ILIO-ILIAC NDGFT","code_information":[{"code":"3603470701","type":"CDM"},{"code":"0360","type":"RC"},{"code":"34707","type":"HCPCS"}],"standard_charges":[{"gross_charge":17492.75,"discounted_cash":17492.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR","code_information":[{"code":"3603470901","type":"CDM"},{"code":"0360","type":"RC"},{"code":"34709","type":"HCPCS"}],"standard_charges":[{"gross_charge":8573.24,"discounted_cash":8573.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRANSCATH RENAL SYMP DENERV BIL","code_information":[{"code":"3610339T01","type":"CDM"},{"code":"0361","type":"RC"},{"code":"0339T","type":"HCPCS"}],"standard_charges":[{"gross_charge":13469.09,"discounted_cash":13469.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION","code_information":[{"code":"3611000501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10005","type":"HCPCS"}],"standard_charges":[{"gross_charge":3294.1,"discounted_cash":3294.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FINE NEEDLE ASPIRATION BX W/US GDN EA ADDL","code_information":[{"code":"3611000601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10006","type":"HCPCS"}],"standard_charges":[{"gross_charge":587.62,"discounted_cash":587.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FINE NEEDLE ASPIRATION BX W/FLUOR GDN 1ST LESION","code_information":[{"code":"3611000701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10007","type":"HCPCS"}],"standard_charges":[{"gross_charge":3294.1,"discounted_cash":3294.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FINE NEEDLE ASPIRATION BX W/FLUOR GDN EA ADDL","code_information":[{"code":"3611000801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10008","type":"HCPCS"}],"standard_charges":[{"gross_charge":531.3,"discounted_cash":531.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FINE NEEDLE ASPIRATION BX W/CT GDN 1ST LESION","code_information":[{"code":"3611000901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10009","type":"HCPCS"}],"standard_charges":[{"gross_charge":6927.94,"discounted_cash":6927.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FINE NEEDLE ASPIRATION BX W/CT GDN EA ADDL","code_information":[{"code":"3611001001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10010","type":"HCPCS"}],"standard_charges":[{"gross_charge":531.3,"discounted_cash":531.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE","code_information":[{"code":"3611003001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10030","type":"HCPCS"}],"standard_charges":[{"gross_charge":6619.01,"discounted_cash":6619.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERQ SFT TISS LOC DEVICE PLMT 1ST LES W/GDNCE","code_information":[{"code":"3611003501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10035","type":"HCPCS"}],"standard_charges":[{"gross_charge":6619.01,"discounted_cash":6619.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLACE INT DVC SOFT TISSUE ADD","code_information":[{"code":"3611003601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10036","type":"HCPCS"}],"standard_charges":[{"gross_charge":657.3,"discounted_cash":657.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRAIN SKIN ABSCESS SIMPLE","code_information":[{"code":"3611006001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":1230.98,"discounted_cash":1230.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRAIN SKIN ABSCESS COMPLIC","code_information":[{"code":"3611006101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10061","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRAIN PILONIDAL CYST SIMPL","code_information":[{"code":"3611008001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10080","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRAIN PILONIDAL CYST COMPLIC","code_information":[{"code":"3611008101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10081","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMOVE FOREIGN BODY SIMPLE","code_information":[{"code":"3611012001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10120","type":"HCPCS"}],"standard_charges":[{"gross_charge":3692.93,"discounted_cash":3692.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRAINAGE OF HEMATOMA/FLUID","code_information":[{"code":"3611014001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10140","type":"HCPCS"}],"standard_charges":[{"gross_charge":3692.93,"discounted_cash":3692.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PUNCTURE DRAINAGE OF LESION","code_information":[{"code":"3611016001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10160","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COMPLEX DRAINAGE, WOUND","code_information":[{"code":"3611018001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10180","type":"HCPCS"}],"standard_charges":[{"gross_charge":6154.89,"discounted_cash":6154.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEBRIDEMENT, INFECTED SKIN, UP TO 10% BSA","code_information":[{"code":"3611100001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11000","type":"HCPCS"}],"standard_charges":[{"gross_charge":2025.45,"discounted_cash":2025.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,=<20 SQ CM","code_information":[{"code":"3611104201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11042","type":"HCPCS"}],"standard_charges":[{"gross_charge":3692.93,"discounted_cash":3692.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,=<20 SQ CM","code_information":[{"code":"3611104301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11043","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,BONE,=<20 SQ CM","code_information":[{"code":"3611104401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11044","type":"HCPCS"}],"standard_charges":[{"gross_charge":3692.93,"discounted_cash":3692.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,EACH ADD 20 SQ CM","code_information":[{"code":"3611104501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11045","type":"HCPCS"}],"standard_charges":[{"gross_charge":3692.93,"discounted_cash":3692.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,EACH ADD 20 SQ CM","code_information":[{"code":"3611104601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11046","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,BONE,EACH ADD 20 SQ CM","code_information":[{"code":"3611104701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11047","type":"HCPCS"}],"standard_charges":[{"gross_charge":3692.93,"discounted_cash":3692.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRIM HYPERKERATOTIC SKIN LESION, ONE","code_information":[{"code":"3611105501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11055","type":"HCPCS"}],"standard_charges":[{"gross_charge":1230.98,"discounted_cash":1230.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRIM BENIGN HYPERKERATOTIC SKIN LESION,2-4","code_information":[{"code":"3611105601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11056","type":"HCPCS"}],"standard_charges":[{"gross_charge":1230.98,"discounted_cash":1230.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRIM BENIGN HYPERKERATOTIC SKIN LESION,>4","code_information":[{"code":"3611105701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11057","type":"HCPCS"}],"standard_charges":[{"gross_charge":1230.98,"discounted_cash":1230.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMOVAL OF SKIN TAGS, UP TO 15","code_information":[{"code":"3611120001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1230.98,"discounted_cash":1230.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SHAV SKIN LES 0.6 TO 1.0 CM TRUNK,ARM,LEG","code_information":[{"code":"3611130101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11301","type":"HCPCS"}],"standard_charges":[{"gross_charge":1230.98,"discounted_cash":1230.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXC TR-EXT BENIGN+MRG<0.5CM","code_information":[{"code":"3611140001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11400","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXC SKIN BENIG 0.6-1 CM TRUNK,ARM,LEG","code_information":[{"code":"3611140101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11401","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXC SKIN BENIG 1.1-2 CM TRUNK,ARM,LEG","code_information":[{"code":"3611140201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11402","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXC SKIN BENIG 2.1-3 CM TRUNK,ARM,LEG","code_information":[{"code":"3611140301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11403","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXC SKIN BENIG 3.1-4 CM TRUNK,ARM,LEG","code_information":[{"code":"3611140401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11404","type":"HCPCS"}],"standard_charges":[{"gross_charge":3692.93,"discounted_cash":3692.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXC SKIN BENIG >4 CM TRUNK,ARM,LEG","code_information":[{"code":"3611140601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11406","type":"HCPCS"}],"standard_charges":[{"gross_charge":3692.93,"discounted_cash":3692.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXCISION BENIGN LES W/ MARG SNHFG <0.5 CM","code_information":[{"code":"3611142001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11420","type":"HCPCS"}],"standard_charges":[{"gross_charge":3692.93,"discounted_cash":3692.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY","code_information":[{"code":"3611142101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11421","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXC SKIN BENIG 1.1-2 CM REMAINDR BODY","code_information":[{"code":"3611142201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11422","type":"HCPCS"}],"standard_charges":[{"gross_charge":3692.93,"discounted_cash":3692.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXC BENIGN LES REMAINDER BODY 2.1-3.0 CM","code_information":[{"code":"3611142301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11423","type":"HCPCS"}],"standard_charges":[{"gross_charge":3692.93,"discounted_cash":3692.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXC SKIN BENIG 3.1-4 CM REMAINDR BODY","code_information":[{"code":"3611142401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11424","type":"HCPCS"}],"standard_charges":[{"gross_charge":3692.93,"discounted_cash":3692.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXC SKIN BENIG >4 CM REMAINDR BODY","code_information":[{"code":"3611142601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11426","type":"HCPCS"}],"standard_charges":[{"gross_charge":6154.89,"discounted_cash":6154.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXC BENIGN LESION FACE/FACIAL <0.5 CM","code_information":[{"code":"3611144002","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11440","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXC SKIN BENIG 0.6-1 CM FACE,FACIAL","code_information":[{"code":"3611144102","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11441","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXC BENIGN LESION F/E/E/N/L/M 1.1 - 2.0 CM","code_information":[{"code":"3611144201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11442","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXC BENIGN LESION FACE/FACIAL 2.1-3.0 CM","code_information":[{"code":"3611144302","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11443","type":"HCPCS"}],"standard_charges":[{"gross_charge":3692.93,"discounted_cash":3692.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXC BENIGN LESION FACE/FACIAL 3.1-4.0 CM","code_information":[{"code":"3611144402","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11444","type":"HCPCS"}],"standard_charges":[{"gross_charge":3692.93,"discounted_cash":3692.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXC BENIGN LESION FACE/FACIAL <4.0 CM","code_information":[{"code":"3611144602","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11446","type":"HCPCS"}],"standard_charges":[{"gross_charge":6154.89,"discounted_cash":6154.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXC SWEAT GLAND LESION, SIMP/INTERM REP","code_information":[{"code":"3611145001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11450","type":"HCPCS"}],"standard_charges":[{"gross_charge":6154.89,"discounted_cash":6154.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXC SWEAT GLAND LESION, COMPLEX REP","code_information":[{"code":"3611145101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11451","type":"HCPCS"}],"standard_charges":[{"gross_charge":6154.89,"discounted_cash":6154.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REM SWEAT GLAND LESION, SIMP/INTERM REP","code_information":[{"code":"3611146201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11462","type":"HCPCS"}],"standard_charges":[{"gross_charge":6154.89,"discounted_cash":6154.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REM SWEAT GLAND LESION, COMPLEX REP","code_information":[{"code":"3611146301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11463","type":"HCPCS"}],"standard_charges":[{"gross_charge":6154.89,"discounted_cash":6154.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXC SWEAT GLAND LES PERINEAL,SIMP/INTERM REP","code_information":[{"code":"3611147001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11470","type":"HCPCS"}],"standard_charges":[{"gross_charge":6154.89,"discounted_cash":6154.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXC SWEAT GLAND LES PERINEAL,COMPLEX REP","code_information":[{"code":"3611147101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11471","type":"HCPCS"}],"standard_charges":[{"gross_charge":6154.89,"discounted_cash":6154.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXCISION MALIGNANT LES W/ MARG  TAL 1.1-2.0 CM","code_information":[{"code":"3611160201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11602","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXC SKIN MALIG 3.1-4 CM TRUNK,ARM,LEG","code_information":[{"code":"3611160401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11604","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXC SKIN MALIG >4 CM TRUNK,ARM,LEG","code_information":[{"code":"3611160601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11606","type":"HCPCS"}],"standard_charges":[{"gross_charge":3692.93,"discounted_cash":3692.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXC MLGNT LESION 1.1-2 CM","code_information":[{"code":"3611162201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11622","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRIM NAIL(S)","code_information":[{"code":"3611171901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11719","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.2,"discounted_cash":246.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEBRIDEMENT OF NAIL(S), 1-5","code_information":[{"code":"3611172001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11720","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.2,"discounted_cash":246.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEBRIDEMENT OF NAILS, 6 OR MORE","code_information":[{"code":"3611172101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11721","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.2,"discounted_cash":246.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMOVAL OF NAIL PLATE","code_information":[{"code":"3611173001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11730","type":"HCPCS"}],"standard_charges":[{"gross_charge":1230.98,"discounted_cash":1230.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMOVAL OF NAIL PLATE EACH ADDL","code_information":[{"code":"3611173201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11732","type":"HCPCS"}],"standard_charges":[{"gross_charge":1230.98,"discounted_cash":1230.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRAIN BLOOD FROM UNDER NAIL","code_information":[{"code":"3611174001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11740","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.2,"discounted_cash":246.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMOVAL OF NAIL BED","code_information":[{"code":"3611175001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11750","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BIOPSY NAIL UNIT","code_information":[{"code":"3611175501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11755","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RECONSTRUC OF NAIL BED","code_information":[{"code":"3611176001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11760","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXCISION OF NAIL FOLD, TOE","code_information":[{"code":"3611176501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11765","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RESUPERF WND BODY <2.5CM","code_information":[{"code":"3611200101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12001","type":"HCPCS"}],"standard_charges":[{"gross_charge":1230.98,"discounted_cash":1230.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RESUP NPTERF WND BODY 2.6-7.5 CM","code_information":[{"code":"3611200201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12002","type":"HCPCS"}],"standard_charges":[{"gross_charge":1230.98,"discounted_cash":1230.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RESUPERF WND BODY 7.6-12.5 CM","code_information":[{"code":"3611200401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12004","type":"HCPCS"}],"standard_charges":[{"gross_charge":1230.98,"discounted_cash":1230.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RESUPERF WND BODY 12.6-20 CM","code_information":[{"code":"3611200501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12005","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RESUPERF WND BODY 20.1-30 CM","code_information":[{"code":"3611200601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12006","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RESUPERF WND BODY >30 CM","code_information":[{"code":"3611200701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12007","type":"HCPCS"}],"standard_charges":[{"gross_charge":1230.98,"discounted_cash":1230.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RESUPERF WND FACE <2.5 CM","code_information":[{"code":"3611201101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12011","type":"HCPCS"}],"standard_charges":[{"gross_charge":1354.08,"discounted_cash":1354.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RESUPERF WND FACE 2.6-5 CM","code_information":[{"code":"3611201301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12013","type":"HCPCS"}],"standard_charges":[{"gross_charge":1489.49,"discounted_cash":1489.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RESUPERF WND FACE 5.1-7.5 CM","code_information":[{"code":"3611201401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12014","type":"HCPCS"}],"standard_charges":[{"gross_charge":1638.44,"discounted_cash":1638.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RESUPERF WND FACE 7.6-12.5 CM","code_information":[{"code":"3611201501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12015","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSURE SUPERF WND DEHIS SIMPLE","code_information":[{"code":"3611202001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12020","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAYR CLOS WND TRUNK,ARM,LEG <2.5 CM","code_information":[{"code":"3611203101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12031","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAYR CLOS WND TRUNK,ARM,LEG 2.6-7.5 CM","code_information":[{"code":"3611203201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12032","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAYR CLOS WND TRUNK,ARM,LEG 7.6-12.5 CM","code_information":[{"code":"3611203401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12034","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAYR CLOS WND TRUNK,ARM,LEG 12.6-20 CM","code_information":[{"code":"3611203501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12035","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAYR CLOS WND TRUNK,ARM,LEG 20.1-30 CM","code_information":[{"code":"3611203601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12036","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAYR CLOS WND TRUNK,ARM,LEG >30 CM","code_information":[{"code":"3611203701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12037","type":"HCPCS"}],"standard_charges":[{"gross_charge":6154.89,"discounted_cash":6154.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAYR CLOS WND REST BODY <2.5 CM","code_information":[{"code":"3611204101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12041","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAYR CLOS WND REST BODY 2.6-7.5 CM","code_information":[{"code":"3611204201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12042","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAYR CLOS WND REST BODY 7.6-12.5 CM","code_information":[{"code":"3611204401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12044","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAYR CLOS WND REST BODY 12.6-20 CM","code_information":[{"code":"3611204501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12045","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAYR CLOS WND REST BODY 20.1-30 CM","code_information":[{"code":"3611204601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12046","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAYR CLOS WND REST BODY >30 CM","code_information":[{"code":"3611204701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12047","type":"HCPCS"}],"standard_charges":[{"gross_charge":6154.89,"discounted_cash":6154.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAYR CLOS WND FACE,FACIAL <2.5 CM","code_information":[{"code":"3611205101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12051","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAYR CLOS WND FACE,FACIAL 2.5-5 CM","code_information":[{"code":"3611205201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12052","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAYR CLOS WND FACE,FACIAL 5.1-7.5 CM","code_information":[{"code":"3611205301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12053","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAYR CLOS WND FACE,FACIAL 7.6-12.5 CM","code_information":[{"code":"3611205401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12054","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAYR CLOS WND FACE,FACIAL 12.6-20 CM","code_information":[{"code":"3611205501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12055","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAYR CLOS WND FACE,FACIAL 20.1-30 CM","code_information":[{"code":"3611205601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12056","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LAYR CLOS WND FACE,FACIAL >30 CM","code_information":[{"code":"3611205701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12057","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RECMPL WND SCALP,EXTR 1.1-2.5 CM","code_information":[{"code":"3611312001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"13120","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RECMPL WND SCALP,EXTR 2.6-7.5 CM","code_information":[{"code":"3611312101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"13121","type":"HCPCS"}],"standard_charges":[{"gross_charge":2532.12,"discounted_cash":2532.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REP,SKIN,SCALP/EXTREM+5 CM/<","code_information":[{"code":"3611312201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"13122","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RECMPL WND HEAD,FAC,HAND 1.1-2.5 CM","code_information":[{"code":"3611313101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"13131","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RECMPL WND HEAD,FAC,HAND 2.6-7.5 CM","code_information":[{"code":"3611313201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"13132","type":"HCPCS"}],"standard_charges":[{"gross_charge":2532.12,"discounted_cash":2532.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RECMPL WND LID,NOS,EAR 2.5-7.5 CM","code_information":[{"code":"3611315201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"13152","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SURGICAL WOUND CLOSURE SECONDARY EXTENSIVE OR COMPLEX","code_information":[{"code":"3611316001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"13160","type":"HCPCS"}],"standard_charges":[{"gross_charge":6154.89,"discounted_cash":6154.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WOUND PREP,TRUNK/ARM/LG 1ST 100 CM OR 1% PEDS","code_information":[{"code":"3611500201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"15002","type":"HCPCS"}],"standard_charges":[{"gross_charge":6154.89,"discounted_cash":6154.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WOUND PREP, TRUNK/ARM/LG EA ADDL 100 CM OR 1% PEDS","code_information":[{"code":"3611500301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"15003","type":"HCPCS"}],"standard_charges":[{"gross_charge":6154.89,"discounted_cash":6154.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WOUND PREP FACE/NECK/HAND/FOOT/GEN 1ST 100 CM OR 1% PEDS","code_information":[{"code":"3611500401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"15004","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SPLIT GRFT TRUNK,ARM,LEG <100 SQCM","code_information":[{"code":"3611510001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"15100","type":"HCPCS"}],"standard_charges":[{"gross_charge":6154.89,"discounted_cash":6154.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EPIDRM AUTOGRFT TRNK/ARM/LEG <100 SQCM","code_information":[{"code":"3611511001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"15110","type":"HCPCS"}],"standard_charges":[{"gross_charge":6154.89,"discounted_cash":6154.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EPI AUTOGRFT FACE/NCK/HND/FT/GEN <100 SQCM","code_information":[{"code":"3611511501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"15115","type":"HCPCS"}],"standard_charges":[{"gross_charge":6154.89,"discounted_cash":6154.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SKIN FULL GRAFT FACE/GEN/HF <21 SQ CM","code_information":[{"code":"3611524001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"15240","type":"HCPCS"}],"standard_charges":[{"gross_charge":6154.89,"discounted_cash":6154.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APP SKN SUB GRFT T/A/L AREA/<100SCM /<1ST 25 SCM","code_information":[{"code":"3611527101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"15271","type":"HCPCS"}],"standard_charges":[{"gross_charge":6154.89,"discounted_cash":6154.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APP LOW COST SKN SUB GRFT T/A/L AREA/<100SCM /<1ST 25 SCM","code_information":[{"code":"3611527102","type":"CDM"},{"code":"0361","type":"RC"},{"code":"15271","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APP SKN SUB GRFT T/A/L AREA/<100SCM EA ADL 25SCM","code_information":[{"code":"3611527201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"15272","type":"HCPCS"}],"standard_charges":[{"gross_charge":6154.89,"discounted_cash":6154.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APP SKN SUB GRFT T/A/L AREA/>100SCM 1ST 100SCM","code_information":[{"code":"3611527301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"15273","type":"HCPCS"}],"standard_charges":[{"gross_charge":6154.89,"discounted_cash":6154.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APP SKN SUB GRFT T/A/L AREA/>100SCM ADL 100SCM","code_information":[{"code":"3611527401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"15274","type":"HCPCS"}],"standard_charges":[{"gross_charge":6154.89,"discounted_cash":6154.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUB GRFT F/S/N/H/F/G/M/D /<100SCM /<1ST 25 SCM","code_information":[{"code":"3611527501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"15275","type":"HCPCS"}],"standard_charges":[{"gross_charge":6154.89,"discounted_cash":6154.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUB LOW COST GRFT F/S/N/H/F/G/M/D /<100SCM /<1ST 25 SCM","code_information":[{"code":"3611527502","type":"CDM"},{"code":"0361","type":"RC"},{"code":"15275","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUB GRFT F/S/N/H/F/G/M/D /<100SCM EA ADL 25SCM","code_information":[{"code":"3611527601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"15276","type":"HCPCS"}],"standard_charges":[{"gross_charge":6154.89,"discounted_cash":6154.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUB LOW COST GRFT F/S/N/H/F/G/M/D /<100SCM EA ADL 25SCM","code_information":[{"code":"3611527602","type":"CDM"},{"code":"0361","type":"RC"},{"code":"15276","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUB GRFT F/S/N/H/F/G/M/D />100SCM 1ST 100SCM","code_information":[{"code":"3611527701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"15277","type":"HCPCS"}],"standard_charges":[{"gross_charge":6154.89,"discounted_cash":6154.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUB GRFT F/S/N/H/F/G/M/D />100SCM ADL 100SCM","code_information":[{"code":"3611527801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"15278","type":"HCPCS"}],"standard_charges":[{"gross_charge":6154.89,"discounted_cash":6154.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REM SUTURES OR STAPLES NOT REQ ANES W/ E/M","code_information":[{"code":"3611585301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"15853","type":"HCPCS"}],"standard_charges":[{"gross_charge":590.23,"discounted_cash":590.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REM SUTURE & STAPLES NOT REQ ANES W/ E/M","code_information":[{"code":"3611585401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"15854","type":"HCPCS"}],"standard_charges":[{"gross_charge":590.23,"discounted_cash":590.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INITIAL RX BURN(S) 1ST DEGREE","code_information":[{"code":"3611600001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"16000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1230.98,"discounted_cash":1230.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRESS/DEBRID SMALL BURN NO ANES","code_information":[{"code":"3611602001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"16020","type":"HCPCS"}],"standard_charges":[{"gross_charge":1230.98,"discounted_cash":1230.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRESS/DEBRID MED BURN NO ANESTH","code_information":[{"code":"3611602501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"16025","type":"HCPCS"}],"standard_charges":[{"gross_charge":1230.98,"discounted_cash":1230.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRESS/DEBRID LARGE BURN NO ANESTH","code_information":[{"code":"3611603001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"16030","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DESTRUC BENIGN/PREMAL,FIRST LESION","code_information":[{"code":"3611700001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"17000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1230.98,"discounted_cash":1230.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DESTRUC BENIGN/PREMAL,2-14 LESIONS","code_information":[{"code":"3611700301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"17003","type":"HCPCS"}],"standard_charges":[{"gross_charge":1230.98,"discounted_cash":1230.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DESTRUC BENIGN/HCEMAL,15+ LESIONS","code_information":[{"code":"3611700401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"17004","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DESTRUCTION BENIGN LESIONS UP TO 14","code_information":[{"code":"3611711001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"17110","type":"HCPCS"}],"standard_charges":[{"gross_charge":1230.98,"discounted_cash":1230.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHEM CAUTERY GRANULATN TISSUE","code_information":[{"code":"3611725001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"17250","type":"HCPCS"}],"standard_charges":[{"gross_charge":1230.98,"discounted_cash":1230.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECT DUCTOGRAM/GALACTOGRAM","code_information":[{"code":"3611903001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19030","type":"HCPCS"}],"standard_charges":[{"gross_charge":1799.7,"discounted_cash":1799.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BX BREAST W DEVICE 1ST LESION STEREOTACTIC GUIDE","code_information":[{"code":"3611908101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19081","type":"HCPCS"}],"standard_charges":[{"gross_charge":10582.4,"discounted_cash":10582.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BX BREAST W DEVICE ADDL LESION STEREOTACT GUIDE","code_information":[{"code":"3611908201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19082","type":"HCPCS"}],"standard_charges":[{"gross_charge":1604.4,"discounted_cash":1604.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BX BREAST W DEVICE 1ST LESION ULTRASOUND GUIDE","code_information":[{"code":"3611908301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19083","type":"HCPCS"}],"standard_charges":[{"gross_charge":11704.13,"discounted_cash":11704.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BX BREAST W DEVICE ADDL LESION ULTRASOUND GUIDE","code_information":[{"code":"3611908401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19084","type":"HCPCS"}],"standard_charges":[{"gross_charge":1604.4,"discounted_cash":1604.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BX BREAST W DEVICE 1ST LESION MAGNETIC RES GUIDE","code_information":[{"code":"3611908501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19085","type":"HCPCS"}],"standard_charges":[{"gross_charge":10582.4,"discounted_cash":10582.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BX BREAST W DEVICE ADDL LESION MAGNET RES GUIDE","code_information":[{"code":"3611908601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19086","type":"HCPCS"}],"standard_charges":[{"gross_charge":1604.4,"discounted_cash":1604.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERQ DEVICE PLACEMT BREAST LOC 1ST LES W GUIDNCE","code_information":[{"code":"3611928101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19281","type":"HCPCS"}],"standard_charges":[{"gross_charge":10582.4,"discounted_cash":10582.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERQ DEVICE PLACEMT BREAST LOC EA LES W GUIDNCE","code_information":[{"code":"3611928201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19282","type":"HCPCS"}],"standard_charges":[{"gross_charge":1604.4,"discounted_cash":1604.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG","code_information":[{"code":"3611928501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19285","type":"HCPCS"}],"standard_charges":[{"gross_charge":10582.4,"discounted_cash":10582.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE","code_information":[{"code":"3611928601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19286","type":"HCPCS"}],"standard_charges":[{"gross_charge":1604.4,"discounted_cash":1604.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID","code_information":[{"code":"3611928701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19287","type":"HCPCS"}],"standard_charges":[{"gross_charge":10582.4,"discounted_cash":10582.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERQ BREAST LOC DEVICE PLACEMT ADD LESIO MR GUID","code_information":[{"code":"3611928801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19288","type":"HCPCS"}],"standard_charges":[{"gross_charge":1604.4,"discounted_cash":1604.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEEDLE BIOPSY,MUSCLE","code_information":[{"code":"3612020601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20206","type":"HCPCS"}],"standard_charges":[{"gross_charge":3692.93,"discounted_cash":3692.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BONE BIOPSY,TROCAR/NEEDLE SUPERF","code_information":[{"code":"3612022001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20220","type":"HCPCS"}],"standard_charges":[{"gross_charge":3692.93,"discounted_cash":3692.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BONE BIOPSY,TROCAR/NEEDLE DEEP","code_information":[{"code":"3612022501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20225","type":"HCPCS"}],"standard_charges":[{"gross_charge":3692.93,"discounted_cash":3692.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BX BONE BIOPSY,EXCISIONAL SUPERF","code_information":[{"code":"3612024001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20240","type":"HCPCS"}],"standard_charges":[{"gross_charge":6154.89,"discounted_cash":6154.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BONE BIOPSY OPEN ,TROCAR/NEEDLE DEEP","code_information":[{"code":"3612024501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20245","type":"HCPCS"}],"standard_charges":[{"gross_charge":6154.89,"discounted_cash":6154.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMOVAL OF FOREIGN BODY","code_information":[{"code":"3612052001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20520","type":"HCPCS"}],"standard_charges":[{"gross_charge":3692.93,"discounted_cash":3692.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMOVAL OF FOREIGN BODY COMPLICATED","code_information":[{"code":"3612052501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20525","type":"HCPCS"}],"standard_charges":[{"gross_charge":10035.94,"discounted_cash":10035.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECT TENDON SHEATH/LIGAMENT","code_information":[{"code":"3612055001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20550","type":"HCPCS"}],"standard_charges":[{"gross_charge":1230.98,"discounted_cash":1230.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECT TRIGGER POINT, 1 OR 2","code_information":[{"code":"3612055201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20552","type":"HCPCS"}],"standard_charges":[{"gross_charge":1230.98,"discounted_cash":1230.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRY NEEDLING 1-2 MUSCLES","code_information":[{"code":"3612056001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20560","type":"HCPCS"}],"standard_charges":[{"gross_charge":304.65,"discounted_cash":304.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRY NEEDLING 3 OR MORE MUSCLES","code_information":[{"code":"3612056101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20561","type":"HCPCS"}],"standard_charges":[{"gross_charge":304.65,"discounted_cash":304.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US","code_information":[{"code":"3612060001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1224.3,"discounted_cash":1224.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT","code_information":[{"code":"3612060401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20604","type":"HCPCS"}],"standard_charges":[{"gross_charge":1246.56,"discounted_cash":1246.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US","code_information":[{"code":"3612060501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1443.75,"discounted_cash":1443.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US","code_information":[{"code":"3612060601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20606","type":"HCPCS"}],"standard_charges":[{"gross_charge":2824.79,"discounted_cash":2824.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US","code_information":[{"code":"3612061001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":1230.98,"discounted_cash":1230.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US","code_information":[{"code":"3612061101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20611","type":"HCPCS"}],"standard_charges":[{"gross_charge":2872.65,"discounted_cash":2872.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE","code_information":[{"code":"3612098201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20982","type":"HCPCS"}],"standard_charges":[{"gross_charge":15090.26,"discounted_cash":15090.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ABLATJ BONE TUMOR CRYO PERQ W/IMG GDN WHEN PRFMD","code_information":[{"code":"3612098301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20983","type":"HCPCS"}],"standard_charges":[{"gross_charge":14879.7,"discounted_cash":14879.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REDUCE TEMPOROMANDIBL DISLOC","code_information":[{"code":"3612148001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"21480","type":"HCPCS"}],"standard_charges":[{"gross_charge":5105.33,"discounted_cash":5105.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION","code_information":[{"code":"3612251301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"22513","type":"HCPCS"}],"standard_charges":[{"gross_charge":33471.74,"discounted_cash":33471.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJ PROC SHOULDER ARTHROGRAPHY/CT/MRI","code_information":[{"code":"3612335001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"23350","type":"HCPCS"}],"standard_charges":[{"gross_charge":2295.01,"discounted_cash":2295.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX GR TUBEROSITY HUM FX","code_information":[{"code":"3612362001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"23620","type":"HCPCS"}],"standard_charges":[{"gross_charge":2536.71,"discounted_cash":2536.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX SHLDR DISLOCATION","code_information":[{"code":"3612365001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"23650","type":"HCPCS"}],"standard_charges":[{"gross_charge":2536.71,"discounted_cash":2536.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECTION FOR ELBOW ARTHROGRAM","code_information":[{"code":"3612422001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"24220","type":"HCPCS"}],"standard_charges":[{"gross_charge":2165.1,"discounted_cash":2165.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX MID HUMERUS FX,MANIPULATN","code_information":[{"code":"3612450501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"24505","type":"HCPCS"}],"standard_charges":[{"gross_charge":5639.73,"discounted_cash":5639.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX RADIAL HEAD DISLOC,CHILD","code_information":[{"code":"3612464001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"24640","type":"HCPCS"}],"standard_charges":[{"gross_charge":2536.71,"discounted_cash":2536.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXC FOREARM LES SC < 3 CM","code_information":[{"code":"3612507501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"25075","type":"HCPCS"}],"standard_charges":[{"gross_charge":3692.93,"discounted_cash":3692.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXC TUMOR SOFT TISS FOREARM&/WRIST SUBFASC <3CM","code_information":[{"code":"3612507601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"25076","type":"HCPCS"}],"standard_charges":[{"gross_charge":3692.93,"discounted_cash":3692.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECTION FOR WRIST ARTHROGRAM","code_information":[{"code":"3612524601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"25246","type":"HCPCS"}],"standard_charges":[{"gross_charge":2165.1,"discounted_cash":2165.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX DIST RAD/ULNA FX","code_information":[{"code":"3612560001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"25600","type":"HCPCS"}],"standard_charges":[{"gross_charge":2536.71,"discounted_cash":2536.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX DIST RAD/ULNA FX,MANIPUL","code_information":[{"code":"3612560501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"25605","type":"HCPCS"}],"standard_charges":[{"gross_charge":5023.06,"discounted_cash":5023.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX RADIO-ULNA DISLOCATION","code_information":[{"code":"3612567501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"25675","type":"HCPCS"}],"standard_charges":[{"gross_charge":2536.71,"discounted_cash":2536.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRAIN FINGER ABSCESS,SIMPLE","code_information":[{"code":"3612601001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"26010","type":"HCPCS"}],"standard_charges":[{"gross_charge":2130.07,"discounted_cash":2130.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRAIN FINGER ABSCESS,COMPLICATED","code_information":[{"code":"3612601101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"26011","type":"HCPCS"}],"standard_charges":[{"gross_charge":16444.17,"discounted_cash":16444.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX METACARPAL FX","code_information":[{"code":"3612660001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"26600","type":"HCPCS"}],"standard_charges":[{"gross_charge":2536.71,"discounted_cash":2536.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX METACARPAL FX,MANIP","code_information":[{"code":"3612660501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"26605","type":"HCPCS"}],"standard_charges":[{"gross_charge":2536.71,"discounted_cash":2536.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX MC-P DISLOC","code_information":[{"code":"3612670001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"26700","type":"HCPCS"}],"standard_charges":[{"gross_charge":2536.71,"discounted_cash":2536.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX MC-P DISLOC,ANESTH","code_information":[{"code":"3612670501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"26705","type":"HCPCS"}],"standard_charges":[{"gross_charge":5639.73,"discounted_cash":5639.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSE RX PROX/MID FING SHFT FX","code_information":[{"code":"3612672001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"26720","type":"HCPCS"}],"standard_charges":[{"gross_charge":2536.71,"discounted_cash":2536.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSE RX FINGR ARTICULAR FX,MANIP","code_information":[{"code":"3612674201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"26742","type":"HCPCS"}],"standard_charges":[{"gross_charge":16347.39,"discounted_cash":16347.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX IP JT DISLOCATION","code_information":[{"code":"3612677001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"26770","type":"HCPCS"}],"standard_charges":[{"gross_charge":2536.71,"discounted_cash":2536.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECTION HIP ARTHROGRAM","code_information":[{"code":"3612709301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27093","type":"HCPCS"}],"standard_charges":[{"gross_charge":2165.1,"discounted_cash":2165.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECTION HIP ARTHROGRAM,ANESTH","code_information":[{"code":"3612709501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27095","type":"HCPCS"}],"standard_charges":[{"gross_charge":2295.01,"discounted_cash":2295.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECTION,SACROILIAC JOINT","code_information":[{"code":"3612709601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27096","type":"HCPCS"}],"standard_charges":[{"gross_charge":2165.1,"discounted_cash":2165.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX POST HIP ARTHRPLAS DISLOC","code_information":[{"code":"3612726501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27265","type":"HCPCS"}],"standard_charges":[{"gross_charge":2536.71,"discounted_cash":2536.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BX THIGH/KNEE SOFT TISSUES,SUPERF","code_information":[{"code":"3612732301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27323","type":"HCPCS"}],"standard_charges":[{"gross_charge":3692.93,"discounted_cash":3692.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE","code_information":[{"code":"3612736901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27369","type":"HCPCS"}],"standard_charges":[{"gross_charge":2165.1,"discounted_cash":2165.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC XRG: ANKLE ARTHROGRAM LT","code_information":[{"code":"3612764801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27648","type":"HCPCS"}],"standard_charges":[{"gross_charge":2165.1,"discounted_cash":2165.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX TIBIA SHAFT FX,MANIPULATN","code_information":[{"code":"3612775201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27752","type":"HCPCS"}],"standard_charges":[{"gross_charge":16347.39,"discounted_cash":16347.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX TRIMALLEOLAR FX,MANIP","code_information":[{"code":"3612781801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27818","type":"HCPCS"}],"standard_charges":[{"gross_charge":16347.39,"discounted_cash":16347.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEEP INCIS FOOT BONE INFECTN","code_information":[{"code":"3612800501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"28005","type":"HCPCS"}],"standard_charges":[{"gross_charge":6154.89,"discounted_cash":6154.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INCISION SUBCUT TOE TENDON","code_information":[{"code":"3612801001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"28010","type":"HCPCS"}],"standard_charges":[{"gross_charge":3692.93,"discounted_cash":3692.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INCISION SUBCUT TOE TENDON,>1","code_information":[{"code":"3612801101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"28011","type":"HCPCS"}],"standard_charges":[{"gross_charge":3692.93,"discounted_cash":3692.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMOVAL OF FOOT LESION (CYST/GANG)","code_information":[{"code":"3612809001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"28090","type":"HCPCS"}],"standard_charges":[{"gross_charge":3692.93,"discounted_cash":3692.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PART REMV OTHR TARSAL/METATARSAL","code_information":[{"code":"3612812201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"28122","type":"HCPCS"}],"standard_charges":[{"gross_charge":6154.89,"discounted_cash":6154.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PART REMV PHALANX OF TOE","code_information":[{"code":"3612812401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"28124","type":"HCPCS"}],"standard_charges":[{"gross_charge":6154.89,"discounted_cash":6154.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMV FOOT FOREIGN BODY,SUBCUTANEOUS","code_information":[{"code":"3612819001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"28190","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMV FOOT FOREIGN BODY,COMPLEX","code_information":[{"code":"3612819301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"28193","type":"HCPCS"}],"standard_charges":[{"gross_charge":3692.93,"discounted_cash":3692.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TENOTOMY OPEN FLEXOR TOE","code_information":[{"code":"3612823201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"28232","type":"HCPCS"}],"standard_charges":[{"gross_charge":3692.93,"discounted_cash":3692.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX TOE FX,MANIPULATN","code_information":[{"code":"3612851501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"28515","type":"HCPCS"}],"standard_charges":[{"gross_charge":2536.71,"discounted_cash":2536.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CLOSED RX I-P JT,TOE DISLOCATION","code_information":[{"code":"3612866001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"28660","type":"HCPCS"}],"standard_charges":[{"gross_charge":1536.71,"discounted_cash":1536.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMPUTATION TOE,MT-P JT","code_information":[{"code":"3612882001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"28820","type":"HCPCS"}],"standard_charges":[{"gross_charge":6154.89,"discounted_cash":6154.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMPUTATION TOE, INTERPHAL JNT","code_information":[{"code":"3612882501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"28825","type":"HCPCS"}],"standard_charges":[{"gross_charge":6154.89,"discounted_cash":6154.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC UNLISTED PROCEDURE, FOOT/TOES","code_information":[{"code":"3612889901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"28899","type":"HCPCS"}],"standard_charges":[{"gross_charge":1230.98,"discounted_cash":1230.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APPLY FOREARM CAST","code_information":[{"code":"3612907501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29075","type":"HCPCS"}],"standard_charges":[{"gross_charge":1230.98,"discounted_cash":1230.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APPLY LONG ARM SPLINT","code_information":[{"code":"3612910501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29105","type":"HCPCS"}],"standard_charges":[{"gross_charge":1741.99,"discounted_cash":1741.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APPLY FOREARM SPLINT,STATIC","code_information":[{"code":"3612912501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29125","type":"HCPCS"}],"standard_charges":[{"gross_charge":1252.04,"discounted_cash":1252.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APPLY LONG LEG SPLINT","code_information":[{"code":"3612950501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29505","type":"HCPCS"}],"standard_charges":[{"gross_charge":1741.99,"discounted_cash":1741.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APPLY LOWER LEG SPLINT","code_information":[{"code":"3612951501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29515","type":"HCPCS"}],"standard_charges":[{"gross_charge":1741.99,"discounted_cash":1741.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC STRAPPING; ANKLE &/OR FOOT","code_information":[{"code":"3612954001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29540","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.2,"discounted_cash":246.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC STRAPPING UNNA BOOT","code_information":[{"code":"3612958001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.2,"discounted_cash":246.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APPL MLT-LAYER VENOUS WOUND COMPRESS BELOW KNEE","code_information":[{"code":"3612958101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.2,"discounted_cash":246.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMOVE NASAL FOREIGN BODY","code_information":[{"code":"3613030001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"30300","type":"HCPCS"}],"standard_charges":[{"gross_charge":1252.04,"discounted_cash":1252.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CTRL NOSEBLEED,ANTER,SIMPLE","code_information":[{"code":"3613090101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"30901","type":"HCPCS"}],"standard_charges":[{"gross_charge":1252.04,"discounted_cash":1252.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CTRL NOSEBLEED,ANTER,COMPLEX","code_information":[{"code":"3613090301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"30903","type":"HCPCS"}],"standard_charges":[{"gross_charge":1242.59,"discounted_cash":1242.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CTRL NOSEBLEED,POST,W/PACKS &/OR CAUT","code_information":[{"code":"3613090501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"30905","type":"HCPCS"}],"standard_charges":[{"gross_charge":1252.04,"discounted_cash":1252.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERT EMERGENCY ENDOTRACH AIRWAY","code_information":[{"code":"3613150001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1563.34,"discounted_cash":1563.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRACH TUBE CHANGE","code_information":[{"code":"3613150201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"31502","type":"HCPCS"}],"standard_charges":[{"gross_charge":994.63,"discounted_cash":994.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CATH ASP NASOTRACHEAL","code_information":[{"code":"3613172001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"31720","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.83,"discounted_cash":350.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEEDLE BIOPSY PLEURA","code_information":[{"code":"3613240001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"32400","type":"HCPCS"}],"standard_charges":[{"gross_charge":4792.69,"discounted_cash":4792.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERCUT BX, LUNG/MEDIASTINUM INCLUDES GUIDANCE","code_information":[{"code":"3613240801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"32408","type":"HCPCS"}],"standard_charges":[{"gross_charge":6927.94,"discounted_cash":6927.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERTION INDWELLING TUNNELED PLEURAL CATHETER","code_information":[{"code":"3613255001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"32550","type":"HCPCS"}],"standard_charges":[{"gross_charge":13597.2,"discounted_cash":13597.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TUBE THORACOSTOMY INCLUDES WATER SEAL","code_information":[{"code":"3613255101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"32551","type":"HCPCS"}],"standard_charges":[{"gross_charge":3625.23,"discounted_cash":3625.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMOVAL OF INDWELLING TUNNELED PLEURAL CATHETER WITH CUFF","code_information":[{"code":"3613255201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"32552","type":"HCPCS"}],"standard_charges":[{"gross_charge":6317.82,"discounted_cash":6317.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING","code_information":[{"code":"3613255501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":3604.3,"discounted_cash":3604.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING","code_information":[{"code":"3613255701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"32557","type":"HCPCS"}],"standard_charges":[{"gross_charge":3079.91,"discounted_cash":3079.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERICARDIOCENTESIS W/IMG GUIDANCE WHEN PERFORMED","code_information":[{"code":"3613301601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33016","type":"HCPCS"}],"standard_charges":[{"gross_charge":3794.7,"discounted_cash":3794.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERQ PRCRD DRG 6YR+ W/O CONGENITAL CAR ANOMALY","code_information":[{"code":"3613301701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33017","type":"HCPCS"}],"standard_charges":[{"gross_charge":1866.54,"discounted_cash":1866.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERICARDIO DRAIN INDWELLING CATH PERQ W/CT GUIDANCE","code_information":[{"code":"3613301901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33019","type":"HCPCS"}],"standard_charges":[{"gross_charge":1603.39,"discounted_cash":1603.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSER HEART TEMP PACER ONE CHMBR","code_information":[{"code":"3613321001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33210","type":"HCPCS"}],"standard_charges":[{"gross_charge":27947.88,"discounted_cash":27947.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EP RMVL OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE","code_information":[{"code":"3613327201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33272","type":"HCPCS"}],"standard_charges":[{"gross_charge":27949.21,"discounted_cash":27949.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERTION SUBQ CARDIAC RHYTHM MONITOR W/PRGRMG","code_information":[{"code":"3613328501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33285","type":"HCPCS"}],"standard_charges":[{"gross_charge":20572.97,"discounted_cash":20572.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMOVAL SUBCUTANEOUS CARDIAC RHYTHM MONITOR","code_information":[{"code":"3613328601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33286","type":"HCPCS"}],"standard_charges":[{"gross_charge":3953.57,"discounted_cash":3953.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REPAIR CONGENITAL AV FISTULA EXTREMITY","code_information":[{"code":"3613518401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"35184","type":"HCPCS"}],"standard_charges":[{"gross_charge":10929.48,"discounted_cash":10929.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLACE NEEDLE IN VEIN","code_information":[{"code":"3613600001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36000","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.01,"discounted_cash":483.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECTION RX EXTREMITY PSEUDOANEURYSM","code_information":[{"code":"3613600201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36002","type":"HCPCS"}],"standard_charges":[{"gross_charge":1813.43,"discounted_cash":1813.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECTION PROC,EXTREMITY,VENOGRAPHY","code_information":[{"code":"3613600501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36005","type":"HCPCS"}],"standard_charges":[{"gross_charge":1529.68,"discounted_cash":1529.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLACE CATH IN VEIN,SVC,IVC","code_information":[{"code":"3613601001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36010","type":"HCPCS"}],"standard_charges":[{"gross_charge":3631.9,"discounted_cash":3631.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLACE CATH IN VEIN,SELECT","code_information":[{"code":"3613601101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36011","type":"HCPCS"}],"standard_charges":[{"gross_charge":4293.11,"discounted_cash":4293.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLACE CATH IN VEIN,SUBSELECT","code_information":[{"code":"3613601201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36012","type":"HCPCS"}],"standard_charges":[{"gross_charge":2853.84,"discounted_cash":2853.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLACE CATH IN RT HRT,MAIN PULM ART","code_information":[{"code":"3613601301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36013","type":"HCPCS"}],"standard_charges":[{"gross_charge":2938.74,"discounted_cash":2938.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLACE CATH IN LT/RT PULM ART","code_information":[{"code":"3613601401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36014","type":"HCPCS"}],"standard_charges":[{"gross_charge":5212.56,"discounted_cash":5212.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLACE CATH IN SUBSEGMT PULM ART","code_information":[{"code":"3613601501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36015","type":"HCPCS"}],"standard_charges":[{"gross_charge":1907.32,"discounted_cash":1907.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLACE CATH CAROT/VERT ART","code_information":[{"code":"3613610001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36100","type":"HCPCS"}],"standard_charges":[{"gross_charge":5110.15,"discounted_cash":5110.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTRO OF NEEDLE OR INTRACATHETER UPR/LXTR ARTERY","code_information":[{"code":"3613614001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36140","type":"HCPCS"}],"standard_charges":[{"gross_charge":5052.05,"discounted_cash":5052.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLACE CATH AORTA VIA TRANSLUMBAR","code_information":[{"code":"3613616001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36160","type":"HCPCS"}],"standard_charges":[{"gross_charge":4745.95,"discounted_cash":4745.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLACE CATH AORTA","code_information":[{"code":"3613620001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36200","type":"HCPCS"}],"standard_charges":[{"gross_charge":4571.53,"discounted_cash":4571.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLACE CATH SELECTIVE ART,NECK","code_information":[{"code":"3613621501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36215","type":"HCPCS"}],"standard_charges":[{"gross_charge":5338.1,"discounted_cash":5338.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLACE CATH SUBSELECT ART,NECK","code_information":[{"code":"3613621601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36216","type":"HCPCS"}],"standard_charges":[{"gross_charge":4275.43,"discounted_cash":4275.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLACE CATH SUBSUBSELECT ART,NECK","code_information":[{"code":"3613621701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36217","type":"HCPCS"}],"standard_charges":[{"gross_charge":4859.03,"discounted_cash":4859.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLACE CATH ADDN SUBSELEC ART,NECK","code_information":[{"code":"3613621801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36218","type":"HCPCS"}],"standard_charges":[{"gross_charge":3377.27,"discounted_cash":3377.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NONSLCTV CATH THOR AORTA ANGIO INTR/XTRCRANL ART","code_information":[{"code":"3613622101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36221","type":"HCPCS"}],"standard_charges":[{"gross_charge":10708.55,"discounted_cash":10708.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART","code_information":[{"code":"3613622201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36222","type":"HCPCS"}],"standard_charges":[{"gross_charge":18475.49,"discounted_cash":18475.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART","code_information":[{"code":"3613622301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36223","type":"HCPCS"}],"standard_charges":[{"gross_charge":21804.39,"discounted_cash":21804.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART","code_information":[{"code":"3613622401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36224","type":"HCPCS"}],"standard_charges":[{"gross_charge":23402.7,"discounted_cash":23402.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY","code_information":[{"code":"3613622501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36225","type":"HCPCS"}],"standard_charges":[{"gross_charge":12870.85,"discounted_cash":12870.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY","code_information":[{"code":"3613622601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36226","type":"HCPCS"}],"standard_charges":[{"gross_charge":23632.81,"discounted_cash":23632.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC","code_information":[{"code":"3613622701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36227","type":"HCPCS"}],"standard_charges":[{"gross_charge":5074.98,"discounted_cash":5074.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SLCTV CATH INTRCRNL BRNCH ANGIO INTRL CAROT/VERT","code_information":[{"code":"3613622801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36228","type":"HCPCS"}],"standard_charges":[{"gross_charge":8907.93,"discounted_cash":8907.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLACE CATH SELECT ART,ABD/PEL","code_information":[{"code":"3613624501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36245","type":"HCPCS"}],"standard_charges":[{"gross_charge":7417.65,"discounted_cash":7417.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLACE CATH SUBSELECT ART,ABD/PEL","code_information":[{"code":"3613624601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36246","type":"HCPCS"}],"standard_charges":[{"gross_charge":6264.78,"discounted_cash":6264.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLACE CATH SUBSUBSELECT ART,ABD/PEL","code_information":[{"code":"3613624701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36247","type":"HCPCS"}],"standard_charges":[{"gross_charge":8374.21,"discounted_cash":8374.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLACE CATH ADDN SUBSEL ART,ABD/PEL","code_information":[{"code":"3613624801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36248","type":"HCPCS"}],"standard_charges":[{"gross_charge":2317.93,"discounted_cash":2317.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UNI","code_information":[{"code":"3613625101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36251","type":"HCPCS"}],"standard_charges":[{"gross_charge":8333.83,"discounted_cash":8333.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I BILAT","code_information":[{"code":"3613625201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36252","type":"HCPCS"}],"standard_charges":[{"gross_charge":11623.82,"discounted_cash":11623.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SUPSLCTV CATH 2ND+ORD RENL&ACCES ARTERY/S&I UNI","code_information":[{"code":"3613625301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36253","type":"HCPCS"}],"standard_charges":[{"gross_charge":16968.55,"discounted_cash":16968.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VENIPUNCTURE 3YR/>  SKILLED","code_information":[{"code":"3613641001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36410","type":"HCPCS"}],"standard_charges":[{"gross_charge":2836.36,"discounted_cash":2836.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECTION SCLEROSANT SINGLE INCMPTNT VEIN","code_information":[{"code":"3613647001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36470","type":"HCPCS"}],"standard_charges":[{"gross_charge":1452.15,"discounted_cash":1452.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENDOVENOUS RF, 1ST VEIN","code_information":[{"code":"3613647501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36475","type":"HCPCS"}],"standard_charges":[{"gross_charge":13158.44,"discounted_cash":13158.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERCUT PORTAL VEIN CATH","code_information":[{"code":"3613648101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36481","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.55,"discounted_cash":1075.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CATH UMBIL VEIN NEWBORN","code_information":[{"code":"3613651001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36510","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.2,"discounted_cash":298.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THER APHERESIS,WHITE BLOOD CELLS","code_information":[{"code":"3613651101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36511","type":"HCPCS"}],"standard_charges":[{"gross_charge":6069.19,"discounted_cash":6069.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RBC DEPLETION BY VENDOR","code_information":[{"code":"3613651202","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36512","type":"HCPCS"}],"standard_charges":[{"gross_charge":6069.19,"discounted_cash":6069.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THERAPEUTIC APHERESIS - PLATELET DEPLETION","code_information":[{"code":"3613651302","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36513","type":"HCPCS"}],"standard_charges":[{"gross_charge":1767.44,"discounted_cash":1767.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THER APHERESIS,PLASMA PHERESIS","code_information":[{"code":"3613651401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36514","type":"HCPCS"}],"standard_charges":[{"gross_charge":13650.95,"discounted_cash":13650.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERT NON-TUNNEL CV CATH < 5 Y/O","code_information":[{"code":"3613655501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36555","type":"HCPCS"}],"standard_charges":[{"gross_charge":5826.45,"discounted_cash":5826.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERT NON-TUNNEL CV CATH","code_information":[{"code":"3613655601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":6263.43,"discounted_cash":6263.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERT TUNNELED CV CATH W/O PORT OR PUMP","code_information":[{"code":"3613655801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36558","type":"HCPCS"}],"standard_charges":[{"gross_charge":7917.14,"discounted_cash":7917.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERT TUNNELED CV CATH WITH PORT","code_information":[{"code":"3613656101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36561","type":"HCPCS"}],"standard_charges":[{"gross_charge":11310.72,"discounted_cash":11310.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERT TUNNELED CV CATH WITH PUMP","code_information":[{"code":"3613656301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36563","type":"HCPCS"}],"standard_charges":[{"gross_charge":14125.66,"discounted_cash":14125.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERTION PICC W/O IMG GDN 5 YR/>","code_information":[{"code":"3613656901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36569","type":"HCPCS"}],"standard_charges":[{"gross_charge":7345.24,"discounted_cash":7345.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERTION PICC W/RS&I < 5 YR","code_information":[{"code":"3613657201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36572","type":"HCPCS"}],"standard_charges":[{"gross_charge":2444.87,"discounted_cash":2444.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERTION PICC W/RS&I 5 YR/>","code_information":[{"code":"3613657301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36573","type":"HCPCS"}],"standard_charges":[{"gross_charge":6640.44,"discounted_cash":6640.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REPLACE NON-TUNNELED CVC COMP W/O SUBQ PORT/PUMP","code_information":[{"code":"3613658001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36580","type":"HCPCS"}],"standard_charges":[{"gross_charge":12326.92,"discounted_cash":12326.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REPLACE TUNNELED CVC COMP W/O SUBQ PORT/PUMP","code_information":[{"code":"3613658101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36581","type":"HCPCS"}],"standard_charges":[{"gross_charge":8379.18,"discounted_cash":8379.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMOVAL TUNNELED CV CATH W/O SUBQ PORT OR PUMP","code_information":[{"code":"3613658901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36589","type":"HCPCS"}],"standard_charges":[{"gross_charge":3038.58,"discounted_cash":3038.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMOVAL TUNNELED CV CATH W SUBQ PORT OR PUMP","code_information":[{"code":"3613659001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36590","type":"HCPCS"}],"standard_charges":[{"gross_charge":12326.92,"discounted_cash":12326.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH","code_information":[{"code":"3613659301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36593","type":"HCPCS"}],"standard_charges":[{"gross_charge":1576.39,"discounted_cash":1576.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REPOSITION VENOUS CATHETER","code_information":[{"code":"3613659701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36597","type":"HCPCS"}],"standard_charges":[{"gross_charge":3794.7,"discounted_cash":3794.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CONTRAST INJ CENT VEN CATH, INC FLOURO","code_information":[{"code":"3613659801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36598","type":"HCPCS"}],"standard_charges":[{"gross_charge":1179.61,"discounted_cash":1179.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERT CATH,ART,PERCUT,SHORTTERM","code_information":[{"code":"3613662001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36620","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.45,"discounted_cash":390.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CATH, UMBILICAL ARTERY","code_information":[{"code":"3613666001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36660","type":"HCPCS"}],"standard_charges":[{"gross_charge":942.15,"discounted_cash":942.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERT NEEDLE,INTRAOSSEOUS INFUSN","code_information":[{"code":"3613668001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36680","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.91,"discounted_cash":1061.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTRO CATH DIALYSIS CIRCUIT DX ANGRPH FLUOR S&I","code_information":[{"code":"3613690101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36901","type":"HCPCS"}],"standard_charges":[{"gross_charge":7134.35,"discounted_cash":7134.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTRO CATH DIALYSIS CIRCUIT W/TRLUML BALO ANGIOP","code_information":[{"code":"3613690201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36902","type":"HCPCS"}],"standard_charges":[{"gross_charge":21252.98,"discounted_cash":21252.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERQ THRMBC/NFS DIAL CIRCUIT TRLUML BALO ANGIOP","code_information":[{"code":"3613690501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36905","type":"HCPCS"}],"standard_charges":[{"gross_charge":33446.94,"discounted_cash":33446.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRLUML BALO ANGIOP CTR DIALYSIS SEG W/IMG S&I","code_information":[{"code":"3613690701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36907","type":"HCPCS"}],"standard_charges":[{"gross_charge":8002.15,"discounted_cash":8002.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REVIS TRANSVEN INTRAHEP PORTOSYS SHUNT","code_information":[{"code":"3613718301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37183","type":"HCPCS"}],"standard_charges":[{"gross_charge":39370.91,"discounted_cash":39370.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST","code_information":[{"code":"3613718401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37184","type":"HCPCS"}],"standard_charges":[{"gross_charge":34427.96,"discounted_cash":34427.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA SBSQ","code_information":[{"code":"3613718501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37185","type":"HCPCS"}],"standard_charges":[{"gross_charge":9685.61,"discounted_cash":9685.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERCUT MECH THROMBECTOMY, VENOUS","code_information":[{"code":"3613718701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37187","type":"HCPCS"}],"standard_charges":[{"gross_charge":26722.24,"discounted_cash":26722.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I","code_information":[{"code":"3613719101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37191","type":"HCPCS"}],"standard_charges":[{"gross_charge":23582.73,"discounted_cash":23582.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I","code_information":[{"code":"3613719301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37193","type":"HCPCS"}],"standard_charges":[{"gross_charge":8214.19,"discounted_cash":8214.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING","code_information":[{"code":"3613719701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37197","type":"HCPCS"}],"standard_charges":[{"gross_charge":33575.43,"discounted_cash":33575.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THROMBOLYSIS ARTERIAL INFUSION ICRA RS&I INIT TX","code_information":[{"code":"3613721101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37211","type":"HCPCS"}],"standard_charges":[{"gross_charge":17616.37,"discounted_cash":17616.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THROMBOLYSIS ART/VENOUS INFSN W/IMAGE SUBSQ TX","code_information":[{"code":"3613721301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37213","type":"HCPCS"}],"standard_charges":[{"gross_charge":14598.7,"discounted_cash":14598.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CESSATION THROMBOLYTIC THRPY W/CATHETER REMOVAL","code_information":[{"code":"3613721401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37214","type":"HCPCS"}],"standard_charges":[{"gross_charge":14266.7,"discounted_cash":14266.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ","code_information":[{"code":"3613721501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37215","type":"HCPCS"}],"standard_charges":[{"gross_charge":19890.24,"discounted_cash":19890.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL","code_information":[{"code":"3613723601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37236","type":"HCPCS"}],"standard_charges":[{"gross_charge":20304.6,"discounted_cash":20304.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST","code_information":[{"code":"3613723801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37238","type":"HCPCS"}],"standard_charges":[{"gross_charge":43432.1,"discounted_cash":43432.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I","code_information":[{"code":"3613724201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37242","type":"HCPCS"}],"standard_charges":[{"gross_charge":66410.28,"discounted_cash":66410.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VASCULAR EMBOLIZE/OCCLUDE ORGAN TUMOR INFARCT","code_information":[{"code":"3613724301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37243","type":"HCPCS"}],"standard_charges":[{"gross_charge":65825.23,"discounted_cash":65825.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE","code_information":[{"code":"3613724401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37244","type":"HCPCS"}],"standard_charges":[{"gross_charge":65614.41,"discounted_cash":65614.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRLML BALO ANGIOP OPEN/PERQ IMG S&I 1ST ART","code_information":[{"code":"3613724601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37246","type":"HCPCS"}],"standard_charges":[{"gross_charge":12317.53,"discounted_cash":12317.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRLML BALO ANGIOP OPEN/PERQ W/IMG S&I 1ST VEIN","code_information":[{"code":"3613724801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37248","type":"HCPCS"}],"standard_charges":[{"gross_charge":13005.55,"discounted_cash":13005.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRLML BALO ANGIOP OPEN/PERQ W/IMG S&I ADDL VEIN","code_information":[{"code":"3613724901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37249","type":"HCPCS"}],"standard_charges":[{"gross_charge":8761.15,"discounted_cash":8761.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTRAVASCULAR US NONCORONARY RS&I INTIAL VESSEL","code_information":[{"code":"3613725201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37252","type":"HCPCS"}],"standard_charges":[{"gross_charge":5120.54,"discounted_cash":5120.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTRAVASCULAR US NONCORONARY RS&I ADDL VESSEL","code_information":[{"code":"3613725301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37253","type":"HCPCS"}],"standard_charges":[{"gross_charge":4604.17,"discounted_cash":4604.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHLEB VEINS - EXTREM - TO 20","code_information":[{"code":"3613776501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37765","type":"HCPCS"}],"standard_charges":[{"gross_charge":8333.82,"discounted_cash":8333.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIAGNOSTIC BONE MARROW ASPIRATIONS","code_information":[{"code":"3613822001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"38220","type":"HCPCS"}],"standard_charges":[{"gross_charge":6263.96,"discounted_cash":6263.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIAGNOSTIC BONE MARROW BIOPSIES","code_information":[{"code":"3613822101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"38221","type":"HCPCS"}],"standard_charges":[{"gross_charge":6695.75,"discounted_cash":6695.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS","code_information":[{"code":"3613822201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"38222","type":"HCPCS"}],"standard_charges":[{"gross_charge":6241.7,"discounted_cash":6241.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BIOPSY/REMOVAL LYMPH NODES, SUPERFICIAL","code_information":[{"code":"3613850001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"38500","type":"HCPCS"}],"standard_charges":[{"gross_charge":3918.23,"discounted_cash":3918.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEEDLE BIOPSY, LYMPH NODE(S)","code_information":[{"code":"3613850501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"38505","type":"HCPCS"}],"standard_charges":[{"gross_charge":5638.11,"discounted_cash":5638.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECTION FOR LYMPHATIC XRAY","code_information":[{"code":"3613879001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"38790","type":"HCPCS"}],"standard_charges":[{"gross_charge":954.45,"discounted_cash":954.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IDENTIFY SENTINEL NODE","code_information":[{"code":"3613879201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"38792","type":"HCPCS"}],"standard_charges":[{"gross_charge":1008.0,"discounted_cash":1008.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REPAIR LIP,<1/2 VERT HEIGHT","code_information":[{"code":"3614065201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"40652","type":"HCPCS"}],"standard_charges":[{"gross_charge":5519.35,"discounted_cash":5519.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REPAIR LIP >1/2 VERT HEIGHT/COMPLEX","code_information":[{"code":"3614065401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"40654","type":"HCPCS"}],"standard_charges":[{"gross_charge":4777.98,"discounted_cash":4777.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMV FB MOUTH VESTIBULE SIMPL","code_information":[{"code":"3614080401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"40804","type":"HCPCS"}],"standard_charges":[{"gross_charge":8175.03,"discounted_cash":8175.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REPAIR TONGUE LACER,<2.6 CM","code_information":[{"code":"3614125001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"41250","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.91,"discounted_cash":1061.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRAINAGE OF GUM LESION","code_information":[{"code":"3614180001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"41800","type":"HCPCS"}],"standard_charges":[{"gross_charge":1252.04,"discounted_cash":1252.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INC/DRAIN PERITONSIL ABSCESS","code_information":[{"code":"3614270001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"42700","type":"HCPCS"}],"standard_charges":[{"gross_charge":2553.81,"discounted_cash":2553.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLACEMENT NG/OG TUBE BY PHYSICIAN","code_information":[{"code":"3614375201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"43752","type":"HCPCS"}],"standard_charges":[{"gross_charge":2099.48,"discounted_cash":2099.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC","code_information":[{"code":"3614376201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"43762","type":"HCPCS"}],"standard_charges":[{"gross_charge":2099.48,"discounted_cash":2099.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC I&D PERIANAL ABSCESS,SUPERFICIAL","code_information":[{"code":"3614605001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"46050","type":"HCPCS"}],"standard_charges":[{"gross_charge":9248.19,"discounted_cash":9248.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INCISE EXTERNAL HEMORRHOID","code_information":[{"code":"3614608301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"46083","type":"HCPCS"}],"standard_charges":[{"gross_charge":1242.59,"discounted_cash":1242.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEEDLE BIOPSY LIVER","code_information":[{"code":"3614700001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"47000","type":"HCPCS"}],"standard_charges":[{"gross_charge":5638.11,"discounted_cash":5638.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHOLECYSTOSTOMY,PERCUTANEOUS, COMPLETE","code_information":[{"code":"3614749001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"47490","type":"HCPCS"}],"standard_charges":[{"gross_charge":14828.5,"discounted_cash":14828.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NJX CHOLANGIO PRQ W/IMG GID RS&I EXISTING ACCESS","code_information":[{"code":"3614753101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"47531","type":"HCPCS"}],"standard_charges":[{"gross_charge":10758.2,"discounted_cash":10758.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NJX CHOLANGIO PRQ W/IMG GID RS&I NEW ACCESS","code_information":[{"code":"3614753201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"47532","type":"HCPCS"}],"standard_charges":[{"gross_charge":9317.59,"discounted_cash":9317.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I INT-EXT","code_information":[{"code":"3614753401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"47534","type":"HCPCS"}],"standard_charges":[{"gross_charge":9317.59,"discounted_cash":9317.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXCHANGE BILIARY DRG CATHETER PRQ W/IMG GID RS&I","code_information":[{"code":"3614753601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"47536","type":"HCPCS"}],"standard_charges":[{"gross_charge":10758.2,"discounted_cash":10758.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMOVAL BILIARY DRG CATHETER REQ FLUOR GID RS&I","code_information":[{"code":"3614753701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"47537","type":"HCPCS"}],"standard_charges":[{"gross_charge":3193.2,"discounted_cash":3193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BALLOON DILAT BILIARY DUCT/AMPULLA PRQ EACH DUCT","code_information":[{"code":"3614754201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"47542","type":"HCPCS"}],"standard_charges":[{"gross_charge":1616.79,"discounted_cash":1616.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE","code_information":[{"code":"3614908201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49082","type":"HCPCS"}],"standard_charges":[{"gross_charge":2457.0,"discounted_cash":2457.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ABDOM PARACENTESIS DX/THER W IMAGING GUIDANCE","code_information":[{"code":"3614908301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49083","type":"HCPCS"}],"standard_charges":[{"gross_charge":3531.68,"discounted_cash":3531.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERITONEAL LAVAGE W/WO IMAGING GUIDANCE","code_information":[{"code":"3614908401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49084","type":"HCPCS"}],"standard_charges":[{"gross_charge":3603.89,"discounted_cash":3603.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERCUT BIOPSY, ABDOMINAL MASS","code_information":[{"code":"3614918001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49180","type":"HCPCS"}],"standard_charges":[{"gross_charge":5638.11,"discounted_cash":5638.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AIR/CONTRAST INJECT INTO ABDOMEN","code_information":[{"code":"3614940001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49400","type":"HCPCS"}],"standard_charges":[{"gross_charge":3399.9,"discounted_cash":3399.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ","code_information":[{"code":"3614940601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49406","type":"HCPCS"}],"standard_charges":[{"gross_charge":9867.86,"discounted_cash":9867.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMAGE FLUID COLLXN DRAINAG CATH TRANSREC/VAGINAL","code_information":[{"code":"3614940701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49407","type":"HCPCS"}],"standard_charges":[{"gross_charge":1565.99,"discounted_cash":1565.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERTION TUNNEL INTRAPERITONEAL CATH W IMAGE GUIDANCE","code_information":[{"code":"3614941801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49418","type":"HCPCS"}],"standard_charges":[{"gross_charge":11082.59,"discounted_cash":11082.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRAINAGE CATHETER EXCHANGE","code_information":[{"code":"3614942301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49423","type":"HCPCS"}],"standard_charges":[{"gross_charge":7664.92,"discounted_cash":7664.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CONTRAST INJ,ABSCESS/CYST VIA CATH TUBE","code_information":[{"code":"3614942401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49424","type":"HCPCS"}],"standard_charges":[{"gross_charge":1516.2,"discounted_cash":1516.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERT GASTROSTOMY TUBE PERCUTANEOUS","code_information":[{"code":"3614944001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49440","type":"HCPCS"}],"standard_charges":[{"gross_charge":4445.02,"discounted_cash":4445.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERT DUODENOSTOMY/JEJUNOSTOMY TUBE PERCUTANEOUS","code_information":[{"code":"3614944101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49441","type":"HCPCS"}],"standard_charges":[{"gross_charge":5072.6,"discounted_cash":5072.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CONVERT GASTROSTOMY-GASTRO-JEJUNOSTOMY TUBE PERCUTANEOUS","code_information":[{"code":"3614944601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49446","type":"HCPCS"}],"standard_charges":[{"gross_charge":5268.75,"discounted_cash":5268.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS","code_information":[{"code":"3614945001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49450","type":"HCPCS"}],"standard_charges":[{"gross_charge":2431.33,"discounted_cash":2431.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REPLACE DUODENOSTOMY/JEJUNOSTOMY TUBE PERCUTANEOUS","code_information":[{"code":"3614945101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49451","type":"HCPCS"}],"standard_charges":[{"gross_charge":8528.92,"discounted_cash":8528.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REPLACEMENT GASTRO-JEJUNOSTOMY TUBE PERCUTANEOUS","code_information":[{"code":"3614945201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49452","type":"HCPCS"}],"standard_charges":[{"gross_charge":3032.95,"discounted_cash":3032.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CONTRAST INJECTION PERCUTANEOUOS RADIOLOGIC EVAL GI TUBE","code_information":[{"code":"3614946501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49465","type":"HCPCS"}],"standard_charges":[{"gross_charge":1516.2,"discounted_cash":1516.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BIOPSY OF KIDNEY,PERCUTANEOUS","code_information":[{"code":"3615020001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50200","type":"HCPCS"}],"standard_charges":[{"gross_charge":5638.11,"discounted_cash":5638.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RMVL & RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH","code_information":[{"code":"3615038701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50387","type":"HCPCS"}],"standard_charges":[{"gross_charge":5559.71,"discounted_cash":5559.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NJX PX ANTEGRDE NFROSGRM &/URTRGRM EXSTNG ACESS","code_information":[{"code":"3615043101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50431","type":"HCPCS"}],"standard_charges":[{"gross_charge":7664.92,"discounted_cash":7664.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLMT NEPHROSTOMY CATH PRQ NEW ACCESS RS&I","code_information":[{"code":"3615043201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50432","type":"HCPCS"}],"standard_charges":[{"gross_charge":20317.3,"discounted_cash":20317.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXCHANGE NEPHROSTOMY CATHETER PRQ W/IMG GID RS&I","code_information":[{"code":"3615043501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50435","type":"HCPCS"}],"standard_charges":[{"gross_charge":11082.59,"discounted_cash":11082.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECT INDWELL CATH,URETER X-RAY","code_information":[{"code":"3615068401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50684","type":"HCPCS"}],"standard_charges":[{"gross_charge":2880.15,"discounted_cash":2880.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECT RETROGRADE/CONDUIT X-RAY","code_information":[{"code":"3615069001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50690","type":"HCPCS"}],"standard_charges":[{"gross_charge":2553.7,"discounted_cash":2553.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER","code_information":[{"code":"3615110201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"51102","type":"HCPCS"}],"standard_charges":[{"gross_charge":8589.83,"discounted_cash":8589.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECTION FOR BLADDER X-RAY","code_information":[{"code":"3615160001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"51600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1668.45,"discounted_cash":1668.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECT FOR RETROGRADE URETHOCYSTO","code_information":[{"code":"3615161001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"51610","type":"HCPCS"}],"standard_charges":[{"gross_charge":2339.4,"discounted_cash":2339.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IRRIGATION OF BLADDER","code_information":[{"code":"3615170001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"51700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1473.67,"discounted_cash":1473.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERT,NON-INDWELLING BLADDER CATHETER","code_information":[{"code":"3615170101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"51701","type":"HCPCS"}],"standard_charges":[{"gross_charge":1252.04,"discounted_cash":1252.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERT,TEMP INDWELLING BLAD CATH,SIMPLE","code_information":[{"code":"3615170201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"51702","type":"HCPCS"}],"standard_charges":[{"gross_charge":836.82,"discounted_cash":836.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERT,TEMP INDWELLING BLAD CATH,COMP","code_information":[{"code":"3615170301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"51703","type":"HCPCS"}],"standard_charges":[{"gross_charge":1707.79,"discounted_cash":1707.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHANGE OF BLADDER TUBE,SIMPLE","code_information":[{"code":"3615170501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"51705","type":"HCPCS"}],"standard_charges":[{"gross_charge":728.75,"discounted_cash":728.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHANGE OF BLADDER TUBE,COMPLICATED","code_information":[{"code":"3615171001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"51710","type":"HCPCS"}],"standard_charges":[{"gross_charge":6913.16,"discounted_cash":6913.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MEAS,POST-VOID RES,US,NON-IMAGING","code_information":[{"code":"3615179801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"51798","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.2,"discounted_cash":248.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CIRCUMCISION,SURG EXCISION NOT CLAMP/DEV/DORSAL SLIT - NEONATE","code_information":[{"code":"3615416001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"54160","type":"HCPCS"}],"standard_charges":[{"gross_charge":627.73,"discounted_cash":627.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IRRIGAT CORPUS CAVERN,PRIAPISM","code_information":[{"code":"3615422001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"54220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1824.22,"discounted_cash":1824.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRAINAGE SCROTAL WALL ABSCESS","code_information":[{"code":"3615510001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"55100","type":"HCPCS"}],"standard_charges":[{"gross_charge":16444.17,"discounted_cash":16444.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC I&D OF VULVA/PERINEUM ABSCESS","code_information":[{"code":"3615640501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"56405","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.74,"discounted_cash":3467.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC I&D BARTHOLIN GLAND ABSCESS","code_information":[{"code":"3615642001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"56420","type":"HCPCS"}],"standard_charges":[{"gross_charge":3266.79,"discounted_cash":3266.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CATH/INJECT HYSTEROSALPINGOGRAM","code_information":[{"code":"3615834001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"58340","type":"HCPCS"}],"standard_charges":[{"gross_charge":2055.9,"discounted_cash":2055.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REOPEN FALLOPIAN TUBE,TRANSCERV CATH","code_information":[{"code":"3615834501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"58345","type":"HCPCS"}],"standard_charges":[{"gross_charge":11017.65,"discounted_cash":11017.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHORION VILLUS BIOPSY","code_information":[{"code":"3615901501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"59015","type":"HCPCS"}],"standard_charges":[{"gross_charge":2660.7,"discounted_cash":2660.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERT CERVICAL DILATOR","code_information":[{"code":"3615920001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"59200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1029.68,"discounted_cash":1029.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANTEPARTUM HEAD MANIPULATION","code_information":[{"code":"3615941201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"59412","type":"HCPCS"}],"standard_charges":[{"gross_charge":10703.72,"discounted_cash":10703.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BIOPSY OF THYROID,PERCUT","code_information":[{"code":"3616010001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"60100","type":"HCPCS"}],"standard_charges":[{"gross_charge":2824.28,"discounted_cash":2824.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BRAIN SHUNT TUBE/RESERV INJECTN","code_information":[{"code":"3616107001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"61070","type":"HCPCS"}],"standard_charges":[{"gross_charge":2664.9,"discounted_cash":2664.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE","code_information":[{"code":"3616227001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":2557.97,"discounted_cash":2557.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THERAPEUTIC SPINAL PUNCTURE DRAINAGE CSF","code_information":[{"code":"3616227201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62272","type":"HCPCS"}],"standard_charges":[{"gross_charge":2312.81,"discounted_cash":2312.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJ,LUMB EPIDUR,BLOOD/CLOT PATCH","code_information":[{"code":"3616227301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62273","type":"HCPCS"}],"standard_charges":[{"gross_charge":4100.75,"discounted_cash":4100.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECTION PROCEDURE MYELOGRAPHY/CT LUMBAR","code_information":[{"code":"3616228401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62284","type":"HCPCS"}],"standard_charges":[{"gross_charge":787.5,"discounted_cash":787.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECT DISKOGRAM,LUMBAR,EA LEVEL","code_information":[{"code":"3616229001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62290","type":"HCPCS"}],"standard_charges":[{"gross_charge":1786.05,"discounted_cash":1786.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJ,CERV/THORAC,FOR DISKOGRAPHY","code_information":[{"code":"3616229101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62291","type":"HCPCS"}],"standard_charges":[{"gross_charge":1786.05,"discounted_cash":1786.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYELOGRAPHY VIA LUMBAR INJECTION RS&I CERVICAL","code_information":[{"code":"3616230201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62302","type":"HCPCS"}],"standard_charges":[{"gross_charge":9421.55,"discounted_cash":9421.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYELOGRAPHY VIA LUMBAR INJECTION RS&I THORACIC","code_information":[{"code":"3616230301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62303","type":"HCPCS"}],"standard_charges":[{"gross_charge":12916.37,"discounted_cash":12916.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYELOGRAPHY VIA LUMBAR INJECT RS&I LUMBOSACRAL","code_information":[{"code":"3616230401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62304","type":"HCPCS"}],"standard_charges":[{"gross_charge":5371.34,"discounted_cash":5371.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYELOGRAPHY VIA LUMBAR INJECTION RS&I 2+ REGIONS","code_information":[{"code":"3616230501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62305","type":"HCPCS"}],"standard_charges":[{"gross_charge":3253.3,"discounted_cash":3253.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN","code_information":[{"code":"3616232101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62321","type":"HCPCS"}],"standard_charges":[{"gross_charge":5552.76,"discounted_cash":5552.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","code_information":[{"code":"3616232301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62323","type":"HCPCS"}],"standard_charges":[{"gross_charge":5631.33,"discounted_cash":5631.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT","code_information":[{"code":"3616232801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62328","type":"HCPCS"}],"standard_charges":[{"gross_charge":3591.99,"discounted_cash":3591.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THERAPEUTIC SPINAL PNXR DRAINAGE CSF W/FLUOR/CT","code_information":[{"code":"3616232901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62329","type":"HCPCS"}],"standard_charges":[{"gross_charge":2375.14,"discounted_cash":2375.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECTION AA&/STRD TRIGEMINAL NERVE EACH BRANCH","code_information":[{"code":"3616440001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64400","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECTION AA&/STRD BRACHIAL PLEXUS","code_information":[{"code":"3616441501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64415","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECTION AA&/STRD AXILLARY NERVE","code_information":[{"code":"3616441701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64417","type":"HCPCS"}],"standard_charges":[{"gross_charge":2759.79,"discounted_cash":2759.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECTION AA&/STRD SCIATIC NERVE","code_information":[{"code":"3616444501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64445","type":"HCPCS"}],"standard_charges":[{"gross_charge":1671.61,"discounted_cash":1671.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECTION AA&/STRD FEMORAL NERVE","code_information":[{"code":"3616444701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH","code_information":[{"code":"3616445001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":2092.66,"discounted_cash":2092.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THERM DEST INTRAOSSEOUS BVN 1ST 2 LUM/SAC","code_information":[{"code":"3616462801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64628","type":"HCPCS"}],"standard_charges":[{"gross_charge":49259.0,"discounted_cash":49259.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THERM DEST INTRAOSSEOUS BVN EA ADD LUM/SAC","code_information":[{"code":"3616462901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64629","type":"HCPCS"}],"standard_charges":[{"gross_charge":24629.5,"discounted_cash":24629.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL","code_information":[{"code":"3616463501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64635","type":"HCPCS"}],"standard_charges":[{"gross_charge":22464.5,"discounted_cash":22464.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EYE RMV FOREIGN BODY CONJ/SUBCONJ/SCLER NONPERFORATING","code_information":[{"code":"3616521001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"65210","type":"HCPCS"}],"standard_charges":[{"gross_charge":2753.67,"discounted_cash":2753.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMV F.B.,EYE,CORNEA,NO SLIT","code_information":[{"code":"3616522001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"65220","type":"HCPCS"}],"standard_charges":[{"gross_charge":2601.7,"discounted_cash":2601.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRAIN EXT EAR ABSC/BLOOD,SIMPLE","code_information":[{"code":"3616900001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"69000","type":"HCPCS"}],"standard_charges":[{"gross_charge":2039.5,"discounted_cash":2039.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DRAIN EXT EAR ABSC/BLOOD,COMPLIC","code_information":[{"code":"3616900501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"69005","type":"HCPCS"}],"standard_charges":[{"gross_charge":16444.17,"discounted_cash":16444.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMV EXT CANAL FOREIGN BODY","code_information":[{"code":"3616920001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"69200","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.2,"discounted_cash":246.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT","code_information":[{"code":"3616920901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"69209","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.2,"discounted_cash":246.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT","code_information":[{"code":"3616921001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"69210","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.2,"discounted_cash":246.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEBRIDEMENT OPEN WOUND 20 SQ CM<","code_information":[{"code":"3619759701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":912.28,"discounted_cash":912.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEBRIDEMENT OPEN WOUND EA ADDL 20 SQ CM","code_information":[{"code":"3619759801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"97598","type":"HCPCS"}],"standard_charges":[{"gross_charge":1039.24,"discounted_cash":1039.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WOUND DEBRIDEMNT, NON-SELECTIVE, EA","code_information":[{"code":"3619760201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"97602","type":"HCPCS"}],"standard_charges":[{"gross_charge":1165.31,"discounted_cash":1165.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEGATIVE PRESSURE WOUND THERAPY DME </= 50 SQ CM","code_information":[{"code":"3619760501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"97605","type":"HCPCS"}],"standard_charges":[{"gross_charge":907.23,"discounted_cash":907.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEGATIVE PRESSURE WOUND THERAPY DME >50 SQ CM","code_information":[{"code":"3619760601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"97606","type":"HCPCS"}],"standard_charges":[{"gross_charge":1702.44,"discounted_cash":1702.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEG PRESSURE WOUND THERAPY NON DME </= 50 SQ CM","code_information":[{"code":"3619760701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"97607","type":"HCPCS"}],"standard_charges":[{"gross_charge":1702.44,"discounted_cash":1702.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NEG PRESSURE WOUND THERAPY NON DME >50 SQ CM","code_information":[{"code":"3619760801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"97608","type":"HCPCS"}],"standard_charges":[{"gross_charge":1539.28,"discounted_cash":1539.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJ FOR SACROILIAC JT ANESTH","code_information":[{"code":"361G026001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"G0260","type":"HCPCS"}],"standard_charges":[{"gross_charge":2824.79,"discounted_cash":2824.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OCCLUSIVE DEVICE IN VEIN ART","code_information":[{"code":"361G026901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"G0269","type":"HCPCS"}],"standard_charges":[{"gross_charge":526.71,"discounted_cash":526.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENERAL ANESTHESIA TIME - INITIAL 30 MINUTES","code_information":[{"code":"3700000001","type":"CDM"},{"code":"0370","type":"RC"},{"code":"3700000001","type":"HCPCS"}],"standard_charges":[{"gross_charge":5898.71,"discounted_cash":5898.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GENERAL ANESTHESIA TIME - EACH ADDL MINUTE","code_information":[{"code":"3700000002","type":"CDM"},{"code":"0370","type":"RC"},{"code":"3700000002","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.23,"discounted_cash":212.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REGIONAL ANESTHESIA TIME - INITIAL 30 MINUTES","code_information":[{"code":"3700000003","type":"CDM"},{"code":"0370","type":"RC"},{"code":"3700000003","type":"HCPCS"}],"standard_charges":[{"gross_charge":2746.51,"discounted_cash":2746.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REGIONAL ANESTHESIA TIME - EACH ADDL MINUTE","code_information":[{"code":"3700000004","type":"CDM"},{"code":"0370","type":"RC"},{"code":"3700000004","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.6,"discounted_cash":118.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MONITORED ANESTHESIA CARE ANESTHESIA TIME - INITIAL 30 MINUTES","code_information":[{"code":"3700000005","type":"CDM"},{"code":"0370","type":"RC"},{"code":"3700000005","type":"HCPCS"}],"standard_charges":[{"gross_charge":4643.06,"discounted_cash":4643.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MONITORED ANESTHESIA CARE ANESTHESIA TIME - EACH ADDL MINUTE","code_information":[{"code":"3700000006","type":"CDM"},{"code":"0370","type":"RC"},{"code":"3700000006","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.24,"discounted_cash":178.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANES LABOR EPIDURAL","code_information":[{"code":"3700000007","type":"CDM"},{"code":"0370","type":"RC"},{"code":"3700000007","type":"HCPCS"}],"standard_charges":[{"gross_charge":2237.13,"discounted_cash":2237.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AN EPIDURAL BLOCK CHARGE","code_information":[{"code":"3700000014","type":"CDM"},{"code":"0370","type":"RC"},{"code":"3700000014","type":"HCPCS"}],"standard_charges":[{"gross_charge":1671.61,"discounted_cash":1671.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS","code_information":[{"code":"3709915101","type":"CDM"},{"code":"0370","type":"RC"},{"code":"99151","type":"HCPCS"}],"standard_charges":[{"gross_charge":543.14,"discounted_cash":543.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS","code_information":[{"code":"3709915201","type":"CDM"},{"code":"0370","type":"RC"},{"code":"99152","type":"HCPCS"}],"standard_charges":[{"gross_charge":543.14,"discounted_cash":543.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOD SED SAME PHYS/QHP INIT 15 MINS 5/> YRS GI ONLY","code_information":[{"code":"3709915202","type":"CDM"},{"code":"0370","type":"RC"},{"code":"99152","type":"HCPCS"}],"standard_charges":[{"gross_charge":609.22,"discounted_cash":609.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOD SED SAME PHYS/QHP EACH ADDL 15 MINS","code_information":[{"code":"3709915301","type":"CDM"},{"code":"0370","type":"RC"},{"code":"99153","type":"HCPCS"}],"standard_charges":[{"gross_charge":609.22,"discounted_cash":609.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS","code_information":[{"code":"3709915501","type":"CDM"},{"code":"0370","type":"RC"},{"code":"99155","type":"HCPCS"}],"standard_charges":[{"gross_charge":512.4,"discounted_cash":512.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS","code_information":[{"code":"3709915601","type":"CDM"},{"code":"0370","type":"RC"},{"code":"99156","type":"HCPCS"}],"standard_charges":[{"gross_charge":543.14,"discounted_cash":543.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS","code_information":[{"code":"3709915701","type":"CDM"},{"code":"0370","type":"RC"},{"code":"99157","type":"HCPCS"}],"standard_charges":[{"gross_charge":512.4,"discounted_cash":512.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD PRODUCT IRRADIATION - EACH","code_information":[{"code":"3908694501","type":"CDM"},{"code":"0390","type":"RC"},{"code":"86945","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.94,"discounted_cash":225.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC POOLING BLOOD PRODUCTS","code_information":[{"code":"3908696501","type":"CDM"},{"code":"0390","type":"RC"},{"code":"86965","type":"HCPCS"}],"standard_charges":[{"gross_charge":1101.73,"discounted_cash":1101.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLASMA COVID-19 CONVALESCENT ABYS","code_information":[{"code":"390C950701","type":"CDM"},{"code":"0390","type":"RC"},{"code":"C9507","type":"HCPCS"}],"standard_charges":[{"gross_charge":3508.29,"discounted_cash":3508.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WHOLE BLOOD UNIT","code_information":[{"code":"390P901001","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9010","type":"HCPCS"}],"standard_charges":[{"gross_charge":1002.81,"discounted_cash":1002.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD PRODUCT - SPLIT UNIT","code_information":[{"code":"390P901101","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9011","type":"HCPCS"}],"standard_charges":[{"gross_charge":1089.42,"discounted_cash":1089.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD SPLIT UNIT NEO LR RBC","code_information":[{"code":"390P901102","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9011","type":"HCPCS"}],"standard_charges":[{"gross_charge":1089.42,"discounted_cash":1089.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD SPLIT UNIT NEO FFP FROZEN WITHIN 8HR","code_information":[{"code":"390P901104","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9011","type":"HCPCS"}],"standard_charges":[{"gross_charge":1089.42,"discounted_cash":1089.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD SPLIT UNIT NEO LR PLATELET PHERESIS","code_information":[{"code":"390P901105","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9011","type":"HCPCS"}],"standard_charges":[{"gross_charge":1089.42,"discounted_cash":1089.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD PRODUCT - CRYOPRECIPITATE UNIT","code_information":[{"code":"390P901201","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9012","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.64,"discounted_cash":589.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD PRODUCT - RBC LEUKO REDUCED UNIT","code_information":[{"code":"390P901601","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":1392.23,"discounted_cash":1392.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD PRODUCT - FRESH FROZEN PLASMA 8HR UNIT","code_information":[{"code":"390P901701","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9017","type":"HCPCS"}],"standard_charges":[{"gross_charge":610.57,"discounted_cash":610.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLATELETS, EACH UNIT","code_information":[{"code":"390P901901","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9019","type":"HCPCS"}],"standard_charges":[{"gross_charge":476.36,"discounted_cash":476.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RED BLOOD CELLS EACH UNIT","code_information":[{"code":"390P902101","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9021","type":"HCPCS"}],"standard_charges":[{"gross_charge":919.34,"discounted_cash":919.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WASHED RED BLOOD CELLS EACH UNIT","code_information":[{"code":"390P902201","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9022","type":"HCPCS"}],"standard_charges":[{"gross_charge":2536.53,"discounted_cash":2536.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD PRODUCT - PLATELETS LEUKO REDUCED UNIT","code_information":[{"code":"390P903101","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9031","type":"HCPCS"}],"standard_charges":[{"gross_charge":1001.7,"discounted_cash":1001.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLATELETS IRRADIATED EACH UNIT","code_information":[{"code":"390P903201","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9032","type":"HCPCS"}],"standard_charges":[{"gross_charge":946.05,"discounted_cash":946.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD PRODUCT - PLATELETS LEUKO REDUCED IRRADIATED UNIT","code_information":[{"code":"390P903301","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9033","type":"HCPCS"}],"standard_charges":[{"gross_charge":1423.53,"discounted_cash":1423.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLATELET PHERESIS UNIT","code_information":[{"code":"390P903401","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9034","type":"HCPCS"}],"standard_charges":[{"gross_charge":2163.67,"discounted_cash":2163.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD PRODUCT - PLATELET PHERESIS LEUKO REDUCED UNIT","code_information":[{"code":"390P903501","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":3595.68,"discounted_cash":3595.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLATELET PHERES LEUKOREDUCED LVDS","code_information":[{"code":"390P903502","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":3595.68,"discounted_cash":3595.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLATELET PHERESIS IRRAD","code_information":[{"code":"390P903601","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9036","type":"HCPCS"}],"standard_charges":[{"gross_charge":4039.08,"discounted_cash":4039.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD PRODUCT - PLATELET PHERESIS LEUKO REDUCED IRRADIATED UNIT","code_information":[{"code":"390P903701","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9037","type":"HCPCS"}],"standard_charges":[{"gross_charge":4559.54,"discounted_cash":4559.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLATE PHERES LEUKOREDU IRRAD LVDS","code_information":[{"code":"390P903702","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9037","type":"HCPCS"}],"standard_charges":[{"gross_charge":4559.54,"discounted_cash":4559.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RBC DEGLYC UNIT","code_information":[{"code":"390P903901","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9039","type":"HCPCS"}],"standard_charges":[{"gross_charge":2916.06,"discounted_cash":2916.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD PRODUCT - RBC LEUKO REDUCED IRRADIATED UNIT","code_information":[{"code":"390P904001","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1924.02,"discounted_cash":1924.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLASMA CRYOPRECIP REDUCED UNIT","code_information":[{"code":"390P904401","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9044","type":"HCPCS"}],"standard_charges":[{"gross_charge":438.52,"discounted_cash":438.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WB/RBC LEUKOREDUCE CMV NEG UNIT","code_information":[{"code":"390P905101","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9051","type":"HCPCS"}],"standard_charges":[{"gross_charge":1416.85,"discounted_cash":1416.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLATELETS  HLA-M  L/R  UNIT LVDS","code_information":[{"code":"390P905202","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9052","type":"HCPCS"}],"standard_charges":[{"gross_charge":2721.22,"discounted_cash":2721.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLATELET PHERESIS LEUKOREDUCE CMV NEG IRRAD UNIT","code_information":[{"code":"390P905301","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9053","type":"HCPCS"}],"standard_charges":[{"gross_charge":2987.13,"discounted_cash":2987.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLATELET PHERESIS LEUKOREDUCE CMV NEG IRRAD UNIT LVDS","code_information":[{"code":"390P905302","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9053","type":"HCPCS"}],"standard_charges":[{"gross_charge":2987.13,"discounted_cash":2987.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WB/RBC LEUKOREDUCE FRZ DEGLYC WASHED UNIT","code_information":[{"code":"390P905401","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9054","type":"HCPCS"}],"standard_charges":[{"gross_charge":2074.63,"discounted_cash":2074.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC WHOLE BLOOD LEUKOREDUCE IRRAD UNIT","code_information":[{"code":"390P905601","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9056","type":"HCPCS"}],"standard_charges":[{"gross_charge":1029.53,"discounted_cash":1029.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RBC FRZ DEGLYC WASHED LEUKOREDUCE IRRAD UNIT","code_information":[{"code":"390P905701","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9057","type":"HCPCS"}],"standard_charges":[{"gross_charge":1740.22,"discounted_cash":1740.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RBC LEUKOREDUCE CMV NEG IRRAD UNIT","code_information":[{"code":"390P905801","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9058","type":"HCPCS"}],"standard_charges":[{"gross_charge":1628.32,"discounted_cash":1628.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD PRODUCT - FRESH FROZEN PLASMA 24H UNIT","code_information":[{"code":"390P905901","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9059","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.63,"discounted_cash":525.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLASMA FRZ DONOR RETEST UNIT","code_information":[{"code":"390P906001","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9060","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.26,"discounted_cash":171.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD PRODUCT - PLATELET PHERESIS PATHOGEN REDUCED","code_information":[{"code":"390P907301","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9073","type":"HCPCS"}],"standard_charges":[{"gross_charge":3898.84,"discounted_cash":3898.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BLOOD TRANSFUSION SERVICE","code_information":[{"code":"3913643001","type":"CDM"},{"code":"0391","type":"RC"},{"code":"36430","type":"HCPCS"}],"standard_charges":[{"gross_charge":3283.02,"discounted_cash":3283.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIGITAL BREAST TOMOSYNTHESIS UNILATERAL","code_information":[{"code":"4017706101","type":"CDM"},{"code":"0401","type":"RC"},{"code":"77061","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.89,"discounted_cash":162.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIGITAL BREAST TOMOSYNTHESIS BILATERAL","code_information":[{"code":"4017706201","type":"CDM"},{"code":"0401","type":"RC"},{"code":"77062","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.6,"discounted_cash":281.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","code_information":[{"code":"4017706505","type":"CDM"},{"code":"0401","type":"RC"},{"code":"77065","type":"HCPCS"}],"standard_charges":[{"gross_charge":1109.11,"discounted_cash":1109.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","code_information":[{"code":"4017706602","type":"CDM"},{"code":"0401","type":"RC"},{"code":"77066","type":"HCPCS"}],"standard_charges":[{"gross_charge":1027.3,"discounted_cash":1027.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MA TOMOSYNTHESIS DIAG ADD ON","code_information":[{"code":"401G027901","type":"CDM"},{"code":"0401","type":"RC"},{"code":"G0279","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.86,"discounted_cash":244.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RAD GUIDED,PERCUT DRAINAGE,W/CATH PLACE","code_information":[{"code":"4027598901","type":"CDM"},{"code":"0402","type":"RC"},{"code":"75989","type":"HCPCS"}],"standard_charges":[{"gross_charge":6638.67,"discounted_cash":6638.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION","code_information":[{"code":"4027637601","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76376","type":"HCPCS"}],"standard_charges":[{"gross_charge":669.42,"discounted_cash":669.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US, HEAD, REAL TIME","code_information":[{"code":"4027650602","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76506","type":"HCPCS"}],"standard_charges":[{"gross_charge":1425.47,"discounted_cash":1425.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US, HEAD/NECK TISSUES,REAL TIME","code_information":[{"code":"4027653603","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76536","type":"HCPCS"}],"standard_charges":[{"gross_charge":1783.69,"discounted_cash":1783.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US, CHEST,REAL TIME","code_information":[{"code":"4027660401","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76604","type":"HCPCS"}],"standard_charges":[{"gross_charge":1824.31,"discounted_cash":1824.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US BREAST UNI REAL TIME WITH IMAGE COMPLETE","code_information":[{"code":"4027664102","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76641","type":"HCPCS"}],"standard_charges":[{"gross_charge":1510.41,"discounted_cash":1510.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US BREAST UNI REAL TIME WITH IMAGE LIMITED","code_information":[{"code":"4027664201","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76642","type":"HCPCS"}],"standard_charges":[{"gross_charge":1224.83,"discounted_cash":1224.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","code_information":[{"code":"4027670001","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76700","type":"HCPCS"}],"standard_charges":[{"gross_charge":2309.32,"discounted_cash":2309.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US, ABDOMEN LIMITED","code_information":[{"code":"4027670501","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76705","type":"HCPCS"}],"standard_charges":[{"gross_charge":2490.27,"discounted_cash":2490.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA","code_information":[{"code":"4027670601","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76706","type":"HCPCS"}],"standard_charges":[{"gross_charge":1371.43,"discounted_cash":1371.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US,RETROPERIT, B-SCAN/REAL TIME,COMPLETE","code_information":[{"code":"4027677002","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76770","type":"HCPCS"}],"standard_charges":[{"gross_charge":2374.56,"discounted_cash":2374.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US, RETROPERITNL ABD, LTD","code_information":[{"code":"4027677502","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76775","type":"HCPCS"}],"standard_charges":[{"gross_charge":1863.7,"discounted_cash":1863.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US,TRANSPLANTED KIDNEY, REAL TIME/ DOPPLER","code_information":[{"code":"4027677601","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4523.85,"discounted_cash":4523.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US, SPINAL CANAL & CONTENTS","code_information":[{"code":"4027680001","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76800","type":"HCPCS"}],"standard_charges":[{"gross_charge":1943.72,"discounted_cash":1943.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US, OB < 14 WKS, SINGLE FETUS","code_information":[{"code":"4027680101","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76801","type":"HCPCS"}],"standard_charges":[{"gross_charge":1325.76,"discounted_cash":1325.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US, OB < 14 WKS, ADD'L FETUS","code_information":[{"code":"4027680201","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76802","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.75,"discounted_cash":330.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US, OB >/= 14 WKS, SNGL FETUS","code_information":[{"code":"4027680501","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76805","type":"HCPCS"}],"standard_charges":[{"gross_charge":3816.03,"discounted_cash":3816.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US, OB >/= 14 WKS, ADDL FETUS","code_information":[{"code":"4027681001","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76810","type":"HCPCS"}],"standard_charges":[{"gross_charge":2682.75,"discounted_cash":2682.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US,PREG UTER,FET & MAT,+ DETL FET EXM","code_information":[{"code":"4027681101","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76811","type":"HCPCS"}],"standard_charges":[{"gross_charge":646.65,"discounted_cash":646.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US,PREG UTER,FET & MAT,+ DETL FET,ADDL","code_information":[{"code":"4027681201","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76812","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.8,"discounted_cash":457.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US,PREGNANT UTERUS,LIMITED, 1/> FETUSES","code_information":[{"code":"4027681501","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76815","type":"HCPCS"}],"standard_charges":[{"gross_charge":1249.45,"discounted_cash":1249.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US,PREGNANT UTERUS,F/U,TRANSABD APP","code_information":[{"code":"4027681601","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76816","type":"HCPCS"}],"standard_charges":[{"gross_charge":1655.67,"discounted_cash":1655.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US,PREGNANT UTERUS,TRANSVAGINAL","code_information":[{"code":"4027681701","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76817","type":"HCPCS"}],"standard_charges":[{"gross_charge":1735.68,"discounted_cash":1735.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FETAL BIOPHYSICAL PROFILE","code_information":[{"code":"4027681801","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76818","type":"HCPCS"}],"standard_charges":[{"gross_charge":3649.86,"discounted_cash":3649.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FETAL BIOPHYS PROF,W/O NST","code_information":[{"code":"4027681901","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76819","type":"HCPCS"}],"standard_charges":[{"gross_charge":2475.49,"discounted_cash":2475.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DOPPLER FETAL UMBILICAL ARTERY","code_information":[{"code":"4027682001","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76820","type":"HCPCS"}],"standard_charges":[{"gross_charge":1570.44,"discounted_cash":1570.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SONO FETAL HEART","code_information":[{"code":"4027682501","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76825","type":"HCPCS"}],"standard_charges":[{"gross_charge":1425.75,"discounted_cash":1425.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ECHOGRAPHY,TRANSVAGINAL","code_information":[{"code":"4027683002","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76830","type":"HCPCS"}],"standard_charges":[{"gross_charge":2090.2,"discounted_cash":2090.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SONO EXAM, HYSTEROSONOGRAPHY","code_information":[{"code":"4027683101","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76831","type":"HCPCS"}],"standard_charges":[{"gross_charge":1025.07,"discounted_cash":1025.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ECHO,PELVIC (NONOBSTETRIC)","code_information":[{"code":"4027685601","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76856","type":"HCPCS"}],"standard_charges":[{"gross_charge":3338.42,"discounted_cash":3338.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SONO PELVIS LIMITED","code_information":[{"code":"4027685701","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76857","type":"HCPCS"}],"standard_charges":[{"gross_charge":1098.04,"discounted_cash":1098.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ECHO,SCROTUM & CONTENTS","code_information":[{"code":"4027687001","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76870","type":"HCPCS"}],"standard_charges":[{"gross_charge":2926.03,"discounted_cash":2926.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ECHO,TRANSRECTAL","code_information":[{"code":"4027687201","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76872","type":"HCPCS"}],"standard_charges":[{"gross_charge":2645.6,"discounted_cash":2645.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ECHO,TRANSRECTAL,PROSTATE VOL","code_information":[{"code":"4027687301","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76873","type":"HCPCS"}],"standard_charges":[{"gross_charge":2645.6,"discounted_cash":2645.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US COMPLETE JOINT REAL TIME W IMAGE DOCUMENTATION","code_information":[{"code":"4027688121","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76881","type":"HCPCS"}],"standard_charges":[{"gross_charge":2703.23,"discounted_cash":2703.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US LMTD JOINT/OTH NONVASC XTR STRUX R-T W/IMG","code_information":[{"code":"4027688202","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76882","type":"HCPCS"}],"standard_charges":[{"gross_charge":1539.95,"discounted_cash":1539.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US INFT HIPS R-T IMG DYNAMIC REQ PHYS/QHP MANJ","code_information":[{"code":"4027688501","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76885","type":"HCPCS"}],"standard_charges":[{"gross_charge":1810.77,"discounted_cash":1810.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US INFT HIPS R-T IMG LMTD STATIC PHYS/QHP MANJ","code_information":[{"code":"4027688603","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76886","type":"HCPCS"}],"standard_charges":[{"gross_charge":1482.1,"discounted_cash":1482.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ECHO GUIDE ENDOMYOCARDIAL BIOPSY IMG S&I","code_information":[{"code":"4027693202","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76932","type":"HCPCS"}],"standard_charges":[{"gross_charge":1749.3,"discounted_cash":1749.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US ECHO GUIDE 4 ARTERY RPR - US GUIDE PSEUDOANEUR/AV FISTULA TRT","code_information":[{"code":"4027693604","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76936","type":"HCPCS"}],"standard_charges":[{"gross_charge":1816.93,"discounted_cash":1816.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US GUIDE, VASCULAR ACCESS","code_information":[{"code":"4027693701","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76937","type":"HCPCS"}],"standard_charges":[{"gross_charge":1021.52,"discounted_cash":1021.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US GUIDE, TISSUE ABLATION","code_information":[{"code":"4027694010","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76940","type":"HCPCS"}],"standard_charges":[{"gross_charge":4696.65,"discounted_cash":4696.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SONO GUIDE NEEDLE BIOPSY","code_information":[{"code":"4027694232","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":3020.82,"discounted_cash":3020.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SONO GUIDE AMNIOCENTESIS","code_information":[{"code":"4027694601","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76946","type":"HCPCS"}],"standard_charges":[{"gross_charge":1321.95,"discounted_cash":1321.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SONO GUIDE RADIOELEMT APPLIC","code_information":[{"code":"4027696501","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76965","type":"HCPCS"}],"standard_charges":[{"gross_charge":1527.04,"discounted_cash":1527.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC US ELASTOGRAPHY","code_information":[{"code":"4027698101","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76981","type":"HCPCS"}],"standard_charges":[{"gross_charge":2645.6,"discounted_cash":2645.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ULTRASONIC GUIDANCE, INTRAOPERATIVE","code_information":[{"code":"4027699802","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76998","type":"HCPCS"}],"standard_charges":[{"gross_charge":1278.84,"discounted_cash":1278.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LIVER ELASTOGRAPH W INTERP","code_information":[{"code":"4029120001","type":"CDM"},{"code":"0402","type":"RC"},{"code":"91200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1278.84,"discounted_cash":1278.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTRACRANIAL LIMITED STUDY - US HEAD DOPPLER LIMITED","code_information":[{"code":"4029388801","type":"CDM"},{"code":"0402","type":"RC"},{"code":"93888","type":"HCPCS"}],"standard_charges":[{"gross_charge":492.14,"discounted_cash":492.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SCREENING DIGITAL BREAST TOMOSYNTHESIS BI","code_information":[{"code":"4037706302","type":"CDM"},{"code":"0403","type":"RC"},{"code":"77063","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.6,"discounted_cash":281.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","code_information":[{"code":"4037706702","type":"CDM"},{"code":"0403","type":"RC"},{"code":"77067","type":"HCPCS"}],"standard_charges":[{"gross_charge":933.81,"discounted_cash":933.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BRAIN IMAGING PET METABOLIC","code_information":[{"code":"4047860802","type":"CDM"},{"code":"0404","type":"RC"},{"code":"78608","type":"HCPCS"}],"standard_charges":[{"gross_charge":5921.0,"discounted_cash":5921.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH","code_information":[{"code":"4047881501","type":"CDM"},{"code":"0404","type":"RC"},{"code":"78815","type":"HCPCS"}],"standard_charges":[{"gross_charge":5921.0,"discounted_cash":5921.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PET IMAGING FOR CT ATTENUATION WHOLE BODY","code_information":[{"code":"4047881601","type":"CDM"},{"code":"0404","type":"RC"},{"code":"78816","type":"HCPCS"}],"standard_charges":[{"gross_charge":5921.0,"discounted_cash":5921.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RT VENT MGMT, INPATIENT, INITIAL DAY","code_information":[{"code":"4109400201","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94002","type":"HCPCS"}],"standard_charges":[{"gross_charge":3812.34,"discounted_cash":3812.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RT HIGH FREQ OSCILLATION INTITAL DAY","code_information":[{"code":"4109400203","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94002","type":"HCPCS"}],"standard_charges":[{"gross_charge":3812.34,"discounted_cash":3812.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RT VENT MGMT, NEONATE INPATIENT, INITIAL DAY","code_information":[{"code":"4109400204","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94002","type":"HCPCS"}],"standard_charges":[{"gross_charge":3812.34,"discounted_cash":3812.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RT VENT MGMT, INPATIENT, SUBQ DAY","code_information":[{"code":"4109400301","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94003","type":"HCPCS"}],"standard_charges":[{"gross_charge":2626.9,"discounted_cash":2626.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RT HIGH FREQ OSCILLAT SUBSEQ DAY","code_information":[{"code":"4109400303","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94003","type":"HCPCS"}],"standard_charges":[{"gross_charge":2626.9,"discounted_cash":2626.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RT VENT MGMT, NEONATE INPATIENT, SUBQ DAY","code_information":[{"code":"4109400304","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94003","type":"HCPCS"}],"standard_charges":[{"gross_charge":2626.9,"discounted_cash":2626.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTRAPULMONARY SURFACTANT ADMINISTJ PHYS/QHP","code_information":[{"code":"4109461001","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94610","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.71,"discounted_cash":351.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RT INHALATION TREATMENT","code_information":[{"code":"4109464001","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.38,"discounted_cash":444.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RT MDI/DPI","code_information":[{"code":"4109464002","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":635.19,"discounted_cash":635.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RT INDUCED SPUTUM","code_information":[{"code":"4109464003","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":1101.73,"discounted_cash":1101.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RT HAND HELD NEBULIZER","code_information":[{"code":"4109464004","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":635.19,"discounted_cash":635.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RT PENTAMADINE TX","code_information":[{"code":"4109464201","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94642","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.71,"discounted_cash":351.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CONTINUOUS INHALATION TX, 1ST HR","code_information":[{"code":"4109464401","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94644","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.16,"discounted_cash":475.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CONTINUOUS INHALATION TX, EACH ADD HR","code_information":[{"code":"4109464501","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94645","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.21,"discounted_cash":317.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RT CPAP NON-EMERGENT","code_information":[{"code":"4109466001","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94660","type":"HCPCS"}],"standard_charges":[{"gross_charge":2460.73,"discounted_cash":2460.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RT BIPAP NON-EMERGENT","code_information":[{"code":"4109466006","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94660","type":"HCPCS"}],"standard_charges":[{"gross_charge":2460.73,"discounted_cash":2460.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DEMO &/OR EVAL,PT USE,AEROSOL DEVICE","code_information":[{"code":"4109466401","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94664","type":"HCPCS"}],"standard_charges":[{"gross_charge":561.33,"discounted_cash":561.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHEST WALL MANIPULATION,INITIAL","code_information":[{"code":"4109466701","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94667","type":"HCPCS"}],"standard_charges":[{"gross_charge":540.4,"discounted_cash":540.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CHEST WALL MANIPULATION,SUBSEQUENT","code_information":[{"code":"4109466801","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94668","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.44,"discounted_cash":311.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MECHANICAL CHEST WALL OSCILLATION LUNG FUNCTION","code_information":[{"code":"4109466901","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94669","type":"HCPCS"}],"standard_charges":[{"gross_charge":761.98,"discounted_cash":761.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THERAPEUTIC PROCD STRG ENDUR","code_information":[{"code":"410G023701","type":"CDM"},{"code":"0410","type":"RC"},{"code":"G0237","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.2,"discounted_cash":247.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OTH RESP PROC, INDIV","code_information":[{"code":"410G023801","type":"CDM"},{"code":"0410","type":"RC"},{"code":"G0238","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.2,"discounted_cash":247.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OTH RESP PROC, GROUP","code_information":[{"code":"410G023901","type":"CDM"},{"code":"0410","type":"RC"},{"code":"G0239","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.38,"discounted_cash":152.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HYPERBARIC OXYGEN THERAPY (HBO) PER 30 MIN","code_information":[{"code":"4139918301","type":"CDM"},{"code":"0413","type":"RC"},{"code":"99183","type":"HCPCS"}],"standard_charges":[{"gross_charge":1888.32,"discounted_cash":1888.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT APPLY STRAPPING SHOULDER","code_information":[{"code":"4202924001","type":"CDM"},{"code":"0420","type":"RC"},{"code":"29240","type":"HCPCS"}],"standard_charges":[{"gross_charge":498.62,"discounted_cash":498.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT STRAPPING OF ELBOW OR WRIST","code_information":[{"code":"4202926001","type":"CDM"},{"code":"0420","type":"RC"},{"code":"29260","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.2,"discounted_cash":248.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT STRAPPING OF KNEE","code_information":[{"code":"4202953001","type":"CDM"},{"code":"0420","type":"RC"},{"code":"29530","type":"HCPCS"}],"standard_charges":[{"gross_charge":498.62,"discounted_cash":498.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT STRAPPING; ANKLE &/OR FOOT","code_information":[{"code":"4202954001","type":"CDM"},{"code":"0420","type":"RC"},{"code":"29540","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.85,"discounted_cash":628.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT STRAPPING UNNA BOOT","code_information":[{"code":"4202958001","type":"CDM"},{"code":"0420","type":"RC"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":988.34,"discounted_cash":988.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT APPL MLT-LAYER VENOUS WOUND COMPRESS BELOW KNEE","code_information":[{"code":"4202958101","type":"CDM"},{"code":"0420","type":"RC"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.85,"discounted_cash":628.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APPL MLTLAYR COMPRES SYS UPARM LWARM HAND&FINGER","code_information":[{"code":"4202958401","type":"CDM"},{"code":"0420","type":"RC"},{"code":"29584","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.2,"discounted_cash":246.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT BIOFEEDBACK TRAINING,ANY MODALITY","code_information":[{"code":"4209090101","type":"CDM"},{"code":"0420","type":"RC"},{"code":"90901","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.87,"discounted_cash":382.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT BIOFEED PERINEAL / RECTAL INIT 15 MIN","code_information":[{"code":"4209091201","type":"CDM"},{"code":"0420","type":"RC"},{"code":"90912","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.87,"discounted_cash":382.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BIOFEED PERINEAL / RECTAL ADDITIONAL 15 MIN","code_information":[{"code":"4209091301","type":"CDM"},{"code":"0420","type":"RC"},{"code":"90913","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.68,"discounted_cash":217.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT RANGE MOTION MEASURE,EACH EXTREM","code_information":[{"code":"4209585101","type":"CDM"},{"code":"0420","type":"RC"},{"code":"95851","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.95,"discounted_cash":363.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CANALITH REPOSITIONING PROCEDURE, PER DAY","code_information":[{"code":"4209599201","type":"CDM"},{"code":"0420","type":"RC"},{"code":"95992","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.49,"discounted_cash":194.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT HOT OR COLD PACKS THERAPY","code_information":[{"code":"4209701001","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97010","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.6,"discounted_cash":350.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MECHANICAL TRACTION THERAPY","code_information":[{"code":"4209701201","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97012","type":"HCPCS"}],"standard_charges":[{"gross_charge":314.98,"discounted_cash":314.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT ELECTRIC STIMULATION THERAPY UNATTENDED","code_information":[{"code":"4209701401","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97014","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.21,"discounted_cash":317.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT VASOPNEUMATIC DEVICE THERAPY","code_information":[{"code":"4209701601","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97016","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.9,"discounted_cash":333.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT PARAFFIN BATH THERAPY","code_information":[{"code":"4209701801","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97018","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.76,"discounted_cash":253.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT WHIRLPOOL THERAPY","code_information":[{"code":"4209702201","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97022","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.15,"discounted_cash":218.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT ELECTRICAL STIMULATION EACH 15 MINUTES","code_information":[{"code":"4209703201","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97032","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.49,"discounted_cash":221.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT IONTOPHORESIS EACH 15 MINUTES","code_information":[{"code":"4209703301","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97033","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.52,"discounted_cash":241.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT ULTRASOUND THERAPY","code_information":[{"code":"4209703501","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97035","type":"HCPCS"}],"standard_charges":[{"gross_charge":398.45,"discounted_cash":398.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT THERAPEUTIC EXERCISES","code_information":[{"code":"4209711001","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97110","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.67,"discounted_cash":328.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT NEUROMUSC REEDUCAT,1+ AREAS, EA 15 MIN","code_information":[{"code":"4209711201","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97112","type":"HCPCS"}],"standard_charges":[{"gross_charge":434.54,"discounted_cash":434.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT AQUATIC THERAPY/EXERCISES","code_information":[{"code":"4209711301","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97113","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.52,"discounted_cash":220.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GAIT TRAINING THERAPY","code_information":[{"code":"4209711601","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97116","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.36,"discounted_cash":332.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT MASSAGE THERAPY","code_information":[{"code":"4209712401","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97124","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.49,"discounted_cash":93.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC  PT-COGNITIVE SKILLS DEV INIT 15 MIN","code_information":[{"code":"4209712901","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97129","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.7,"discounted_cash":176.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT MANUAL THER TECH,1+REGIONS,EA 15 MIN","code_information":[{"code":"4209714001","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97140","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.73,"discounted_cash":259.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT GROUP THERAPEUTIC PROCEDURES","code_information":[{"code":"4209715001","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97150","type":"HCPCS"}],"standard_charges":[{"gross_charge":314.98,"discounted_cash":314.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN","code_information":[{"code":"4209753001","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97530","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.35,"discounted_cash":268.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT SENSORY INTEGRATIVE TECHNIQUES EACH 15 MINUTES","code_information":[{"code":"4209753301","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97533","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.38,"discounted_cash":417.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES","code_information":[{"code":"4209753501","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97535","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.7,"discounted_cash":282.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT COMMUNITY/WORK REINTEGRATION TRAINJ EA 15 MIN","code_information":[{"code":"4209753701","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97537","type":"HCPCS"}],"standard_charges":[{"gross_charge":572.08,"discounted_cash":572.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT WHEELCHAIR MNGEMENT TRAINING, EA 15 MIN","code_information":[{"code":"4209754201","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97542","type":"HCPCS"}],"standard_charges":[{"gross_charge":313.9,"discounted_cash":313.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT GROUP CAREGIVER TRAINING W/O PT","code_information":[{"code":"4209755201","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97552","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.19,"discounted_cash":155.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT DEBRIDEMENT OPEN WOUND 20 SQ CM<","code_information":[{"code":"4209759701","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":903.76,"discounted_cash":903.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT DEBRIDEMENT OPEN WOUND EA ADDL 20 SQ CM","code_information":[{"code":"4209759801","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97598","type":"HCPCS"}],"standard_charges":[{"gross_charge":1029.53,"discounted_cash":1029.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT WOUND DEBRIDEMNT, NON-SELECTIVE, EA","code_information":[{"code":"4209760201","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97602","type":"HCPCS"}],"standard_charges":[{"gross_charge":1165.31,"discounted_cash":1165.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT NEGATIVE PRESSURE WOUND THERAPY DME </= 50 SQ CM","code_information":[{"code":"4209760501","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97605","type":"HCPCS"}],"standard_charges":[{"gross_charge":820.28,"discounted_cash":820.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT PHYSICAL PERFORMANCE TEST","code_information":[{"code":"4209775001","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97750","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.33,"discounted_cash":62.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT ORTHOTIC MGMT AND TRAINING, EACH 15 MIN","code_information":[{"code":"4209776001","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97760","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.85,"discounted_cash":446.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PT ORTHOTICS/PROSTH MGMT &/TRAINJ SBSQ ENCTR 15 MIN","code_information":[{"code":"4209776301","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97763","type":"HCPCS"}],"standard_charges":[{"gross_charge":414.84,"discounted_cash":414.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS","code_information":[{"code":"4249716101","type":"CDM"},{"code":"0424","type":"RC"},{"code":"97161","type":"HCPCS"}],"standard_charges":[{"gross_charge":494.86,"discounted_cash":494.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS","code_information":[{"code":"4249716201","type":"CDM"},{"code":"0424","type":"RC"},{"code":"97162","type":"HCPCS"}],"standard_charges":[{"gross_charge":765.67,"discounted_cash":765.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45 MINS","code_information":[{"code":"4249716301","type":"CDM"},{"code":"0424","type":"RC"},{"code":"97163","type":"HCPCS"}],"standard_charges":[{"gross_charge":845.68,"discounted_cash":845.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS","code_information":[{"code":"4249716401","type":"CDM"},{"code":"0424","type":"RC"},{"code":"97164","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.82,"discounted_cash":270.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT APPLY LONG ARM SPLINT","code_information":[{"code":"4302910501","type":"CDM"},{"code":"0430","type":"RC"},{"code":"29105","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.85,"discounted_cash":628.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT APPLY FOREARM SPLINT,STATIC","code_information":[{"code":"4302912501","type":"CDM"},{"code":"0430","type":"RC"},{"code":"29125","type":"HCPCS"}],"standard_charges":[{"gross_charge":498.62,"discounted_cash":498.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT APPLY FOREARM SPLINT,DYNAMIC","code_information":[{"code":"4302912601","type":"CDM"},{"code":"0430","type":"RC"},{"code":"29126","type":"HCPCS"}],"standard_charges":[{"gross_charge":498.62,"discounted_cash":498.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT APPLY FINGER SPLINT,STATIC","code_information":[{"code":"4302913001","type":"CDM"},{"code":"0430","type":"RC"},{"code":"29130","type":"HCPCS"}],"standard_charges":[{"gross_charge":498.62,"discounted_cash":498.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT APPLY FINGER SPLINT,DYNAMIC","code_information":[{"code":"4302913101","type":"CDM"},{"code":"0430","type":"RC"},{"code":"29131","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.2,"discounted_cash":248.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT APPLY STRAPPING SHOULDER","code_information":[{"code":"4302924001","type":"CDM"},{"code":"0430","type":"RC"},{"code":"29240","type":"HCPCS"}],"standard_charges":[{"gross_charge":498.62,"discounted_cash":498.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT STRAPPING ELBOW OR WRIST","code_information":[{"code":"4302926001","type":"CDM"},{"code":"0430","type":"RC"},{"code":"29260","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.2,"discounted_cash":248.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT STRAPPING OF HAND OR FINGER","code_information":[{"code":"4302928001","type":"CDM"},{"code":"0430","type":"RC"},{"code":"29280","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.2,"discounted_cash":248.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT STRAPPING OF KNEE","code_information":[{"code":"4302953001","type":"CDM"},{"code":"0430","type":"RC"},{"code":"29530","type":"HCPCS"}],"standard_charges":[{"gross_charge":498.62,"discounted_cash":498.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT STRAPPING; ANKLE &/OR FOOT","code_information":[{"code":"4302954001","type":"CDM"},{"code":"0430","type":"RC"},{"code":"29540","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.85,"discounted_cash":628.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT APPL MLT-LAYER VENOUS WOUND COMPRESS BELOW KNEE","code_information":[{"code":"4302958101","type":"CDM"},{"code":"0430","type":"RC"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.85,"discounted_cash":628.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT APPL MLTLAYR COMPRES SYS UPARM LWARM HAND&FINGER","code_information":[{"code":"4302958401","type":"CDM"},{"code":"0430","type":"RC"},{"code":"29584","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.85,"discounted_cash":628.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT HOT OR COLD PACKS THERAPY","code_information":[{"code":"4309701001","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97010","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.6,"discounted_cash":350.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT ELECTRIC STIMULATION THERAPY UNATTENDED","code_information":[{"code":"4309701401","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97014","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.21,"discounted_cash":317.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT PARAFFIN BATH THERAPY","code_information":[{"code":"4309701801","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97018","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.76,"discounted_cash":253.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT WHIRLPOOL THERAPY","code_information":[{"code":"4309702201","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97022","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.15,"discounted_cash":218.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT ELECTRICAL STIMULATION EACH 15 MINUTES","code_information":[{"code":"4309703201","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97032","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.49,"discounted_cash":221.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT IONTOPHORESIS EACH 15 MINUTES","code_information":[{"code":"4309703301","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97033","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.52,"discounted_cash":241.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT ULTRASOUND THERAPY","code_information":[{"code":"4309703501","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97035","type":"HCPCS"}],"standard_charges":[{"gross_charge":398.45,"discounted_cash":398.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT THERAPEUTIC EXERCISES","code_information":[{"code":"4309711001","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97110","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.67,"discounted_cash":328.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT NEUROMUSC REEDUCAT,1+ AREAS, EA 15 MIN","code_information":[{"code":"4309711201","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97112","type":"HCPCS"}],"standard_charges":[{"gross_charge":434.54,"discounted_cash":434.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT AQUATIC THERAPY/EXERCISES","code_information":[{"code":"4309711301","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97113","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.52,"discounted_cash":220.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT MASSAGE THERAPY","code_information":[{"code":"4309712401","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97124","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.49,"discounted_cash":93.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC  OT COGNITIVE SKILLS DEV INIT 15 MIN","code_information":[{"code":"4309712901","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97129","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.45,"discounted_cash":132.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC  OT COGNITIVE SKILLS DEV ADDITIONAL 15 MIN","code_information":[{"code":"4309713001","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97130","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.82,"discounted_cash":155.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT MANUAL THER TECH,1+REGIONS,EA 15 MIN","code_information":[{"code":"4309714001","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97140","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":234.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT GROUP THERAPEUTIC PROCEDURES","code_information":[{"code":"4309715001","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97150","type":"HCPCS"}],"standard_charges":[{"gross_charge":314.98,"discounted_cash":314.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN","code_information":[{"code":"4309753001","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97530","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.35,"discounted_cash":268.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT SENSORY INTEGRATIVE TECHNIQUES EACH 15 MINUTES","code_information":[{"code":"4309753301","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97533","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.38,"discounted_cash":417.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES","code_information":[{"code":"4309753501","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97535","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.67,"discounted_cash":312.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT COMMUNITY/WORK REINTEGRATION TRAINJ EA 15 MIN","code_information":[{"code":"4309753701","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97537","type":"HCPCS"}],"standard_charges":[{"gross_charge":572.08,"discounted_cash":572.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT WHEELCHAIR MNGEMENT TRAINING, EA 15 MIN","code_information":[{"code":"4309754201","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97542","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.82,"discounted_cash":283.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT PHYSICAL PERFORMANCE TEST","code_information":[{"code":"4309775001","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97750","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.99,"discounted_cash":58.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT ORTHOTIC MGMT AND TRAINING, EACH 15 MIN","code_information":[{"code":"4309776001","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97760","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.02,"discounted_cash":404.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT PROSTHETIC TRAINING, EACH 15 MIN","code_information":[{"code":"4309776101","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97761","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.02,"discounted_cash":404.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OT ORTHOTICS/PROSTH MGMT &/TRAINJ SBSQ ENCTR 15 MIN","code_information":[{"code":"4309776301","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97763","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.08,"discounted_cash":375.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS","code_information":[{"code":"4349716501","type":"CDM"},{"code":"0434","type":"RC"},{"code":"97165","type":"HCPCS"}],"standard_charges":[{"gross_charge":664.73,"discounted_cash":664.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS","code_information":[{"code":"4349716601","type":"CDM"},{"code":"0434","type":"RC"},{"code":"97166","type":"HCPCS"}],"standard_charges":[{"gross_charge":773.05,"discounted_cash":773.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OCCUPATIONAL THERAPY EVAL HIGH COMPLEX 60 MINS","code_information":[{"code":"4349716701","type":"CDM"},{"code":"0434","type":"RC"},{"code":"97167","type":"HCPCS"}],"standard_charges":[{"gross_charge":906.0,"discounted_cash":906.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OCCUPATIONAL THER RE-EVAL EST PLAN CARE 30 MINS","code_information":[{"code":"4349716801","type":"CDM"},{"code":"0434","type":"RC"},{"code":"97168","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.59,"discounted_cash":333.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SPEECH/HEARING THERAPY, INDIVIDUAL","code_information":[{"code":"4409250701","type":"CDM"},{"code":"0440","type":"RC"},{"code":"92507","type":"HCPCS"}],"standard_charges":[{"gross_charge":643.8,"discounted_cash":643.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SPEECH/HEARING THERAPY, GROUP","code_information":[{"code":"4409250801","type":"CDM"},{"code":"0440","type":"RC"},{"code":"92508","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.3,"discounted_cash":436.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ORAL FUNCTION THERAPY","code_information":[{"code":"4409252601","type":"CDM"},{"code":"0440","type":"RC"},{"code":"92526","type":"HCPCS"}],"standard_charges":[{"gross_charge":743.51,"discounted_cash":743.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THER SRVC(S),NON-SPEECH GEN DEV, W/PROG","code_information":[{"code":"4409260601","type":"CDM"},{"code":"0440","type":"RC"},{"code":"92606","type":"HCPCS"}],"standard_charges":[{"gross_charge":643.31,"discounted_cash":643.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THER SRVC, SPEECH GEN DEV USE, W/PROG","code_information":[{"code":"4409260901","type":"CDM"},{"code":"0440","type":"RC"},{"code":"92609","type":"HCPCS"}],"standard_charges":[{"gross_charge":643.31,"discounted_cash":643.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC  SLP COGNITIVE SKILLS DEV INIT 15 MIN","code_information":[{"code":"4409712901","type":"CDM"},{"code":"0440","type":"RC"},{"code":"97129","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.49,"discounted_cash":146.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC  SLP COGNITIVE SKILLS DEV ADDITIONAL 15 MIN","code_information":[{"code":"4409713001","type":"CDM"},{"code":"0440","type":"RC"},{"code":"97130","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.34,"discounted_cash":172.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SLP SENSORY INTEGRATIVE TECHNIQUES EACH 15 MINUTES","code_information":[{"code":"4409753301","type":"CDM"},{"code":"0440","type":"RC"},{"code":"97533","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.38,"discounted_cash":417.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ST CAREGIVER TRAINING 1ST 30 MIN W/O PT","code_information":[{"code":"4409755001","type":"CDM"},{"code":"0440","type":"RC"},{"code":"97550","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.19,"discounted_cash":155.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EVALUATION OF SPEECH FLUENCY (STUTTER CLUTTER)","code_information":[{"code":"4449252101","type":"CDM"},{"code":"0444","type":"RC"},{"code":"92521","type":"HCPCS"}],"standard_charges":[{"gross_charge":793.57,"discounted_cash":793.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE","code_information":[{"code":"4449252201","type":"CDM"},{"code":"0444","type":"RC"},{"code":"92522","type":"HCPCS"}],"standard_charges":[{"gross_charge":544.1,"discounted_cash":544.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION","code_information":[{"code":"4449252301","type":"CDM"},{"code":"0444","type":"RC"},{"code":"92523","type":"HCPCS"}],"standard_charges":[{"gross_charge":840.76,"discounted_cash":840.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE","code_information":[{"code":"4449252401","type":"CDM"},{"code":"0444","type":"RC"},{"code":"92524","type":"HCPCS"}],"standard_charges":[{"gross_charge":904.77,"discounted_cash":904.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EVAL VOICE PROSTH DEVICE","code_information":[{"code":"4449259701","type":"CDM"},{"code":"0444","type":"RC"},{"code":"92597","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.81,"discounted_cash":533.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EVAL,SPEECH-GEN AUG/ALT COMM DEV,1ST HR","code_information":[{"code":"4449260701","type":"CDM"},{"code":"0444","type":"RC"},{"code":"92607","type":"HCPCS"}],"standard_charges":[{"gross_charge":643.31,"discounted_cash":643.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EVAL,ORAL & PHARYNGEAL SWALLOW FUNCTION","code_information":[{"code":"4449261001","type":"CDM"},{"code":"0444","type":"RC"},{"code":"92610","type":"HCPCS"}],"standard_charges":[{"gross_charge":829.68,"discounted_cash":829.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EVAL,SWALLOW FUNCTION,CINE/VIDEO RECORD","code_information":[{"code":"4449261101","type":"CDM"},{"code":"0444","type":"RC"},{"code":"92611","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.96,"discounted_cash":697.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ENDOSCOPIC EVAL,SWALLOW,CINE/VIDEO","code_information":[{"code":"4449261201","type":"CDM"},{"code":"0444","type":"RC"},{"code":"92612","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.91,"discounted_cash":274.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ASSESSMENT OF APHASIA","code_information":[{"code":"4449610501","type":"CDM"},{"code":"0444","type":"RC"},{"code":"96105","type":"HCPCS"}],"standard_charges":[{"gross_charge":648.88,"discounted_cash":648.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC STANDARDIZED COGNITIVE PERFORMANCE TESTING","code_information":[{"code":"4449612501","type":"CDM"},{"code":"0444","type":"RC"},{"code":"96125","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.91,"discounted_cash":274.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EMERGENCY DEPARTMENT VISIT LEVEL 1","code_information":[{"code":"4509928101","type":"CDM"},{"code":"0450","type":"RC"},{"code":"99281","type":"HCPCS"}],"standard_charges":[{"gross_charge":1386.74,"discounted_cash":1386.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EMERGENCY DEPT VISIT LEFT BEFORE SEEING PROVIDER","code_information":[{"code":"4509928103","type":"CDM"},{"code":"0450","type":"RC"},{"code":"99281","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.85,"discounted_cash":485.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EMERGENCY DEPARTMENT VISIT LEVEL 2","code_information":[{"code":"4509928201","type":"CDM"},{"code":"0450","type":"RC"},{"code":"99282","type":"HCPCS"}],"standard_charges":[{"gross_charge":2584.59,"discounted_cash":2584.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EMERGENCY DEPARTMENT VISIT LEVEL 3","code_information":[{"code":"4509928301","type":"CDM"},{"code":"0450","type":"RC"},{"code":"99283","type":"HCPCS"}],"standard_charges":[{"gross_charge":3858.25,"discounted_cash":3858.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EMERGENCY DEPARTMENT VISIT LEVEL 4","code_information":[{"code":"4509928401","type":"CDM"},{"code":"0450","type":"RC"},{"code":"99284","type":"HCPCS"}],"standard_charges":[{"gross_charge":5468.64,"discounted_cash":5468.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EMERGENCY DEPARTMENT VISIT LEVEL 5","code_information":[{"code":"4509928501","type":"CDM"},{"code":"0450","type":"RC"},{"code":"99285","type":"HCPCS"}],"standard_charges":[{"gross_charge":7102.65,"discounted_cash":7102.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CRITICAL CARE, E/M 30-74 MINUTES","code_information":[{"code":"4509929101","type":"CDM"},{"code":"0450","type":"RC"},{"code":"99291","type":"HCPCS"}],"standard_charges":[{"gross_charge":7982.4,"discounted_cash":7982.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CRITICAL CARE, ADDL 30 MIN","code_information":[{"code":"4509929201","type":"CDM"},{"code":"0450","type":"RC"},{"code":"99292","type":"HCPCS"}],"standard_charges":[{"gross_charge":1834.07,"discounted_cash":1834.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BREATHING CAPACITY TEST","code_information":[{"code":"4609401002","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94010","type":"HCPCS"}],"standard_charges":[{"gross_charge":613.02,"discounted_cash":613.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EVAL OF BRONCHOSPASM","code_information":[{"code":"4609406001","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94060","type":"HCPCS"}],"standard_charges":[{"gross_charge":1582.69,"discounted_cash":1582.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VITAL CAPACITY TEST","code_information":[{"code":"4609415002","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94150","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.05,"discounted_cash":424.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LUNG FUNCTION TEST (MBC/MVV)","code_information":[{"code":"4609420001","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94200","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.2,"discounted_cash":248.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RESPIRATORY FLOW VOLUME LOOP","code_information":[{"code":"4609437501","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94375","type":"HCPCS"}],"standard_charges":[{"gross_charge":537.94,"discounted_cash":537.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXERCISE BRONCHOSPASM PRE/POST SPIROMETRY  WITH PULSE OX AND ECG","code_information":[{"code":"4609461701","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94617","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.68,"discounted_cash":505.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PULMONARY STRESS TEST - SIMPLE","code_information":[{"code":"4609461801","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94618","type":"HCPCS"}],"standard_charges":[{"gross_charge":556.47,"discounted_cash":556.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXERCISE BRONCHOSPASM PRE/POST SPIROMETRY  WITH PULSE OX","code_information":[{"code":"4609461901","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94619","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.71,"discounted_cash":251.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIOPULMONARY EXERCISE TESTING","code_information":[{"code":"4609462101","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94621","type":"HCPCS"}],"standard_charges":[{"gross_charge":2463.07,"discounted_cash":2463.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OXYGEN UPTAKE INDIRECT EVAL - RESTING - SEPARATE PROCEDURE","code_information":[{"code":"4609469001","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94690","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.72,"discounted_cash":164.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST","code_information":[{"code":"4609472601","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94726","type":"HCPCS"}],"standard_charges":[{"gross_charge":1507.0,"discounted_cash":1507.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&VOL","code_information":[{"code":"4609472701","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94727","type":"HCPCS"}],"standard_charges":[{"gross_charge":676.7,"discounted_cash":676.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIFFUSING CAPACITY","code_information":[{"code":"4609472901","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94729","type":"HCPCS"}],"standard_charges":[{"gross_charge":731.24,"discounted_cash":731.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RT NONINVASV OXYGEN SATUR;SINGLE","code_information":[{"code":"4609476001","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94760","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.35,"discounted_cash":236.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NONINVASV OXYGEN SATUR,MULTIPLE","code_information":[{"code":"4609476101","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94761","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.63,"discounted_cash":557.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NONINVASV OXYGEN SATUT CONTINUOUS","code_information":[{"code":"4609476201","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94762","type":"HCPCS"}],"standard_charges":[{"gross_charge":1090.65,"discounted_cash":1090.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CAR SEAT/BED TEST INFT THRU 12 MO 60 MIN","code_information":[{"code":"4609478001","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94780","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.64,"discounted_cash":168.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CAR SEAT/BED TESTNG W/INTERP & REPORT +30MIN","code_information":[{"code":"4609478101","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94781","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.64,"discounted_cash":168.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EVOKED AUDITORY TEST,LIMITED","code_information":[{"code":"4719258701","type":"CDM"},{"code":"0471","type":"RC"},{"code":"92587","type":"HCPCS"}],"standard_charges":[{"gross_charge":544.1,"discounted_cash":544.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AUD: AUDITORY EVOKED POTENTIALS, HEARING STATUS DETERMINATION AUTOMATED","code_information":[{"code":"4719265001","type":"CDM"},{"code":"0471","type":"RC"},{"code":"92650","type":"HCPCS"}],"standard_charges":[{"gross_charge":544.1,"discounted_cash":544.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AUD: AUDITORY EVOKED POTENTIALS, HEARING STATUS DETERMINATION MANUAL","code_information":[{"code":"4719265101","type":"CDM"},{"code":"0471","type":"RC"},{"code":"92651","type":"HCPCS"}],"standard_charges":[{"gross_charge":544.1,"discounted_cash":544.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AUDITORY EVOKED POTENTIAL THRESHOLD EST AT MULT FREQ W/ INTERP AND RPT","code_information":[{"code":"4719265201","type":"CDM"},{"code":"0471","type":"RC"},{"code":"92652","type":"HCPCS"}],"standard_charges":[{"gross_charge":1916.59,"discounted_cash":1916.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AUDITORY EVOKED POTENTIAL NEURODIAGNOSTIC WITH INTERP AND REPORT","code_information":[{"code":"4719265301","type":"CDM"},{"code":"0471","type":"RC"},{"code":"92653","type":"HCPCS"}],"standard_charges":[{"gross_charge":1916.59,"discounted_cash":1916.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CORONARY FRACT FLOW RESRV ANALYSIS AND MODELING","code_information":[{"code":"4800503T01","type":"CDM"},{"code":"0480","type":"RC"},{"code":"0503T","type":"HCPCS"}],"standard_charges":[{"gross_charge":4232.0,"discounted_cash":4232.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NON-INVAS EST C-FFR SFTW ANAL CTA","code_information":[{"code":"4807558001","type":"CDM"},{"code":"0480","type":"RC"},{"code":"75580","type":"HCPCS"}],"standard_charges":[{"gross_charge":4232.0,"discounted_cash":4232.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEART/LUNG RESUSCITATION (CPR)","code_information":[{"code":"4809295001","type":"CDM"},{"code":"0480","type":"RC"},{"code":"92950","type":"HCPCS"}],"standard_charges":[{"gross_charge":3301.49,"discounted_cash":3301.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIOVERSION, ELECTIVE;EXTERN","code_information":[{"code":"4809296001","type":"CDM"},{"code":"0480","type":"RC"},{"code":"92960","type":"HCPCS"}],"standard_charges":[{"gross_charge":7040.96,"discounted_cash":7040.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTERROG DEV EVAL PM/LDLS PM PHYS/QHP IN PERSON","code_information":[{"code":"4809328805","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93288","type":"HCPCS"}],"standard_charges":[{"gross_charge":461.09,"discounted_cash":461.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COMPRE ELECTROPHYSIOLOGIC W/O ARRHYT INDUCTION","code_information":[{"code":"4809361901","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93619","type":"HCPCS"}],"standard_charges":[{"gross_charge":18337.68,"discounted_cash":18337.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ELECTROPHYSIOLOGIC F/U STUDY","code_information":[{"code":"4809362401","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93624","type":"HCPCS"}],"standard_charges":[{"gross_charge":25192.38,"discounted_cash":25192.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TILT TABLE EVALUATION","code_information":[{"code":"4809366001","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93660","type":"HCPCS"}],"standard_charges":[{"gross_charge":5152.14,"discounted_cash":5152.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OP PAD REHAB (SET)","code_information":[{"code":"4809366801","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93668","type":"HCPCS"}],"standard_charges":[{"gross_charge":670.29,"discounted_cash":670.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC AMBULATORY BLOOD PRESS MONITOR 24 HOUR CONTINUOUS RECORDING ONLY","code_information":[{"code":"4809378601","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93786","type":"HCPCS"}],"standard_charges":[{"gross_charge":430.33,"discounted_cash":430.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIOVERSION ELECTRIC INT - CARDIOVERSION INTERNAL","code_information":[{"code":"4809396101","type":"CDM"},{"code":"0480","type":"RC"},{"code":"92961","type":"HCPCS"}],"standard_charges":[{"gross_charge":6366.15,"discounted_cash":6366.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRANSCATH INS DUAL-CHAMB LEADLESS PACEMKR W/ IMG COMP SYS","code_information":[{"code":"4810795T01","type":"CDM"},{"code":"0481","type":"RC"},{"code":"0795T","type":"HCPCS"}],"standard_charges":[{"gross_charge":40294.56,"discounted_cash":40294.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSER HART PACER XVENOUS ATR/VENTR","code_information":[{"code":"4813320801","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33208","type":"HCPCS"}],"standard_charges":[{"gross_charge":44766.6,"discounted_cash":44766.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CCL INSER HEART TEMP PACER ONE CHMBR","code_information":[{"code":"4813321001","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33210","type":"HCPCS"}],"standard_charges":[{"gross_charge":10825.63,"discounted_cash":10825.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CCL INSERT PULSE GENER DUAL CHMBR","code_information":[{"code":"4813321301","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33213","type":"HCPCS"}],"standard_charges":[{"gross_charge":23374.1,"discounted_cash":23374.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CCL RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE","code_information":[{"code":"4813321501","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33215","type":"HCPCS"}],"standard_charges":[{"gross_charge":10929.48,"discounted_cash":10929.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CCL INSJ 1 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB","code_information":[{"code":"4813321601","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33216","type":"HCPCS"}],"standard_charges":[{"gross_charge":11060.76,"discounted_cash":11060.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CCL INSJ 2 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB","code_information":[{"code":"4813321701","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33217","type":"HCPCS"}],"standard_charges":[{"gross_charge":11618.23,"discounted_cash":11618.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CCL RELOCATION OF SKIN POCKET FOR PACEMAKER","code_information":[{"code":"4813322201","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33222","type":"HCPCS"}],"standard_charges":[{"gross_charge":10181.34,"discounted_cash":10181.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CCL RELOCATE SKIN POCKET IMPLANTABLE DEFIBRILLATOR","code_information":[{"code":"4813322301","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33223","type":"HCPCS"}],"standard_charges":[{"gross_charge":6437.42,"discounted_cash":6437.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSJ ELTRD CAR VEN SYS ATTCH PREV PM/DFB PLS GEN","code_information":[{"code":"4813322401","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33224","type":"HCPCS"}],"standard_charges":[{"gross_charge":45355.54,"discounted_cash":45355.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CCL INSJ ELTRD CAR VEN SYS TM INSJ DFB/PM PLS GEN","code_information":[{"code":"4813322501","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33225","type":"HCPCS"}],"standard_charges":[{"gross_charge":8854.98,"discounted_cash":8854.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CCL REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD","code_information":[{"code":"4813322701","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33227","type":"HCPCS"}],"standard_charges":[{"gross_charge":15789.64,"discounted_cash":15789.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS","code_information":[{"code":"4813322801","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33228","type":"HCPCS"}],"standard_charges":[{"gross_charge":19589.06,"discounted_cash":19589.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CCL REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LEAD","code_information":[{"code":"4813322901","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33229","type":"HCPCS"}],"standard_charges":[{"gross_charge":22674.46,"discounted_cash":22674.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CCL REMV PERM PACER GENERATOR","code_information":[{"code":"4813323301","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33233","type":"HCPCS"}],"standard_charges":[{"gross_charge":8574.13,"discounted_cash":8574.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CCL REMV TRANSVEN PACER ELECTRODE,1 LEAD","code_information":[{"code":"4813323401","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33234","type":"HCPCS"}],"standard_charges":[{"gross_charge":8695.9,"discounted_cash":8695.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CCL REMV TRANSVEN PACER ELECTRODE,2 LEAD","code_information":[{"code":"4813323501","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33235","type":"HCPCS"}],"standard_charges":[{"gross_charge":19886.23,"discounted_cash":19886.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CCL REMOVAL IMPLANTABLE DEFIB PULSE GENERATOR ONLY","code_information":[{"code":"4813324101","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33241","type":"HCPCS"}],"standard_charges":[{"gross_charge":8695.9,"discounted_cash":8695.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CCL INSJ/RPLCMT PERM DFB W/TRNSVNS LDS 1/DUAL CHMBR","code_information":[{"code":"4813324901","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33249","type":"HCPCS"}],"standard_charges":[{"gross_charge":29931.0,"discounted_cash":29931.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CCL RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD","code_information":[{"code":"4813326201","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33262","type":"HCPCS"}],"standard_charges":[{"gross_charge":84503.36,"discounted_cash":84503.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CCL RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD","code_information":[{"code":"4813326301","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33263","type":"HCPCS"}],"standard_charges":[{"gross_charge":39496.54,"discounted_cash":39496.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CCL RMVL IMPLTBL DFB PLS GEN W/RPLCMT PLS GEN MLT LD","code_information":[{"code":"4813326401","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33264","type":"HCPCS"}],"standard_charges":[{"gross_charge":73864.38,"discounted_cash":73864.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TCAT INSJ/RPL PERM LEADLESS PACEMAKER RV W/IMG","code_information":[{"code":"4813327401","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33274","type":"HCPCS"}],"standard_charges":[{"gross_charge":56228.63,"discounted_cash":56228.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RHC W/PLC PRESSURE SENSOR","code_information":[{"code":"4813328901","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33289","type":"HCPCS"}],"standard_charges":[{"gross_charge":21260.58,"discounted_cash":21260.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERQ CLSR TCAT L ATR APNDGE W/ENDOCARDIAL IMPLNT","code_information":[{"code":"4813334001","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33340","type":"HCPCS"}],"standard_charges":[{"gross_charge":43909.06,"discounted_cash":43909.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CCL REPLACE AORTIC VALVE PERQ FEMORAL ARTRY APPROACH","code_information":[{"code":"4813336101","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33361","type":"HCPCS"}],"standard_charges":[{"gross_charge":39577.51,"discounted_cash":39577.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERT INTRA-AORTIC BALLOON ASST DEVICE","code_information":[{"code":"4813396701","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33967","type":"HCPCS"}],"standard_charges":[{"gross_charge":6415.58,"discounted_cash":6415.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CCL INSJ PERQ VAD W/IMAGING ARTERY ACCESS ONLY","code_information":[{"code":"4813399001","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33990","type":"HCPCS"}],"standard_charges":[{"gross_charge":17153.48,"discounted_cash":17153.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CCL REMOVAL PERCUTANEOUS VAD DIFFERENT SESSION","code_information":[{"code":"4813399201","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33992","type":"HCPCS"}],"standard_charges":[{"gross_charge":7349.68,"discounted_cash":7349.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REVASC ILIAC ART,ANGIOPLST, INITIAL VESSEL, STRAIGHTFORWARD","code_information":[{"code":"4813725401","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37254","type":"HCPCS"}],"standard_charges":[{"gross_charge":12317.53,"discounted_cash":12317.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REVASC ILIAC ART,ANGIOPLST/STENT, INIT VESSEL, STRAIGHTFORWARD","code_information":[{"code":"4813725801","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37258","type":"HCPCS"}],"standard_charges":[{"gross_charge":20304.6,"discounted_cash":20304.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REVASC ILIAC ART,ANGIOPLST/STENT, EA ADD VESSEL, STRAIGHTFORWARD","code_information":[{"code":"4813725901","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37259","type":"HCPCS"}],"standard_charges":[{"gross_charge":13787.03,"discounted_cash":13787.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REVASC FEM/POP ART, ANGIOPLST, STRAIGHTFORWARD","code_information":[{"code":"4813726301","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37263","type":"HCPCS"}],"standard_charges":[{"gross_charge":37397.0,"discounted_cash":37397.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REVASC FEM/POP ART, ANGIOPLST, COMPLEX","code_information":[{"code":"4813726501","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37265","type":"HCPCS"}],"standard_charges":[{"gross_charge":19592.26,"discounted_cash":19592.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REVASC FEM/POP ART, ANGIOPLST/STENT, STRAIGHTFORWARD","code_information":[{"code":"4813726701","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37267","type":"HCPCS"}],"standard_charges":[{"gross_charge":20304.6,"discounted_cash":20304.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REVASC FEM/POP ART, ANGIOPLST/STENT, COMPLEX","code_information":[{"code":"4813726901","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37269","type":"HCPCS"}],"standard_charges":[{"gross_charge":34105.65,"discounted_cash":34105.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REVASC FEM/POP ART, ANGIOPLST/ATHERECTOMY, STRAIGHTFORWARD","code_information":[{"code":"4813727101","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37271","type":"HCPCS"}],"standard_charges":[{"gross_charge":26304.65,"discounted_cash":26304.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REVASC FEM/POP ART, ANGIOPLST/ATHERECTOMY, COMPLEX","code_information":[{"code":"4813727301","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37273","type":"HCPCS"}],"standard_charges":[{"gross_charge":36830.78,"discounted_cash":36830.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REVASC FEM/POP ART, ANGIOPLST/STENT/ATHER, STRAIGHTFORWARD","code_information":[{"code":"4813727501","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37275","type":"HCPCS"}],"standard_charges":[{"gross_charge":35517.47,"discounted_cash":35517.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REVASC FEM/POP ART, ANGIOPLST/STENT/ATHERECTOMY, COMPLEX EA ADD LES","code_information":[{"code":"4813727801","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37278","type":"HCPCS"}],"standard_charges":[{"gross_charge":19190.32,"discounted_cash":19190.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REVASC TIBIAL/PERON ART, ANGIOPLST INITIAL, STRAIGHTFORWARD","code_information":[{"code":"4813728001","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37280","type":"HCPCS"}],"standard_charges":[{"gross_charge":20304.6,"discounted_cash":20304.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REVASC TIBIAL/PERON ART,ANGIOPLST/STENT INITIAL, COMPLEX","code_information":[{"code":"4813728601","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37286","type":"HCPCS"}],"standard_charges":[{"gross_charge":35269.55,"discounted_cash":35269.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REVASC EVASC IMVT W/ ANGIO UNILAT INITIAL VESSEL, STRAIGHTFORWARD","code_information":[{"code":"4813729601","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37296","type":"HCPCS"}],"standard_charges":[{"gross_charge":20304.6,"discounted_cash":20304.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CATH PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH","code_information":[{"code":"4819292001","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92920","type":"HCPCS"}],"standard_charges":[{"gross_charge":39370.91,"discounted_cash":39370.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CATH PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH - LC","code_information":[{"code":"4819292002","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92920","type":"HCPCS"}],"standard_charges":[{"gross_charge":39370.91,"discounted_cash":39370.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CATH PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH - LD","code_information":[{"code":"4819292003","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92920","type":"HCPCS"}],"standard_charges":[{"gross_charge":39370.91,"discounted_cash":39370.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CATH PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH - RC","code_information":[{"code":"4819292004","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92920","type":"HCPCS"}],"standard_charges":[{"gross_charge":30960.26,"discounted_cash":30960.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CATH PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH - LM","code_information":[{"code":"4819292005","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92920","type":"HCPCS"}],"standard_charges":[{"gross_charge":39370.91,"discounted_cash":39370.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PRQ TRLUML CORONARY ANGIO/ATHERECT ONE ART/BRNCH","code_information":[{"code":"4819292401","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92924","type":"HCPCS"}],"standard_charges":[{"gross_charge":41047.94,"discounted_cash":41047.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PRQ TRANSLUMINAL CORONARY STENT W/ANGIO SGL ART/BRNCH, 1 LES/COR SEG","code_information":[{"code":"4819292801","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92928","type":"HCPCS"}],"standard_charges":[{"gross_charge":31909.44,"discounted_cash":31909.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH 2+ LES/SEG/STENT","code_information":[{"code":"4819293001","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92930","type":"HCPCS"}],"standard_charges":[{"gross_charge":58190.63,"discounted_cash":58190.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PRQ TRLUML CORONRY STENT/ATH/ANGIO ONE ART/BRNCH","code_information":[{"code":"4819293301","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92933","type":"HCPCS"}],"standard_charges":[{"gross_charge":31944.17,"discounted_cash":31944.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PRQ TRANSLUMINAL CORONARY BYP GRFT REVASC SGL MAJ COR ART/BRANCH","code_information":[{"code":"4819293701","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92937","type":"HCPCS"}],"standard_charges":[{"gross_charge":31911.01,"discounted_cash":31911.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PRQ TRANSLUMINAL CORONARY TOT OCCLUS REVASC MI SGL MAJ COR ART/BRANCH","code_information":[{"code":"4819294101","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92941","type":"HCPCS"}],"standard_charges":[{"gross_charge":30917.73,"discounted_cash":30917.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PRQ TRANSLUMINAL CORONARY CHRONIC OCCL REVASC SGL COR ART, ANTEGRADE APP","code_information":[{"code":"4819294301","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92943","type":"HCPCS"}],"standard_charges":[{"gross_charge":32214.49,"discounted_cash":32214.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERQ TRLUML REVSC CHRNC TOT OCCLS 1 ANTGRD & RTRGR","code_information":[{"code":"4819294501","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92945","type":"HCPCS"}],"standard_charges":[{"gross_charge":38368.28,"discounted_cash":38368.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TEMPORARY EXTERNAL PACING","code_information":[{"code":"4819295301","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92953","type":"HCPCS"}],"standard_charges":[{"gross_charge":2492.52,"discounted_cash":2492.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERC TRANSLUMINAL CORONARY LITHO","code_information":[{"code":"4819297201","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92972","type":"HCPCS"}],"standard_charges":[{"gross_charge":22114.75,"discounted_cash":22114.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PRQ TRANSLUMINAL CORONARY MECHANICL ASP THROMBECTOMY","code_information":[{"code":"4819297301","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92973","type":"HCPCS"}],"standard_charges":[{"gross_charge":6298.87,"discounted_cash":6298.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CATH INTRAVASC US,HEART,1ST VESSEL","code_information":[{"code":"4819297801","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92978","type":"HCPCS"}],"standard_charges":[{"gross_charge":6976.99,"discounted_cash":6976.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CATH INTRAVASC US,HEART,1ST VESSEL - LC","code_information":[{"code":"4819297802","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92978","type":"HCPCS"}],"standard_charges":[{"gross_charge":6976.99,"discounted_cash":6976.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CATH INTRAVASC US,HEART,1ST VESSEL - LD","code_information":[{"code":"4819297803","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92978","type":"HCPCS"}],"standard_charges":[{"gross_charge":6976.99,"discounted_cash":6976.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CATH INTRAVASC US,HEART,1ST VESSEL - RC","code_information":[{"code":"4819297804","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92978","type":"HCPCS"}],"standard_charges":[{"gross_charge":6976.99,"discounted_cash":6976.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CATH INTRAVASC CORONARY SONO,ADDN VESSEL","code_information":[{"code":"4819297901","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92979","type":"HCPCS"}],"standard_charges":[{"gross_charge":4945.62,"discounted_cash":4945.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CATH INTRAVASC CORONARY SONO,ADDN VESSEL - LC","code_information":[{"code":"4819297902","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92979","type":"HCPCS"}],"standard_charges":[{"gross_charge":4945.62,"discounted_cash":4945.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERCUT AORTIC VALVULOPLASTY","code_information":[{"code":"4819298601","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92986","type":"HCPCS"}],"standard_charges":[{"gross_charge":15937.87,"discounted_cash":15937.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERCUT MITRAL VALVULOPLASTY","code_information":[{"code":"4819298701","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92987","type":"HCPCS"}],"standard_charges":[{"gross_charge":27347.8,"discounted_cash":27347.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERCUT PULMONARY VALVULOPLASTY","code_information":[{"code":"4819299001","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92990","type":"HCPCS"}],"standard_charges":[{"gross_charge":27347.8,"discounted_cash":27347.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT","code_information":[{"code":"4819345101","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93451","type":"HCPCS"}],"standard_charges":[{"gross_charge":10901.3,"discounted_cash":10901.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEFT HEART CATH INJECT VETRICULOGRAPHY, IMAGE SUPERVISE/INTERP","code_information":[{"code":"4819345201","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93452","type":"HCPCS"}],"standard_charges":[{"gross_charge":27736.19,"discounted_cash":27736.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RIGHT & LEFT HEART CATH INJECT VETRICULOGRAPHY, IMAGE SUPERVISE/INTERP","code_information":[{"code":"4819345301","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93453","type":"HCPCS"}],"standard_charges":[{"gross_charge":27736.19,"discounted_cash":27736.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CATH PLACE/CORONARY ANGIO, IMG SUPER/INTERP","code_information":[{"code":"4819345401","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93454","type":"HCPCS"}],"standard_charges":[{"gross_charge":14269.43,"discounted_cash":14269.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CATH PLACE/CORONARY ANGIO, IMG SUPER/INTERP, BYPASS ANGIO","code_information":[{"code":"4819345501","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93455","type":"HCPCS"}],"standard_charges":[{"gross_charge":17261.65,"discounted_cash":17261.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CATH PLACE/CORONARY ANGIO, IMG SUPER/INTERP,W RIGHT HEART CATH","code_information":[{"code":"4819345601","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93456","type":"HCPCS"}],"standard_charges":[{"gross_charge":20274.62,"discounted_cash":20274.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CATH PLACE/CORON ANGIO, IMG SUPER/INTERP, BYPASS ANGIO,W R HEART CATH","code_information":[{"code":"4819345701","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93457","type":"HCPCS"}],"standard_charges":[{"gross_charge":24898.39,"discounted_cash":24898.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CATH PLACE/CORON ANGIO, IMG SUPER/INTERP,W LEFT HEART VENTRICULOGRAPHY","code_information":[{"code":"4819345801","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93458","type":"HCPCS"}],"standard_charges":[{"gross_charge":22114.75,"discounted_cash":22114.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CATH PLACE/CORON ANGIO, IMG SUPER/INTERP, BYPASS ANGIO,W L HRT VENTRIC","code_information":[{"code":"4819345901","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93459","type":"HCPCS"}],"standard_charges":[{"gross_charge":25679.3,"discounted_cash":25679.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CATH PLACE/CORON ANGIO, IMG SUPER/INTERP,R&L HRT CATH, L HRT VENTRIC","code_information":[{"code":"4819346001","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93460","type":"HCPCS"}],"standard_charges":[{"gross_charge":21444.05,"discounted_cash":21444.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CATH PLACE/COR ANG,IMG SUPR/INTRP,BYPASS ANG, R&L CATH, L HRT VENTRIC","code_information":[{"code":"4819346101","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93461","type":"HCPCS"}],"standard_charges":[{"gross_charge":25548.83,"discounted_cash":25548.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC LEFT HEART CATH BY TRANSEPTAL PUNCTURE","code_information":[{"code":"4819346201","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93462","type":"HCPCS"}],"standard_charges":[{"gross_charge":9044.25,"discounted_cash":9044.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MEDICATION ADMIN & HEMODYNAMIC MEASURMENT","code_information":[{"code":"4819346301","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93463","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.86,"discounted_cash":354.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INSERT/PLACE FLOW DIRECT CATH","code_information":[{"code":"4819350301","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93503","type":"HCPCS"}],"standard_charges":[{"gross_charge":12326.92,"discounted_cash":12326.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CATH INJECT SELECT COR ANGIO DURING CONGENITAL HEART CATH","code_information":[{"code":"4819356301","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93563","type":"HCPCS"}],"standard_charges":[{"gross_charge":4233.54,"discounted_cash":4233.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CATH INJECT SELECT COR/GRAFT ANGIO DURING CONGENITAL HEART CATH","code_information":[{"code":"4819356401","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93564","type":"HCPCS"}],"standard_charges":[{"gross_charge":1484.99,"discounted_cash":1484.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECT SELECT LEFT VENT/ATRIAL ANGIO DURING HEART CATH","code_information":[{"code":"4819356501","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93565","type":"HCPCS"}],"standard_charges":[{"gross_charge":3661.87,"discounted_cash":3661.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECT SELECT RIGHT VENT/ATRIAL ANGIO DURING HEART CATH","code_information":[{"code":"4819356601","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93566","type":"HCPCS"}],"standard_charges":[{"gross_charge":3815.49,"discounted_cash":3815.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECT SUPRAVALVULAR AORTOGRAPHY DURING HEART CATH","code_information":[{"code":"4819356701","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93567","type":"HCPCS"}],"standard_charges":[{"gross_charge":3276.56,"discounted_cash":3276.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECT PULMONARY ANGIOGRAPHY DURING HEART CATH","code_information":[{"code":"4819356801","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93568","type":"HCPCS"}],"standard_charges":[{"gross_charge":2914.05,"discounted_cash":2914.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEART FLOW RESERV MEASURE,INIT VESSL","code_information":[{"code":"4819357101","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93571","type":"HCPCS"}],"standard_charges":[{"gross_charge":3103.98,"discounted_cash":3103.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEART FLOW RESERV MEASURE,ADDN VESSL","code_information":[{"code":"4819357201","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93572","type":"HCPCS"}],"standard_charges":[{"gross_charge":1828.99,"discounted_cash":1828.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJ W/ CATH SEL PULM ART ANGIO W/IMG BIL","code_information":[{"code":"4819357301","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93573","type":"HCPCS"}],"standard_charges":[{"gross_charge":1995.0,"discounted_cash":1995.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERC CLOS,CONG INTERATRIAL COMMUN W/IMPL","code_information":[{"code":"4819358001","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93580","type":"HCPCS"}],"standard_charges":[{"gross_charge":42663.65,"discounted_cash":42663.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERC CLOSURE,CONG VSD W/IMPLANT","code_information":[{"code":"4819358101","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93581","type":"HCPCS"}],"standard_charges":[{"gross_charge":56269.83,"discounted_cash":56269.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CATH PERCUTAN TRANSCATH CLOSURE PAT DUCT ARTERIOSUS","code_information":[{"code":"4819358201","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93582","type":"HCPCS"}],"standard_charges":[{"gross_charge":88023.7,"discounted_cash":88023.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CATH PERCUTANEOUS TRANSCATHETER SEPTAL REDUCTION THER","code_information":[{"code":"4819358301","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93583","type":"HCPCS"}],"standard_charges":[{"gross_charge":22316.95,"discounted_cash":22316.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CATH PERQ TRANSCATH CLS PARAVALVR LEAK 1 MITRAL VALVE","code_information":[{"code":"4819359001","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93590","type":"HCPCS"}],"standard_charges":[{"gross_charge":44819.0,"discounted_cash":44819.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC R/L HEART CATH CONGEN DEFECT NML NATIVE CONNECTIONS","code_information":[{"code":"4819359601","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93596","type":"HCPCS"}],"standard_charges":[{"gross_charge":27736.19,"discounted_cash":27736.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BUNDLE OF HIS RECORDING","code_information":[{"code":"4819360001","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93600","type":"HCPCS"}],"standard_charges":[{"gross_charge":13297.45,"discounted_cash":13297.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTRA-ATRIAL RECORDING","code_information":[{"code":"4819360201","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93602","type":"HCPCS"}],"standard_charges":[{"gross_charge":13297.45,"discounted_cash":13297.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RIGHT VENTRICULAR RECORDING","code_information":[{"code":"4819360301","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93603","type":"HCPCS"}],"standard_charges":[{"gross_charge":5471.15,"discounted_cash":5471.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MAP,TACHYCARDIA SITE W/CATH MANIPUL","code_information":[{"code":"4819360901","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93609","type":"HCPCS"}],"standard_charges":[{"gross_charge":8669.75,"discounted_cash":8669.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTRA-ATRIAL PACING","code_information":[{"code":"4819361001","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93610","type":"HCPCS"}],"standard_charges":[{"gross_charge":13813.58,"discounted_cash":13813.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTRAVENTRICULAR PACING","code_information":[{"code":"4819361201","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93612","type":"HCPCS"}],"standard_charges":[{"gross_charge":13297.45,"discounted_cash":13297.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTRACARD ELECTROPHYS 3-DIMENS MAPPING","code_information":[{"code":"4819361301","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93613","type":"HCPCS"}],"standard_charges":[{"gross_charge":6238.75,"discounted_cash":6238.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INDUC ARRHYTH BY HEART RHYTHM PACING","code_information":[{"code":"4819361801","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93618","type":"HCPCS"}],"standard_charges":[{"gross_charge":13020.1,"discounted_cash":13020.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION","code_information":[{"code":"4819362001","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93620","type":"HCPCS"}],"standard_charges":[{"gross_charge":25192.38,"discounted_cash":25192.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC","code_information":[{"code":"4819362101","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93621","type":"HCPCS"}],"standard_charges":[{"gross_charge":31993.78,"discounted_cash":31993.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC COMPRE ELECTROPHYSIOL XM W/LEFT VENTR PACNG/REC","code_information":[{"code":"4819362201","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93622","type":"HCPCS"}],"standard_charges":[{"gross_charge":15900.11,"discounted_cash":15900.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC STIM/PACING HEART POST IV DRUG INFU","code_information":[{"code":"4819362301","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93623","type":"HCPCS"}],"standard_charges":[{"gross_charge":9109.98,"discounted_cash":9109.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EVAL CARDIOVERT LEADS,INITIAL","code_information":[{"code":"4819364001","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93640","type":"HCPCS"}],"standard_charges":[{"gross_charge":4563.94,"discounted_cash":4563.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EVAL CARDIOVERT LEADS/PULS GEN","code_information":[{"code":"4819364101","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93641","type":"HCPCS"}],"standard_charges":[{"gross_charge":9269.14,"discounted_cash":9269.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS","code_information":[{"code":"4819364201","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93642","type":"HCPCS"}],"standard_charges":[{"gross_charge":8170.77,"discounted_cash":8170.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ABLATE AV NODE FUNCTION","code_information":[{"code":"4819365001","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93650","type":"HCPCS"}],"standard_charges":[{"gross_charge":20103.05,"discounted_cash":20103.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EPHYS EVAL W/ABLATION SUPRAVENT ARRHYTHMIA","code_information":[{"code":"4819365301","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93653","type":"HCPCS"}],"standard_charges":[{"gross_charge":60296.94,"discounted_cash":60296.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EPHYS EVAL W/ABLATION VENTRICULAR TACHYCARDIA","code_information":[{"code":"4819365401","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93654","type":"HCPCS"}],"standard_charges":[{"gross_charge":60473.74,"discounted_cash":60473.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ICAR CATHETER ABLATION ARRHYTHMIA ADD ON","code_information":[{"code":"4819365501","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93655","type":"HCPCS"}],"standard_charges":[{"gross_charge":12245.87,"discounted_cash":12245.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EPHYS EVL TRNSPTL TX ATRIAL FIB ISOLAT PULM VEIN","code_information":[{"code":"4819365601","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93656","type":"HCPCS"}],"standard_charges":[{"gross_charge":59073.41,"discounted_cash":59073.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ABLATE L/R ATRIAL FIBRIL W/ ISOLATED PULM VEIN","code_information":[{"code":"4819365701","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93657","type":"HCPCS"}],"standard_charges":[{"gross_charge":19768.3,"discounted_cash":19768.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INTRACARD ECHO, THER/DX INTERVENT","code_information":[{"code":"4819366201","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93662","type":"HCPCS"}],"standard_charges":[{"gross_charge":8996.62,"discounted_cash":8996.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIOVASCULAR PROCEDURE UNLISTED","code_information":[{"code":"4819379901","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93799","type":"HCPCS"}],"standard_charges":[{"gross_charge":1963.96,"discounted_cash":1963.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CCL PTA PLCMT DRUG ELUTING SNGL STENT MAJ COR VESSEL","code_information":[{"code":"481C960001","type":"CDM"},{"code":"0481","type":"RC"},{"code":"C9600","type":"HCPCS"}],"standard_charges":[{"gross_charge":41547.03,"discounted_cash":41547.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CCL PTA PLCMT DRUG ELUTING ADDITIONAL STENT MAJ COR VESSEL","code_information":[{"code":"481C960101","type":"CDM"},{"code":"0481","type":"RC"},{"code":"C9601","type":"HCPCS"}],"standard_charges":[{"gross_charge":33652.25,"discounted_cash":33652.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CCL ATHER W/DRUG ELUTING SNGL STENT MAJ COR VESSEL","code_information":[{"code":"481C960201","type":"CDM"},{"code":"0481","type":"RC"},{"code":"C9602","type":"HCPCS"}],"standard_charges":[{"gross_charge":42960.66,"discounted_cash":42960.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CCL ATHER W/DRUG ELUTING ADDITIONAL STENT MAJ COR VESSEL","code_information":[{"code":"481C960301","type":"CDM"},{"code":"0481","type":"RC"},{"code":"C9603","type":"HCPCS"}],"standard_charges":[{"gross_charge":20698.08,"discounted_cash":20698.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CCL REVAS COR GRAFT W DRUG STENT PLCMT SINGLE","code_information":[{"code":"481C960401","type":"CDM"},{"code":"0481","type":"RC"},{"code":"C9604","type":"HCPCS"}],"standard_charges":[{"gross_charge":41542.11,"discounted_cash":41542.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CCL REVAS COR GRAFT W DRUG STENT PLCMT ADDITIONAL","code_information":[{"code":"481C960501","type":"CDM"},{"code":"0481","type":"RC"},{"code":"C9605","type":"HCPCS"}],"standard_charges":[{"gross_charge":20698.08,"discounted_cash":20698.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CCL AMI REVAS W DRUG STENT PLCMT SINGLE","code_information":[{"code":"481C960601","type":"CDM"},{"code":"0481","type":"RC"},{"code":"C9606","type":"HCPCS"}],"standard_charges":[{"gross_charge":40560.91,"discounted_cash":40560.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CCL REVAS CHRON OCCL W DRUG STENT PLCMT SINGLE","code_information":[{"code":"481C960701","type":"CDM"},{"code":"0481","type":"RC"},{"code":"C9607","type":"HCPCS"}],"standard_charges":[{"gross_charge":41394.38,"discounted_cash":41394.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PERC D-E COR REVASC CHRO ADDITIONAL","code_information":[{"code":"481C960801","type":"CDM"},{"code":"0481","type":"RC"},{"code":"C9608","type":"HCPCS"}],"standard_charges":[{"gross_charge":18485.07,"discounted_cash":18485.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REVASC ENDOVAS ANY VESSEL W/ IV LITHO/ANGIO","code_information":[{"code":"481C976401","type":"CDM"},{"code":"0481","type":"RC"},{"code":"C9764","type":"HCPCS"}],"standard_charges":[{"gross_charge":21337.48,"discounted_cash":21337.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REVASC ENDOVAS ANY VESSEL W/ IV LITHO/ANGIO/STENT","code_information":[{"code":"481C976501","type":"CDM"},{"code":"0481","type":"RC"},{"code":"C9765","type":"HCPCS"}],"standard_charges":[{"gross_charge":28007.55,"discounted_cash":28007.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REVASC ENDOVAS ANY VESSEL W/ IV LITHO/ATHER/STENT","code_information":[{"code":"481C976701","type":"CDM"},{"code":"0481","type":"RC"},{"code":"C9767","type":"HCPCS"}],"standard_charges":[{"gross_charge":28007.55,"discounted_cash":28007.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ILIAC ART ANGIO,CARDIAC CATH","code_information":[{"code":"481G027801","type":"CDM"},{"code":"0481","type":"RC"},{"code":"G0278","type":"HCPCS"}],"standard_charges":[{"gross_charge":7596.71,"discounted_cash":7596.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIAC STRESS TEST EXERCISE/PHARM - TRACING ONLY","code_information":[{"code":"4829301701","type":"CDM"},{"code":"0482","type":"RC"},{"code":"93017","type":"HCPCS"}],"standard_charges":[{"gross_charge":3882.51,"discounted_cash":3882.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIAC STRESS TST,TRACING - STRESS TEST ONLY, PHARM","code_information":[{"code":"4829301752","type":"CDM"},{"code":"0482","type":"RC"},{"code":"93017","type":"HCPCS"}],"standard_charges":[{"gross_charge":3882.51,"discounted_cash":3882.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ECHO XTHORACIC,CONG ANOM,COMPLETE","code_information":[{"code":"4839330302","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93303","type":"HCPCS"}],"standard_charges":[{"gross_charge":5409.3,"discounted_cash":5409.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ECHO XTHORACIC,CONG ANOM,LIMITED","code_information":[{"code":"4839330402","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93304","type":"HCPCS"}],"standard_charges":[{"gross_charge":2180.75,"discounted_cash":2180.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TTE W/DOPPLER COMPLETE - TRANSTHORACIC ECHO (TTE) COMPLETE","code_information":[{"code":"4839330601","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93306","type":"HCPCS"}],"standard_charges":[{"gross_charge":6805.02,"discounted_cash":6805.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TTE W/DOPPLER COMPLETE - TTE COMPLETE","code_information":[{"code":"4839330602","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93306","type":"HCPCS"}],"standard_charges":[{"gross_charge":6805.02,"discounted_cash":6805.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TTE W/DOPPLER W OR WO FOL W CONTRAST","code_information":[{"code":"4839330603","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93306","type":"HCPCS"}],"standard_charges":[{"gross_charge":6805.02,"discounted_cash":6805.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ECHO HEART XTHORACIC,COMPLETE, W/O DOPPLER","code_information":[{"code":"4839330702","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93307","type":"HCPCS"}],"standard_charges":[{"gross_charge":1968.54,"discounted_cash":1968.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TTE F-UP OR LMTD W OR WO FOL W CONTRAST","code_information":[{"code":"4839330807","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93308","type":"HCPCS"}],"standard_charges":[{"gross_charge":2024.9,"discounted_cash":2024.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TTE F-UP OR LMTD - TTE LIMITED W/ COLOR","code_information":[{"code":"4839330809","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93308","type":"HCPCS"}],"standard_charges":[{"gross_charge":2024.9,"discounted_cash":2024.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TTE F-UP OR LMTD - TTE LIMITED W/ DOPPLER AND COLOR","code_information":[{"code":"4839330810","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93308","type":"HCPCS"}],"standard_charges":[{"gross_charge":2024.9,"discounted_cash":2024.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TTE F-UP OR LMTD W/ DOPPLER/COLOR W OR WO FOL W CONT","code_information":[{"code":"4839330811","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93308","type":"HCPCS"}],"standard_charges":[{"gross_charge":2024.9,"discounted_cash":2024.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ECHO TRANSESOPHAGEAL - TEE LIMITED","code_information":[{"code":"4839331202","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93312","type":"HCPCS"}],"standard_charges":[{"gross_charge":6921.12,"discounted_cash":6921.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TEE COMPLETE W OR WO FOL W CONTRAST","code_information":[{"code":"4839331204","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93312","type":"HCPCS"}],"standard_charges":[{"gross_charge":3229.35,"discounted_cash":3229.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ECHO TRANSESOPHAGEAL - TEE COMPLETE W/ DOPPLER & COLOR","code_information":[{"code":"4839331206","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93312","type":"HCPCS"}],"standard_charges":[{"gross_charge":3229.35,"discounted_cash":3229.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ECHO TRANSESOPHAGEAL - TEE COMPLETE W/ COLOR","code_information":[{"code":"4839331208","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93312","type":"HCPCS"}],"standard_charges":[{"gross_charge":3229.35,"discounted_cash":3229.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DOPPLER ECHO HEART,COMPLETE","code_information":[{"code":"4839332007","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93320","type":"HCPCS"}],"standard_charges":[{"gross_charge":2303.78,"discounted_cash":2303.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DOPPLER ECHO HEART,LIMITED,F/U","code_information":[{"code":"4839332104","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93321","type":"HCPCS"}],"standard_charges":[{"gross_charge":1040.66,"discounted_cash":1040.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DOPPLER COLOR FLOW VELOCITY MAP","code_information":[{"code":"4839332527","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93325","type":"HCPCS"}],"standard_charges":[{"gross_charge":2228.15,"discounted_cash":2228.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC STRESS TTE W OR WO FOL W CONTRAST ECG","code_information":[{"code":"4839335002","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93350","type":"HCPCS"}],"standard_charges":[{"gross_charge":3751.43,"discounted_cash":3751.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG","code_information":[{"code":"4839335101","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93351","type":"HCPCS"}],"standard_charges":[{"gross_charge":3391.89,"discounted_cash":3391.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ECHO TEE GUID TCAT ICAR/VESSEL STRUCTURAL INTVN","code_information":[{"code":"4839335501","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93355","type":"HCPCS"}],"standard_charges":[{"gross_charge":5408.55,"discounted_cash":5408.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MYOCRD STRAIN IMG SPECKLE TRCK ASSMT MYOCRD MECH","code_information":[{"code":"4839335601","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93356","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.25,"discounted_cash":278.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OFFICE OUTPATIENT NEW PT SF MDM","code_information":[{"code":"51099202PB","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99202","type":"HCPCS"}],"standard_charges":[{"gross_charge":723.45,"discounted_cash":723.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OFFICE OUTPATIENT NEW PT LOW LVL MDM","code_information":[{"code":"51099203PB","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99203","type":"HCPCS"}],"standard_charges":[{"gross_charge":923.23,"discounted_cash":923.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OFFICE OUTPATIENT NEW PT MOD LVL MDM","code_information":[{"code":"51099204PB","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":1046.33,"discounted_cash":1046.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OFFICE OUTPATIENT NEW PT HIGH LVL MDM","code_information":[{"code":"51099205PB","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99205","type":"HCPCS"}],"standard_charges":[{"gross_charge":1169.43,"discounted_cash":1169.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OFFICE OUTPATIENT VISIT EST PT MINIMAL","code_information":[{"code":"51099211PB","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":584.72,"discounted_cash":584.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OFFICE OUTPATIENT VISIT EST PT SF MDM","code_information":[{"code":"51099212PB","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":738.59,"discounted_cash":738.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OFFICE OUTPATIENT VISIT EST PT LOW LVL MDM","code_information":[{"code":"51099213PB","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":861.68,"discounted_cash":861.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OFFICE OUTPATIENT VISIT EST PT MOD LVL MDM","code_information":[{"code":"51099214PB","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":984.78,"discounted_cash":984.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OFFICE OUTPATIENT VISIT EST PT HIGH LVL MDM","code_information":[{"code":"51099215PB","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":1107.88,"discounted_cash":1107.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OFFICE/OP CONSULT NEW/ESTAB PATIENT 40 MIN","code_information":[{"code":"5109924401","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99244","type":"HCPCS"}],"standard_charges":[{"gross_charge":664.46,"discounted_cash":664.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PREVENT COUNSEL,INDIV,30 MIN","code_information":[{"code":"5109940201","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99402","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.42,"discounted_cash":181.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, CHEST","code_information":[{"code":"6107155001","type":"CDM"},{"code":"0610","type":"RC"},{"code":"71550","type":"HCPCS"}],"standard_charges":[{"gross_charge":3652.87,"discounted_cash":3652.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, CHEST, W/CONTRAST","code_information":[{"code":"6107155101","type":"CDM"},{"code":"0610","type":"RC"},{"code":"71551","type":"HCPCS"}],"standard_charges":[{"gross_charge":6353.0,"discounted_cash":6353.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, CHEST, COMBO","code_information":[{"code":"6107155202","type":"CDM"},{"code":"0610","type":"RC"},{"code":"71552","type":"HCPCS"}],"standard_charges":[{"gross_charge":9053.14,"discounted_cash":9053.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST","code_information":[{"code":"6107555701","type":"CDM"},{"code":"0610","type":"RC"},{"code":"75557","type":"HCPCS"}],"standard_charges":[{"gross_charge":1025.07,"discounted_cash":1025.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARDIAC MRI W/W/O CONTRAST & FURTHER SEQ","code_information":[{"code":"6107556101","type":"CDM"},{"code":"0610","type":"RC"},{"code":"75561","type":"HCPCS"}],"standard_charges":[{"gross_charge":1638.34,"discounted_cash":1638.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MR SAFTEY IMPLANT & FOREIGN BODY ASSMT CLIN STAFF 1ST 15 MIN","code_information":[{"code":"6107601401","type":"CDM"},{"code":"0610","type":"RC"},{"code":"76014","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.49,"discounted_cash":105.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MR SAFTEY IMPLANT & FOREIGN BODY ASSMT CLIN STAFF EA ADD 30 MIN","code_information":[{"code":"6107601501","type":"CDM"},{"code":"0610","type":"RC"},{"code":"76015","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.98,"discounted_cash":210.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MR SAFETY IMPLT ELECTRONICS PREP SUPV PHYS/QHP","code_information":[{"code":"6107601801","type":"CDM"},{"code":"0610","type":"RC"},{"code":"76018","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.92,"discounted_cash":346.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI BREAST WO CONTRAST BILATERAL","code_information":[{"code":"6107704701","type":"CDM"},{"code":"0610","type":"RC"},{"code":"77047","type":"HCPCS"}],"standard_charges":[{"gross_charge":1025.07,"discounted_cash":1025.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI BRAIN","code_information":[{"code":"6117055102","type":"CDM"},{"code":"0611","type":"RC"},{"code":"70551","type":"HCPCS"}],"standard_charges":[{"gross_charge":7833.94,"discounted_cash":7833.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI BRAIN CONTRAST","code_information":[{"code":"6117055202","type":"CDM"},{"code":"0611","type":"RC"},{"code":"70552","type":"HCPCS"}],"standard_charges":[{"gross_charge":10111.25,"discounted_cash":10111.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI BRAIN COMBO","code_information":[{"code":"6117055302","type":"CDM"},{"code":"0611","type":"RC"},{"code":"70553","type":"HCPCS"}],"standard_charges":[{"gross_charge":12130.06,"discounted_cash":12130.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, CERV SPINE","code_information":[{"code":"6127214102","type":"CDM"},{"code":"0612","type":"RC"},{"code":"72141","type":"HCPCS"}],"standard_charges":[{"gross_charge":9072.31,"discounted_cash":9072.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, CERV SPINE CONTRAST","code_information":[{"code":"6127214201","type":"CDM"},{"code":"0612","type":"RC"},{"code":"72142","type":"HCPCS"}],"standard_charges":[{"gross_charge":13455.82,"discounted_cash":13455.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, DORSAL SPINE","code_information":[{"code":"6127214602","type":"CDM"},{"code":"0612","type":"RC"},{"code":"72146","type":"HCPCS"}],"standard_charges":[{"gross_charge":8731.33,"discounted_cash":8731.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, DORSAL SPINE CONTRAST","code_information":[{"code":"6127214701","type":"CDM"},{"code":"0612","type":"RC"},{"code":"72147","type":"HCPCS"}],"standard_charges":[{"gross_charge":9467.45,"discounted_cash":9467.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, LUMBAR SPINE","code_information":[{"code":"6127214802","type":"CDM"},{"code":"0612","type":"RC"},{"code":"72148","type":"HCPCS"}],"standard_charges":[{"gross_charge":9458.83,"discounted_cash":9458.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, LUMBAR SPINE CONTRAST","code_information":[{"code":"6127214901","type":"CDM"},{"code":"0612","type":"RC"},{"code":"72149","type":"HCPCS"}],"standard_charges":[{"gross_charge":5024.86,"discounted_cash":5024.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, CERV SPINE COMBO","code_information":[{"code":"6127215601","type":"CDM"},{"code":"0612","type":"RC"},{"code":"72156","type":"HCPCS"}],"standard_charges":[{"gross_charge":12182.99,"discounted_cash":12182.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, DORSAL SPINE COMBO","code_information":[{"code":"6127215701","type":"CDM"},{"code":"0612","type":"RC"},{"code":"72157","type":"HCPCS"}],"standard_charges":[{"gross_charge":12170.68,"discounted_cash":12170.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, LUMBAR SPINE COMBO","code_information":[{"code":"6127215801","type":"CDM"},{"code":"0612","type":"RC"},{"code":"72158","type":"HCPCS"}],"standard_charges":[{"gross_charge":11491.19,"discounted_cash":11491.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, TMJ","code_information":[{"code":"6147033601","type":"CDM"},{"code":"0614","type":"RC"},{"code":"70336","type":"HCPCS"}],"standard_charges":[{"gross_charge":1025.07,"discounted_cash":1025.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, PELVIS, W/O CONTRAST","code_information":[{"code":"6147219501","type":"CDM"},{"code":"0614","type":"RC"},{"code":"72195","type":"HCPCS"}],"standard_charges":[{"gross_charge":8410.05,"discounted_cash":8410.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, PELVIS W/CONTRAST","code_information":[{"code":"6147219601","type":"CDM"},{"code":"0614","type":"RC"},{"code":"72196","type":"HCPCS"}],"standard_charges":[{"gross_charge":8491.08,"discounted_cash":8491.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, PELVIS, COMBO","code_information":[{"code":"6147219701","type":"CDM"},{"code":"0614","type":"RC"},{"code":"72197","type":"HCPCS"}],"standard_charges":[{"gross_charge":10371.0,"discounted_cash":10371.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MR ANGIO PELVIS(MRA)","code_information":[{"code":"6147219802","type":"CDM"},{"code":"0614","type":"RC"},{"code":"72198","type":"HCPCS"}],"standard_charges":[{"gross_charge":6705.83,"discounted_cash":6705.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, UPPER EXTREMITY W/O CONTRAST","code_information":[{"code":"6147321803","type":"CDM"},{"code":"0614","type":"RC"},{"code":"73218","type":"HCPCS"}],"standard_charges":[{"gross_charge":7555.74,"discounted_cash":7555.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, UPPER EXTREMITY W/CONTRAST - MR UPPER EXTREMITY W IV CONTRAST","code_information":[{"code":"6147321901","type":"CDM"},{"code":"0614","type":"RC"},{"code":"73219","type":"HCPCS"}],"standard_charges":[{"gross_charge":7467.12,"discounted_cash":7467.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI UPPER EXTREMITY COMBO","code_information":[{"code":"6147322004","type":"CDM"},{"code":"0614","type":"RC"},{"code":"73220","type":"HCPCS"}],"standard_charges":[{"gross_charge":8961.52,"discounted_cash":8961.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, JOINT UPPER EXTREM","code_information":[{"code":"6147322106","type":"CDM"},{"code":"0614","type":"RC"},{"code":"73221","type":"HCPCS"}],"standard_charges":[{"gross_charge":9671.79,"discounted_cash":9671.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, JOINT UPPER EXTREM W/CONTRAST","code_information":[{"code":"6147322205","type":"CDM"},{"code":"0614","type":"RC"},{"code":"73222","type":"HCPCS"}],"standard_charges":[{"gross_charge":6030.23,"discounted_cash":6030.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, JOINT UPPER EXTREM COMBO","code_information":[{"code":"6147322306","type":"CDM"},{"code":"0614","type":"RC"},{"code":"73223","type":"HCPCS"}],"standard_charges":[{"gross_charge":9436.68,"discounted_cash":9436.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, LOWER EXTREM","code_information":[{"code":"6147371806","type":"CDM"},{"code":"0614","type":"RC"},{"code":"73718","type":"HCPCS"}],"standard_charges":[{"gross_charge":8747.33,"discounted_cash":8747.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, LOWER EXTREM W/CONTRAST","code_information":[{"code":"6147371902","type":"CDM"},{"code":"0614","type":"RC"},{"code":"73719","type":"HCPCS"}],"standard_charges":[{"gross_charge":6700.26,"discounted_cash":6700.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI LWR EXTREMITY W/O&W/DYE - MR LOWER EXTREMITY W AND WO IV CONT","code_information":[{"code":"6147372008","type":"CDM"},{"code":"0614","type":"RC"},{"code":"73720","type":"HCPCS"}],"standard_charges":[{"gross_charge":10239.27,"discounted_cash":10239.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI LOWER EXTREMITY JOINT, W/O CONTRAST","code_information":[{"code":"6147372103","type":"CDM"},{"code":"0614","type":"RC"},{"code":"73721","type":"HCPCS"}],"standard_charges":[{"gross_charge":9055.08,"discounted_cash":9055.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, JOINT OF LEG W/CONTRAST","code_information":[{"code":"6147372207","type":"CDM"},{"code":"0614","type":"RC"},{"code":"73722","type":"HCPCS"}],"standard_charges":[{"gross_charge":7823.28,"discounted_cash":7823.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, JOINT OF LEG. COMBO - MR LOWER EXTREMITY W AND WO IV CONTRAST","code_information":[{"code":"6147372305","type":"CDM"},{"code":"0614","type":"RC"},{"code":"73723","type":"HCPCS"}],"standard_charges":[{"gross_charge":10197.42,"discounted_cash":10197.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, ABDOMEN (MRI)","code_information":[{"code":"6147418102","type":"CDM"},{"code":"0614","type":"RC"},{"code":"74181","type":"HCPCS"}],"standard_charges":[{"gross_charge":8131.84,"discounted_cash":8131.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, ABDOMEN W/CONTRAST","code_information":[{"code":"6147418202","type":"CDM"},{"code":"0614","type":"RC"},{"code":"74182","type":"HCPCS"}],"standard_charges":[{"gross_charge":3169.82,"discounted_cash":3169.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, ABDOMEN, COMBO","code_information":[{"code":"6147418303","type":"CDM"},{"code":"0614","type":"RC"},{"code":"74183","type":"HCPCS"}],"standard_charges":[{"gross_charge":11736.14,"discounted_cash":11736.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MR ELASTOGRAPHY","code_information":[{"code":"6147639101","type":"CDM"},{"code":"0614","type":"RC"},{"code":"76391","type":"HCPCS"}],"standard_charges":[{"gross_charge":2830.36,"discounted_cash":2830.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI BREAST WITHOUT CONTRAST MATERIAL UNILATERAL","code_information":[{"code":"6147704601","type":"CDM"},{"code":"0614","type":"RC"},{"code":"77046","type":"HCPCS"}],"standard_charges":[{"gross_charge":1025.07,"discounted_cash":1025.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI BREAST W/WO CONTRAST W/ CAD","code_information":[{"code":"6147704801","type":"CDM"},{"code":"0614","type":"RC"},{"code":"77048","type":"HCPCS"}],"standard_charges":[{"gross_charge":7488.26,"discounted_cash":7488.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI BREAST W/WO CONTRAST W/ CAD BILATERAL","code_information":[{"code":"6147704901","type":"CDM"},{"code":"0614","type":"RC"},{"code":"77049","type":"HCPCS"}],"standard_charges":[{"gross_charge":8404.26,"discounted_cash":8404.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, FACE, NECK","code_information":[{"code":"6157054002","type":"CDM"},{"code":"0615","type":"RC"},{"code":"70540","type":"HCPCS"}],"standard_charges":[{"gross_charge":7927.5,"discounted_cash":7927.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, FACE, NECK W/CONTRAST","code_information":[{"code":"6157054202","type":"CDM"},{"code":"0615","type":"RC"},{"code":"70542","type":"HCPCS"}],"standard_charges":[{"gross_charge":7362.5,"discounted_cash":7362.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRI, FACE, NECK, COMBO","code_information":[{"code":"6157054302","type":"CDM"},{"code":"0615","type":"RC"},{"code":"70543","type":"HCPCS"}],"standard_charges":[{"gross_charge":8357.11,"discounted_cash":8357.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRA HEAD W/O CONTRAST","code_information":[{"code":"6157054401","type":"CDM"},{"code":"0615","type":"RC"},{"code":"70544","type":"HCPCS"}],"standard_charges":[{"gross_charge":6719.91,"discounted_cash":6719.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRA HEAD W/ CONTRAST","code_information":[{"code":"6157054501","type":"CDM"},{"code":"0615","type":"RC"},{"code":"70545","type":"HCPCS"}],"standard_charges":[{"gross_charge":7138.44,"discounted_cash":7138.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MR ANGIO, HEAD, COMBO","code_information":[{"code":"6157054601","type":"CDM"},{"code":"0615","type":"RC"},{"code":"70546","type":"HCPCS"}],"standard_charges":[{"gross_charge":6832.71,"discounted_cash":6832.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRA NECK W/O CONTRAST","code_information":[{"code":"6157054701","type":"CDM"},{"code":"0615","type":"RC"},{"code":"70547","type":"HCPCS"}],"standard_charges":[{"gross_charge":7638.22,"discounted_cash":7638.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRA NECK W/ CONTRAST","code_information":[{"code":"6157054801","type":"CDM"},{"code":"0615","type":"RC"},{"code":"70548","type":"HCPCS"}],"standard_charges":[{"gross_charge":6472.1,"discounted_cash":6472.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MR ANGIO, NECK, COMBO","code_information":[{"code":"6157054901","type":"CDM"},{"code":"0615","type":"RC"},{"code":"70549","type":"HCPCS"}],"standard_charges":[{"gross_charge":10001.42,"discounted_cash":10001.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRA LOWER EXTRM W/ CONTRAST","code_information":[{"code":"6167372508","type":"CDM"},{"code":"0616","type":"RC"},{"code":"73725","type":"HCPCS"}],"standard_charges":[{"gross_charge":6966.27,"discounted_cash":6966.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRA LOWER EXTREMITY W/O CONTRAST","code_information":[{"code":"6167372510","type":"CDM"},{"code":"0616","type":"RC"},{"code":"73725","type":"HCPCS"}],"standard_charges":[{"gross_charge":6705.83,"discounted_cash":6705.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRA CHEST W/ CONTRAST","code_information":[{"code":"6187155502","type":"CDM"},{"code":"0618","type":"RC"},{"code":"71555","type":"HCPCS"}],"standard_charges":[{"gross_charge":6705.83,"discounted_cash":6705.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRA CHEST WO CONTRAST","code_information":[{"code":"6187155503","type":"CDM"},{"code":"0618","type":"RC"},{"code":"71555","type":"HCPCS"}],"standard_charges":[{"gross_charge":6966.27,"discounted_cash":6966.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRA PELVIS W/ CONTRAST","code_information":[{"code":"6187219801","type":"CDM"},{"code":"0618","type":"RC"},{"code":"72198","type":"HCPCS"}],"standard_charges":[{"gross_charge":6705.83,"discounted_cash":6705.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRA PELVIS W/O CONTRAST","code_information":[{"code":"6187219802","type":"CDM"},{"code":"0618","type":"RC"},{"code":"72198","type":"HCPCS"}],"standard_charges":[{"gross_charge":6966.27,"discounted_cash":6966.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRA UPPER EXTREM W/ CONTRAST","code_information":[{"code":"6187322501","type":"CDM"},{"code":"0618","type":"RC"},{"code":"73225","type":"HCPCS"}],"standard_charges":[{"gross_charge":1638.34,"discounted_cash":1638.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MR ANGIO ABDOMEN (MRA) W/ CONTRAST","code_information":[{"code":"6187418501","type":"CDM"},{"code":"0618","type":"RC"},{"code":"74185","type":"HCPCS"}],"standard_charges":[{"gross_charge":6705.83,"discounted_cash":6705.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MR ANGIO ABDOMEN (MRA) W/O CONTRAST","code_information":[{"code":"6187418502","type":"CDM"},{"code":"0618","type":"RC"},{"code":"74185","type":"HCPCS"}],"standard_charges":[{"gross_charge":7704.69,"discounted_cash":7704.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MRA LOWER EXTREMITY W/WO CONTRAST","code_information":[{"code":"618C891401","type":"CDM"},{"code":"0618","type":"RC"},{"code":"C8914","type":"HCPCS"}],"standard_charges":[{"gross_charge":1638.34,"discounted_cash":1638.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RHIG RHOPHYLAC 300MCG/2ML NDC 44206030001","code_information":[{"code":"636J279102","type":"CDM"},{"code":"0636","type":"RC"},{"code":"J2791","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.06,"discounted_cash":45.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC APPLY RIGID LEG CAST","code_information":[{"code":"7002944501","type":"CDM"},{"code":"0700","type":"RC"},{"code":"29445","type":"HCPCS"}],"standard_charges":[{"gross_charge":1230.98,"discounted_cash":1230.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CAST REMOVAL","code_information":[{"code":"7002970001","type":"CDM"},{"code":"0700","type":"RC"},{"code":"29700","type":"HCPCS"}],"standard_charges":[{"gross_charge":896.11,"discounted_cash":896.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PACU RECOVERY PHASE 1 - INITIAL 30 MINUTES","code_information":[{"code":"7100000003","type":"CDM"},{"code":"0710","type":"RC"},{"code":"7100000003","type":"HCPCS"}],"standard_charges":[{"gross_charge":4989.33,"discounted_cash":4989.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PACU RECOVERY PHASE 1 - EACH ADDL MIN","code_information":[{"code":"7100000004","type":"CDM"},{"code":"0710","type":"RC"},{"code":"7100000004","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.03,"discounted_cash":127.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PACU RECOVERY PHASE 2 - INITIAL 30 MINUTES","code_information":[{"code":"7100000005","type":"CDM"},{"code":"0710","type":"RC"},{"code":"7100000005","type":"HCPCS"}],"standard_charges":[{"gross_charge":4015.55,"discounted_cash":4015.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PACU RECOVERY PHASE 2 - EACH ADDL MIN","code_information":[{"code":"7100000006","type":"CDM"},{"code":"0710","type":"RC"},{"code":"7100000006","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.44,"discounted_cash":101.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FETAL CONTRACTN STRESS TEST","code_information":[{"code":"7205902001","type":"CDM"},{"code":"0720","type":"RC"},{"code":"59020","type":"HCPCS"}],"standard_charges":[{"gross_charge":1501.44,"discounted_cash":1501.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FETAL NON-STRESS TEST","code_information":[{"code":"7205902501","type":"CDM"},{"code":"0720","type":"RC"},{"code":"59025","type":"HCPCS"}],"standard_charges":[{"gross_charge":1501.44,"discounted_cash":1501.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OBSTETRICAL CARE,VAG DELIVERY ROUTINE","code_information":[{"code":"7205940901","type":"CDM"},{"code":"0720","type":"RC"},{"code":"59409","type":"HCPCS"}],"standard_charges":[{"gross_charge":22494.89,"discounted_cash":22494.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OBSTETRICAL CARE,VAG DELIVERY COMPLEX","code_information":[{"code":"7205940902","type":"CDM"},{"code":"0720","type":"RC"},{"code":"59409","type":"HCPCS"}],"standard_charges":[{"gross_charge":24402.57,"discounted_cash":24402.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DELIVERY/BIRTHING ROOM RESUSCITATION","code_information":[{"code":"7229946501","type":"CDM"},{"code":"0722","type":"RC"},{"code":"99465","type":"HCPCS"}],"standard_charges":[{"gross_charge":2502.02,"discounted_cash":2502.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CIRCUMCISION,OTHR,NEWBORN","code_information":[{"code":"7230000001","type":"CDM"},{"code":"0723","type":"RC"},{"code":"7230000001","type":"HCPCS"}],"standard_charges":[{"gross_charge":627.73,"discounted_cash":627.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ELECTROCARDIOGRAM, TRACING - ECG 12-LEAD","code_information":[{"code":"7309300502","type":"CDM"},{"code":"0730","type":"RC"},{"code":"93005","type":"HCPCS"}],"standard_charges":[{"gross_charge":846.41,"discounted_cash":846.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC RHYTHM ECG, TRACING","code_information":[{"code":"7309304101","type":"CDM"},{"code":"0730","type":"RC"},{"code":"93041","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.61,"discounted_cash":259.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXT ECG RECORD CONTIN 48 HR, RECORD - HOLTER MONITOR - 24 HOUR","code_information":[{"code":"7319322502","type":"CDM"},{"code":"0731","type":"RC"},{"code":"93225","type":"HCPCS"}],"standard_charges":[{"gross_charge":1531.79,"discounted_cash":1531.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ECG MONIT/REPRT UP TO 48 HRS - HOLTER MONITOR - 24 HOUR","code_information":[{"code":"7319322601","type":"CDM"},{"code":"0731","type":"RC"},{"code":"93226","type":"HCPCS"}],"standard_charges":[{"gross_charge":1284.6,"discounted_cash":1284.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ECG ANALYSIS/RPT >48 HRS  <7 DAYS - HOLTER REC ANALYSIS/RPT - 2 -7 DAYS","code_information":[{"code":"7319324301","type":"CDM"},{"code":"0731","type":"RC"},{"code":"93243","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.71,"discounted_cash":251.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EXT ECG,PT DEMAND EVENT, SYMPT MEMORY LOOP, RECORD","code_information":[{"code":"7319327001","type":"CDM"},{"code":"0731","type":"RC"},{"code":"93270","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.18,"discounted_cash":168.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EEG 12-26 HR W/O VIDEO, TECH UNMONITORED","code_information":[{"code":"7409570801","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95708","type":"HCPCS"}],"standard_charges":[{"gross_charge":4200.08,"discounted_cash":4200.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EEG W/O VID 12-26HRS RT MON","code_information":[{"code":"7409571001","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95710","type":"HCPCS"}],"standard_charges":[{"gross_charge":5468.79,"discounted_cash":5468.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EEG 12-26 HR W/VIDEO, TECH, REALTIME MON","code_information":[{"code":"7409571601","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95716","type":"HCPCS"}],"standard_charges":[{"gross_charge":4152.67,"discounted_cash":4152.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EEG,EXTENDED MONITORING,41-60 MINUTES","code_information":[{"code":"7409581201","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95812","type":"HCPCS"}],"standard_charges":[{"gross_charge":872.52,"discounted_cash":872.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EEG EXTENDED MONITORING 61-119 MINUTES","code_information":[{"code":"7409581301","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95813","type":"HCPCS"}],"standard_charges":[{"gross_charge":965.01,"discounted_cash":965.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EEG,W/AWAKE & DROWSY RECORD","code_information":[{"code":"7409581601","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95816","type":"HCPCS"}],"standard_charges":[{"gross_charge":2105.12,"discounted_cash":2105.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EEG,W/AWAKE & ASLEEP RECORD","code_information":[{"code":"7409581901","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95819","type":"HCPCS"}],"standard_charges":[{"gross_charge":2328.26,"discounted_cash":2328.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EEG,COMA/SLEEP RECORD ONLY","code_information":[{"code":"7409582201","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95822","type":"HCPCS"}],"standard_charges":[{"gross_charge":2105.12,"discounted_cash":2105.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EEG EVAL CEREBRAL DEATH","code_information":[{"code":"7409582401","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95824","type":"HCPCS"}],"standard_charges":[{"gross_charge":2084.8,"discounted_cash":2084.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SHORT-LATENCY SOMATOSENS EP STD UPR & LOW LIMBS","code_information":[{"code":"7409593801","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95938","type":"HCPCS"}],"standard_charges":[{"gross_charge":2202.19,"discounted_cash":2202.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EEG DURING SURGERY","code_information":[{"code":"7409595502","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95955","type":"HCPCS"}],"standard_charges":[{"gross_charge":7317.69,"discounted_cash":7317.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GI/ENDO - LEVEL 1 FIRST 5 MINUTES","code_information":[{"code":"7500000001","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":9987.0,"discounted_cash":9987.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GI/ENDO - LEVEL 1 EACH ADDL MINUTE","code_information":[{"code":"7500000002","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":249.0,"discounted_cash":249.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GI/ENDO - LEVEL 2 FIRST 5 MINUTES","code_information":[{"code":"7500000003","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":9987.0,"discounted_cash":9987.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GI/ENDO - LEVEL 2 EACH ADDL MINUTE","code_information":[{"code":"7500000004","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":249.0,"discounted_cash":249.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GI/ENDO - LEVEL 3 FIRST 5 MINUTES","code_information":[{"code":"7500000005","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":12484.0,"discounted_cash":12484.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GI/ENDO - LEVEL 3 EACH ADDL MINUTE","code_information":[{"code":"7500000006","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":312.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GI/ENDO - LEVEL 4 FIRST 5 MINUTES","code_information":[{"code":"7500000007","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":14981.0,"discounted_cash":14981.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GI/ENDO - LEVEL 4 EACH ADDL MINUTE","code_information":[{"code":"7500000008","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":374.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GI/ENDO - LEVEL 5 FIRST 5 MINUTES","code_information":[{"code":"7500000009","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":17478.0,"discounted_cash":17478.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GI/ENDO - LEVEL 5 EACH ADDL MINUTE","code_information":[{"code":"7500000010","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":468.0,"discounted_cash":468.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OBSERVATION CARVE-OUT","code_information":[{"code":"762G037803","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.69,"discounted_cash":105.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OBSERVATION CARVE-OUT - CARDIOLOGY","code_information":[{"code":"762G037804","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.69,"discounted_cash":105.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OBSERVATION CARVE-OUT - RESPIRATORY","code_information":[{"code":"762G037805","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.69,"discounted_cash":105.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OBSERVATION CARVE-OUT - SURGICAL","code_information":[{"code":"762G037806","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.69,"discounted_cash":105.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OBSERVATION CARVE-OUT - G.I.","code_information":[{"code":"762G037809","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.69,"discounted_cash":105.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OBSERVATION CARVE-OUT - RADIOLOGY","code_information":[{"code":"762G037810","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.69,"discounted_cash":105.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OBSERVATION CARVE-OUT - INFUSION","code_information":[{"code":"762G037811","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.69,"discounted_cash":105.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OBSERVATION CARVE-OUT - RECOVERY TIME","code_information":[{"code":"762G037812","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.69,"discounted_cash":105.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OBSERVATION CARVE-OUT - REVENUE INTEGRITY","code_information":[{"code":"762G037813","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.69,"discounted_cash":105.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OBSERVATION CARVE-OUT - PT OT ST","code_information":[{"code":"762G037814","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.69,"discounted_cash":105.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIRECT REFER HOSPITAL OBSERV","code_information":[{"code":"762G037901","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0379","type":"HCPCS"}],"standard_charges":[{"gross_charge":1237.66,"discounted_cash":1237.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SARS-COV-2 VACCINE ADMIN (PFIZER) 30MCG/0.3ML, 1ST DOSE","code_information":[{"code":"7710001A01","type":"CDM"},{"code":"0771","type":"RC"},{"code":"0001A","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.65,"discounted_cash":55.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SARS-COV-2 VACCINE ADMIN (PFIZER) 30MCG/0.3ML, 2ND DOSE","code_information":[{"code":"7710002A01","type":"CDM"},{"code":"0771","type":"RC"},{"code":"0002A","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.65,"discounted_cash":55.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SARS-COV-2 VACCINE ADMIN (PFIZER) 30MCG/0.3ML, 3RD DOSE","code_information":[{"code":"7710003A01","type":"CDM"},{"code":"0771","type":"RC"},{"code":"0003A","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.36,"discounted_cash":252.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SARS-COV-2 VACCINE ADMIN (MODERNA) 100MCG/0.5ML, 1ST DOSE","code_information":[{"code":"7710011A01","type":"CDM"},{"code":"0771","type":"RC"},{"code":"0011A","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.65,"discounted_cash":55.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SARS-COV-2 VACCINE ADMIN (MODERNA) 100MCG/0.5ML, 2ND DOSE","code_information":[{"code":"7710012A01","type":"CDM"},{"code":"0771","type":"RC"},{"code":"0012A","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.65,"discounted_cash":55.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNIZ ADMIN, THRU AGE 18, ANY ROUTE,W COUNSEL, 1ST VACCINE/TOXOID","code_information":[{"code":"7719046001","type":"CDM"},{"code":"0771","type":"RC"},{"code":"90460","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.14,"discounted_cash":365.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNIZ ADMIN, THRU AGE 18, ANY ROUTE,W COUNSEL, EA ADD VACCINE/TOXOID","code_information":[{"code":"7719046101","type":"CDM"},{"code":"0771","type":"RC"},{"code":"90461","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.14,"discounted_cash":365.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID","code_information":[{"code":"7719047101","type":"CDM"},{"code":"0771","type":"RC"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":403.84,"discounted_cash":403.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNIZ ADMIN, INFLUENZA","code_information":[{"code":"7719047102","type":"CDM"},{"code":"0771","type":"RC"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.59,"discounted_cash":317.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNIZ ADMIN, PNEUMOCOCCAL","code_information":[{"code":"7719047103","type":"CDM"},{"code":"0771","type":"RC"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":359.45,"discounted_cash":359.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNIZ,ADMIN,EACH ADDL","code_information":[{"code":"7719047201","type":"CDM"},{"code":"0771","type":"RC"},{"code":"90472","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.98,"discounted_cash":296.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNE ADMIN ORAL/NASAL 1 VAC","code_information":[{"code":"7719047301","type":"CDM"},{"code":"0771","type":"RC"},{"code":"90473","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.63,"discounted_cash":278.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IMMUNE ADMIN ORAL/NASAL EA ADDL VAC","code_information":[{"code":"7719047401","type":"CDM"},{"code":"0771","type":"RC"},{"code":"90474","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.63,"discounted_cash":278.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TELEHEALTH FACILITY FEE","code_information":[{"code":"780Q301402","type":"CDM"},{"code":"0780","type":"RC"},{"code":"Q3014","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.15,"discounted_cash":90.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FRAGMENT KIDNEY STONE/ ESWL","code_information":[{"code":"7905059001","type":"CDM"},{"code":"0790","type":"RC"},{"code":"50590","type":"HCPCS"}],"standard_charges":[{"gross_charge":39444.17,"discounted_cash":39444.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIALYSIS  - PERITONEAL INPATIENT W/ SINGLE EVAL","code_information":[{"code":"8009094501","type":"CDM"},{"code":"0800","type":"RC"},{"code":"90945","type":"HCPCS"}],"standard_charges":[{"gross_charge":1396.77,"discounted_cash":1396.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIALYSIS - PERITONEAL INPATIENT EXCHANGE FLUSH","code_information":[{"code":"8009094502","type":"CDM"},{"code":"0800","type":"RC"},{"code":"90945","type":"HCPCS"}],"standard_charges":[{"gross_charge":1396.77,"discounted_cash":1396.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INPT HEMODIALYSIS PROCEDURE W/ PHYS/QHP SNGL EVALUATION","code_information":[{"code":"8019093501","type":"CDM"},{"code":"0801","type":"RC"},{"code":"90935","type":"HCPCS"}],"standard_charges":[{"gross_charge":5529.56,"discounted_cash":5529.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEMODIALYSIS PROCEDURE INPATIENT CRRT W/ SINGLE EVALUATION","code_information":[{"code":"8019093503","type":"CDM"},{"code":"0801","type":"RC"},{"code":"90935","type":"HCPCS"}],"standard_charges":[{"gross_charge":2063.03,"discounted_cash":2063.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HEMODIALYSIS INPATIENT SLOW LOW EFF DIALYSIS - SLED","code_information":[{"code":"8019093504","type":"CDM"},{"code":"0801","type":"RC"},{"code":"90935","type":"HCPCS"}],"standard_charges":[{"gross_charge":5529.56,"discounted_cash":5529.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC UNSCHED DIALYSIS ESRD PT HOS","code_information":[{"code":"829G025701","type":"CDM"},{"code":"0829","type":"RC"},{"code":"G0257","type":"HCPCS"}],"standard_charges":[{"gross_charge":5485.24,"discounted_cash":5485.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS/QHP EVAL - MISCELLANEOUS DIALYSIS","code_information":[{"code":"8819094501","type":"CDM"},{"code":"0881","type":"RC"},{"code":"90945","type":"HCPCS"}],"standard_charges":[{"gross_charge":21209.75,"discounted_cash":21209.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ELECTROCONVULSIVE THERAPY","code_information":[{"code":"9019087001","type":"CDM"},{"code":"0901","type":"RC"},{"code":"90870","type":"HCPCS"}],"standard_charges":[{"gross_charge":5389.78,"discounted_cash":5389.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BH IOP PER DIEM PSYCHIATRIC","code_information":[{"code":"9050000001","type":"CDM"},{"code":"0905","type":"RC"},{"code":"9050000001","type":"HCPCS"}],"standard_charges":[{"gross_charge":707.0,"discounted_cash":707.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PSYCHOTHERAPY PATIENT &/ FAMILY 30 MINUTES","code_information":[{"code":"9149083201","type":"CDM"},{"code":"0914","type":"RC"},{"code":"90832","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.0,"discounted_cash":401.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PSYCHOTHERAPY PATIENT &/ FAMILY 45 MINUTES","code_information":[{"code":"9149083401","type":"CDM"},{"code":"0914","type":"RC"},{"code":"90834","type":"HCPCS"}],"standard_charges":[{"gross_charge":535.0,"discounted_cash":535.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PSYCHOTHERAPY W/ PT 60 MINUTES","code_information":[{"code":"9149083701","type":"CDM"},{"code":"0914","type":"RC"},{"code":"90837","type":"HCPCS"}],"standard_charges":[{"gross_charge":669.0,"discounted_cash":669.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PSYCHOTHERAPY CRISIS INIT 60 MIN","code_information":[{"code":"9149083901","type":"CDM"},{"code":"0914","type":"RC"},{"code":"90839","type":"HCPCS"}],"standard_charges":[{"gross_charge":669.0,"discounted_cash":669.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GROUP PSYCHOTHERAPY, IOP/PHP","code_information":[{"code":"9159085301","type":"CDM"},{"code":"0915","type":"RC"},{"code":"90853","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.0,"discounted_cash":299.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PHP GRP PSYCHOTHERAPY 45-50 MIN","code_information":[{"code":"915G041101","type":"CDM"},{"code":"0915","type":"RC"},{"code":"G0411","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.0,"discounted_cash":299.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC FAMILY PSYCHOTHERAPY W/ PT 50 MIN","code_information":[{"code":"9169084701","type":"CDM"},{"code":"0916","type":"RC"},{"code":"90847","type":"HCPCS"}],"standard_charges":[{"gross_charge":535.0,"discounted_cash":535.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MULTIP FAMILY-GROUP PSYCHOTHERAPY","code_information":[{"code":"9169084901","type":"CDM"},{"code":"0916","type":"RC"},{"code":"90849","type":"HCPCS"}],"standard_charges":[{"gross_charge":535.0,"discounted_cash":535.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC BH ASSESSMENT/REASSESSMENT","code_information":[{"code":"9189615601","type":"CDM"},{"code":"0918","type":"RC"},{"code":"96156","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.0,"discounted_cash":299.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC GI TRC IMG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R","code_information":[{"code":"9209111001","type":"CDM"},{"code":"0920","type":"RC"},{"code":"91110","type":"HCPCS"}],"standard_charges":[{"gross_charge":4042.31,"discounted_cash":4042.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRANSCRAN DOPPLER INTRACRAN ART","code_information":[{"code":"9209388601","type":"CDM"},{"code":"0920","type":"RC"},{"code":"93886","type":"HCPCS"}],"standard_charges":[{"gross_charge":1411.28,"discounted_cash":1411.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC UNATTENDED SLEEP STUDY W/ RESP ANAL","code_information":[{"code":"9209580101","type":"CDM"},{"code":"0920","type":"RC"},{"code":"95801","type":"HCPCS"}],"standard_charges":[{"gross_charge":498.62,"discounted_cash":498.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MULTIPLE SLEEP LATENCY TEST W/ SCORING","code_information":[{"code":"9209580501","type":"CDM"},{"code":"0920","type":"RC"},{"code":"95805","type":"HCPCS"}],"standard_charges":[{"gross_charge":10730.43,"discounted_cash":10730.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","code_information":[{"code":"9209581002","type":"CDM"},{"code":"0920","type":"RC"},{"code":"95810","type":"HCPCS"}],"standard_charges":[{"gross_charge":10267.43,"discounted_cash":10267.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND","code_information":[{"code":"9209581102","type":"CDM"},{"code":"0920","type":"RC"},{"code":"95811","type":"HCPCS"}],"standard_charges":[{"gross_charge":10209.55,"discounted_cash":10209.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRANSCRAN MTR STIM UPPER 95928","code_information":[{"code":"9209592801","type":"CDM"},{"code":"0920","type":"RC"},{"code":"95928","type":"HCPCS"}],"standard_charges":[{"gross_charge":4152.67,"discounted_cash":4152.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TRANSCRAN MTR STIM LOWER 95929","code_information":[{"code":"9209592901","type":"CDM"},{"code":"0920","type":"RC"},{"code":"95929","type":"HCPCS"}],"standard_charges":[{"gross_charge":2202.19,"discounted_cash":2202.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IONM 1 ON 1 IN OR W/ATTENDANCE EACH 15 MINUTES","code_information":[{"code":"9209594001","type":"CDM"},{"code":"0920","type":"RC"},{"code":"95940","type":"HCPCS"}],"standard_charges":[{"gross_charge":564.38,"discounted_cash":564.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ANALYZE IMP NEUROSTIM W/PROGRAM, SIMPLE","code_information":[{"code":"9209597101","type":"CDM"},{"code":"0920","type":"RC"},{"code":"95971","type":"HCPCS"}],"standard_charges":[{"gross_charge":452.63,"discounted_cash":452.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ELEC ALYS IMPLT NPGT CPLX SP/PN PRGRMG","code_information":[{"code":"9209597201","type":"CDM"},{"code":"0920","type":"RC"},{"code":"95972","type":"HCPCS"}],"standard_charges":[{"gross_charge":452.63,"discounted_cash":452.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HOME SLEEP TEST TYPE III","code_information":[{"code":"920G039902","type":"CDM"},{"code":"0920","type":"RC"},{"code":"G0399","type":"HCPCS"}],"standard_charges":[{"gross_charge":1255.46,"discounted_cash":1255.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HOME SLEEP STUDY TYPE 4","code_information":[{"code":"920G040001","type":"CDM"},{"code":"0920","type":"RC"},{"code":"G0400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1177.55,"discounted_cash":1177.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DUPLEX SCAN EXTRACRANIAL,BILAT","code_information":[{"code":"9219388003","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93880","type":"HCPCS"}],"standard_charges":[{"gross_charge":2695.84,"discounted_cash":2695.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DUPLEX SCAN EXTRACRANIAL,LIMITED","code_information":[{"code":"9219388201","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93882","type":"HCPCS"}],"standard_charges":[{"gross_charge":1584.77,"discounted_cash":1584.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 1-2 LEVEL","code_information":[{"code":"9219392203","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93922","type":"HCPCS"}],"standard_charges":[{"gross_charge":936.86,"discounted_cash":936.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVELS","code_information":[{"code":"9219392301","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93923","type":"HCPCS"}],"standard_charges":[{"gross_charge":1316.68,"discounted_cash":1316.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NON-INVASIVE LOWER EXTREM ART STRESS/REST, COMPLETE,BILATERAL","code_information":[{"code":"9219392401","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93924","type":"HCPCS"}],"standard_charges":[{"gross_charge":625.33,"discounted_cash":625.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DUPLEX LO EXTREM ART BILAT","code_information":[{"code":"9219392502","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93925","type":"HCPCS"}],"standard_charges":[{"gross_charge":2844.28,"discounted_cash":2844.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DUPLEX LO EXTREM ART UNILAT/LTD","code_information":[{"code":"9219392602","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93926","type":"HCPCS"}],"standard_charges":[{"gross_charge":1422.14,"discounted_cash":1422.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DUPLEX UP EXTREM ART BILAT","code_information":[{"code":"9219393003","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93930","type":"HCPCS"}],"standard_charges":[{"gross_charge":3332.08,"discounted_cash":3332.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DUPLEX UP EXTREM ART UNILAT/LTD","code_information":[{"code":"9219393101","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93931","type":"HCPCS"}],"standard_charges":[{"gross_charge":1666.04,"discounted_cash":1666.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DUPLEX EXTREM VENOUS,BILAT","code_information":[{"code":"9219397001","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93970","type":"HCPCS"}],"standard_charges":[{"gross_charge":2779.54,"discounted_cash":2779.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DUPLEX EXTREM VENOUS,UNI OR LTD - US DOPPLER VENOUS ARM","code_information":[{"code":"9219397102","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93971","type":"HCPCS"}],"standard_charges":[{"gross_charge":1906.79,"discounted_cash":1906.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DUPLEX EXTREM VENOUS,UNI OR LTD - CV US DOPPLER VENOUS LEG","code_information":[{"code":"9219397104","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93971","type":"HCPCS"}],"standard_charges":[{"gross_charge":1748.43,"discounted_cash":1748.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DUPLEX EXTREM VENOUS,UNI OR LTD - LOWER EXTREM SUPERFICIAL VEIN MAP","code_information":[{"code":"9219397108","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93971","type":"HCPCS"}],"standard_charges":[{"gross_charge":1906.79,"discounted_cash":1906.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VASCULAR STUDY - RENAL ARTERY DUPLEX","code_information":[{"code":"9219397502","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93975","type":"HCPCS"}],"standard_charges":[{"gross_charge":3297.79,"discounted_cash":3297.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VASC DUPLEX ABD/PEL VASC STUDY,COMPLETE","code_information":[{"code":"9219397504","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93975","type":"HCPCS"}],"standard_charges":[{"gross_charge":3023.92,"discounted_cash":3023.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VASCULAR STUDY - US ABDOMEN DOPPLER LIMITED","code_information":[{"code":"9219397601","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93976","type":"HCPCS"}],"standard_charges":[{"gross_charge":1558.42,"discounted_cash":1558.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DUPLEX LARGE VESSEL(S),COMPLETE","code_information":[{"code":"9219397801","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93978","type":"HCPCS"}],"standard_charges":[{"gross_charge":1203.89,"discounted_cash":1203.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DUPLEX LARGE VESSEL(S),LIMITED","code_information":[{"code":"9219397901","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93979","type":"HCPCS"}],"standard_charges":[{"gross_charge":1450.09,"discounted_cash":1450.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VASCULAR STUDY - PENILE DUPLEX","code_information":[{"code":"9219398001","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93980","type":"HCPCS"}],"standard_charges":[{"gross_charge":1311.11,"discounted_cash":1311.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VASC DUPLEX PREOP ART/VEN DIALYSIS SHUNT PLANNING STUDY,COMPLETE BILAT","code_information":[{"code":"9219398501","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93985","type":"HCPCS"}],"standard_charges":[{"gross_charge":2388.5,"discounted_cash":2388.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VASC DUPLEX PREOP ART/VEN DIALYSIS SHUNT PLANNING STUDY,COMPLETE UNILAT","code_information":[{"code":"9219398601","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93986","type":"HCPCS"}],"standard_charges":[{"gross_charge":1510.34,"discounted_cash":1510.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DUPLEX HEMODIALYSIS ACCESS","code_information":[{"code":"9219399001","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93990","type":"HCPCS"}],"standard_charges":[{"gross_charge":1729.53,"discounted_cash":1729.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EMG, NEEDLE, TWO LIMBS","code_information":[{"code":"9229586101","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95861","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.68,"discounted_cash":505.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EMG,NEEDLE,THOR PARASPIN MUS,EXC T1/T12 - EMG THORACIC/PARASPINAL","code_information":[{"code":"9229586901","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95869","type":"HCPCS"}],"standard_charges":[{"gross_charge":629.84,"discounted_cash":629.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EMG,1 EXTREM,NONPARASPINAL","code_information":[{"code":"9229587002","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95870","type":"HCPCS"}],"standard_charges":[{"gross_charge":629.84,"discounted_cash":629.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOTOR &/SENS 1-2 NRV CNDJ PRECONF ELTRODE LIMB","code_information":[{"code":"9229590701","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95907","type":"HCPCS"}],"standard_charges":[{"gross_charge":629.84,"discounted_cash":629.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOTOR &/SENS 3-4 NRV CNDJ PRECONF ELTRODE LIMB","code_information":[{"code":"9229590801","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95908","type":"HCPCS"}],"standard_charges":[{"gross_charge":1194.22,"discounted_cash":1194.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOTOR &/SENS 5-6 NRV CNDJ PRECONF ELTRODE LIMB","code_information":[{"code":"9229590901","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95909","type":"HCPCS"}],"standard_charges":[{"gross_charge":1194.22,"discounted_cash":1194.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOTOR &/SENS 7-8 NRV CNDJ PRECONF ELTRODE LIMB","code_information":[{"code":"9229591001","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95910","type":"HCPCS"}],"standard_charges":[{"gross_charge":1194.22,"discounted_cash":1194.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOTOR &/SENS 9-10 NRV CNDJ PRECONF ELTRODE LIMB","code_information":[{"code":"9229591101","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95911","type":"HCPCS"}],"standard_charges":[{"gross_charge":2202.19,"discounted_cash":2202.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOTOR &/SENS 11-12 NRV CNDJ PRECONF ELTRODE LIMB","code_information":[{"code":"9229591201","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95912","type":"HCPCS"}],"standard_charges":[{"gross_charge":2202.19,"discounted_cash":2202.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MOTOR &/SENS 13/> NRV CNDJ PRECONF ELTRODE LIMB","code_information":[{"code":"9229591301","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95913","type":"HCPCS"}],"standard_charges":[{"gross_charge":2202.19,"discounted_cash":2202.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EMG SSEP UPPER EXTREMITY","code_information":[{"code":"9229592501","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95925","type":"HCPCS"}],"standard_charges":[{"gross_charge":1194.22,"discounted_cash":1194.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SOMATOSENSORY TEST,LOWER LIMBS","code_information":[{"code":"9229592601","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95926","type":"HCPCS"}],"standard_charges":[{"gross_charge":1194.22,"discounted_cash":1194.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC SSEP STUDY TRUNK/HEAD","code_information":[{"code":"9229592701","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95927","type":"HCPCS"}],"standard_charges":[{"gross_charge":1194.22,"discounted_cash":1194.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC VISUAL EP TESTING CNS EXCEPT GLAUCOMA W/I&R","code_information":[{"code":"9229593001","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95930","type":"HCPCS"}],"standard_charges":[{"gross_charge":1194.22,"discounted_cash":1194.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC THERAPEUTIC PHLEBOTOMY (SEPARATE PROCEDURE)","code_information":[{"code":"9409919501","type":"CDM"},{"code":"0940","type":"RC"},{"code":"99195","type":"HCPCS"}],"standard_charges":[{"gross_charge":827.22,"discounted_cash":827.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MED NUTR THER, 1ST, INDIV, EA 15 MIN","code_information":[{"code":"9429780201","type":"CDM"},{"code":"0942","type":"RC"},{"code":"97802","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.27,"discounted_cash":160.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MED NUTR THER, SUBSQ, INDIV, EA 15 MIN","code_information":[{"code":"9429780301","type":"CDM"},{"code":"0942","type":"RC"},{"code":"97803","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.2,"discounted_cash":120.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES","code_information":[{"code":"9429940601","type":"CDM"},{"code":"0942","type":"RC"},{"code":"99406","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.34,"discounted_cash":204.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC TOBACCO USE CESSATION INTENSIVE >10 MINUTES","code_information":[{"code":"9429940701","type":"CDM"},{"code":"0942","type":"RC"},{"code":"99407","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.04,"discounted_cash":256.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIAB MANAGE TRN  PER INDIV","code_information":[{"code":"942G010801","type":"CDM"},{"code":"0942","type":"RC"},{"code":"G0108","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.25,"discounted_cash":278.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DIAB MANAGE TRN IND/GROUP","code_information":[{"code":"942G010901","type":"CDM"},{"code":"0942","type":"RC"},{"code":"G0109","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.74,"discounted_cash":174.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OPPS/PHP TRAINING & EDUC PER SESSION 45 MIN","code_information":[{"code":"942G017701","type":"CDM"},{"code":"0942","type":"RC"},{"code":"G0177","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.0,"discounted_cash":363.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC CARD REHAB PHASE 1 INPATIENT","code_information":[{"code":"9430000001","type":"CDM"},{"code":"0943","type":"RC"},{"code":"9430000001","type":"HCPCS"}],"standard_charges":[{"gross_charge":594.24,"discounted_cash":594.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OUTPATIENT CARDIAC REHAB W/O CONT ECG MONITOR","code_information":[{"code":"9439379701","type":"CDM"},{"code":"0943","type":"RC"},{"code":"93797","type":"HCPCS"}],"standard_charges":[{"gross_charge":379.26,"discounted_cash":379.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC OUTPATIENT CARDIAC REHAB W/CONT ECG MONITORING","code_information":[{"code":"9439379801","type":"CDM"},{"code":"0943","type":"RC"},{"code":"93798","type":"HCPCS"}],"standard_charges":[{"gross_charge":594.24,"discounted_cash":594.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PULMONARY REHAB W/O OXI MONITOR PER SESSION","code_information":[{"code":"9489462501","type":"CDM"},{"code":"0948","type":"RC"},{"code":"94625","type":"HCPCS"}],"standard_charges":[{"gross_charge":423.28,"discounted_cash":423.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PULMONARY REHAB W/ OXI MONITOR PER SESSION","code_information":[{"code":"9489462601","type":"CDM"},{"code":"0948","type":"RC"},{"code":"94626","type":"HCPCS"}],"standard_charges":[{"gross_charge":468.15,"discounted_cash":468.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MAINTENANCE CARDIAC REHAB","code_information":[{"code":"9970000001","type":"CDM"},{"code":"0997","type":"RC"},{"code":"9970000001","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.96,"discounted_cash":29.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC MAINTENANCE PULMONARY REHAB","code_information":[{"code":"9970000002","type":"CDM"},{"code":"0997","type":"RC"},{"code":"9970000002","type":"HCPCS"}],"standard_charges":[{"gross_charge":511.85,"discounted_cash":511.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC PB OFFICE/OUTPT VISIT,PROCEDURE ONLY","code_information":[{"code":"9990000011","type":"CDM"},{"code":"0999","type":"RC"},{"code":"9990000011","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.85,"discounted_cash":485.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC EMERGENCY DEPARTMENT VISIT LEFT BEFORE MEDICAL SCREENING EXAM","code_information":[{"code":"9999928102","type":"CDM"},{"code":"0999","type":"RC"},{"code":"99281","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.85,"discounted_cash":485.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Contrast x-ray of brain","code_information":[{"code":"70010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":1410.25,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":833.79},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1410.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of facial bones","code_information":[{"code":"70140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam pituitary saddle","code_information":[{"code":"70240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of jaw joint","code_information":[{"code":"70332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":801.02,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":473.59},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":801.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of salivary gland","code_information":[{"code":"70380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Ct maxillofacial w/o dye","code_information":[{"code":"70486","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":298.55,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":176.51},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":298.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Mri orbit/face/neck w/o dye","code_information":[{"code":"70540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":695.86,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":411.42},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":695.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Mr angiograph neck w/o&w/dye","code_information":[{"code":"70549","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":1163.59,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":687.95},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1163.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Mri brain w/o & w/dye","code_information":[{"code":"70559","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":1163.59,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":687.95},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1163.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"Chest x-ray&fluoro 4/> views","code_information":[{"code":"71034","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":218.66,"maximum":369.84,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":218.66},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":369.84}]}]},{"description":"Ct thorax w/o dye","code_information":[{"code":"71250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":298.55,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":176.51},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":298.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of spine 1 view","code_information":[{"code":"72020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam thoracolmb 2/> vw","code_information":[{"code":"72080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Ct neck spine w/o & w/dye","code_information":[{"code":"72127","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":661.91,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":391.35},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":661.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"Mri neck spine w/dye","code_information":[{"code":"72142","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":1006.77,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":595.24},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1006.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of pelvis","code_information":[{"code":"72170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":199.35,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Mri pelvis w/o & w/dye","code_information":[{"code":"72197","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":1163.59,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":687.95},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1163.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Discography cerv/thor spine","code_information":[{"code":"72285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":6517.65,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":3853.47},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6517.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2737.85},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2737.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":2737.85},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":2737.85},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of humerus","code_information":[{"code":"73060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-ray of wrist","code_information":[{"code":"73115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":801.02,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":473.59},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":801.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Mri Upper Extremity W/O Dye","code_information":[{"code":"73218","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":695.86,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":411.42},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":695.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of hips","code_information":[{"code":"73520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":126.85,"maximum":214.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":126.85},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":214.56}]}]},{"description":"Contrast x-ray of knee joint","code_information":[{"code":"73580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":801.02,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":473.59},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":801.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of heel","code_information":[{"code":"73650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Mri lwr extremity w/o&w/dye","code_information":[{"code":"73720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":1163.59,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":687.95},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1163.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Ct abdomen w/o dye","code_information":[{"code":"74150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":298.55,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":176.51},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":298.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Mri abdomen w/o dye","code_information":[{"code":"74181","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":695.86,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":411.42},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":695.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"X-ray upper gi delay w/kub","code_information":[{"code":"74241","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":211.07,"maximum":356.99,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":211.07},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":356.99}]}]},{"description":"Ct colonography dx","code_information":[{"code":"74261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":298.55,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":176.51},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":298.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-ray of bile ducts","code_information":[{"code":"74320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1030.97,"maximum":1743.76,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1030.97},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1743.76}]}]},{"description":"X-ray exam of penis","code_information":[{"code":"74445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":608.09,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":359.53},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":608.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"X-ray female genital tract","code_information":[{"code":"74740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":750.46,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":443.7},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":750.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Ct hrt w/3d image congen","code_information":[{"code":"75573","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":309.85,"maximum":665.25,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":309.85},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":524.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Artery x-rays spine","code_information":[{"code":"75705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10654.87,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":6299.53},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10654.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":7250.43},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7250.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":7250.43},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":7250.43},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Artery x-rays lungs","code_information":[{"code":"75743","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6081.96,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":3595.87},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6081.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Nonvascular shunt x-ray","code_information":[{"code":"75809","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":214.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":126.85},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":214.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray adrenal gland","code_information":[{"code":"75840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6081.96,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":3595.87},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6081.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray liver w/hemodynam","code_information":[{"code":"75889","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6081.96,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":3595.87},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6081.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of fistula","code_information":[{"code":"76080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":394.93,"maximum":1041.93,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":443.7},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":750.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":582.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1041.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":609.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":639.08,"additional_payer_notes":"APC"}]}]},{"description":"Ct procedure","code_information":[{"code":"76497","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":187.81,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":111.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":187.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Echo exam of eye thickness","code_information":[{"code":"76514","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.7,"maximum":55.15,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":30.86},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29.7},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.7},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":29.7},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":29.7},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"Echo exam of abdomen","code_information":[{"code":"76705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":317.67,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":187.82},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":317.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Ob us nuchal meas 1 gest","code_information":[{"code":"76813","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":317.67,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":187.82},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":317.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Echo exam of fetal heart","code_information":[{"code":"76825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":349.85,"maximum":1041.93,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":349.85},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":591.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":582.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1041.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":827.37},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":827.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":609.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":827.37},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":827.37},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":639.08,"additional_payer_notes":"APC"}]}]},{"description":"Us exam scrotum","code_information":[{"code":"76870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":317.67,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":187.82},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":317.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Ultrasound exam follow-up","code_information":[{"code":"76970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":125.68,"maximum":212.57,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":125.68},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":212.57}]}]},{"description":"Mammogram, One Breast","code_information":[{"code":"77055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":78.15,"maximum":132.18,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":78.15},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":132.18}]}]},{"description":"X-rays bone length studies","code_information":[{"code":"77073","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":199.35,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"DXA Bone Density, Vert Fx","code_information":[{"code":"77082","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":135.38,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38}]}]},{"description":"Parathyroid planar imaging","code_information":[{"code":"78070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":400.47,"maximum":762.31,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":400.47},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":677.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Plasma volume single","code_information":[{"code":"78110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":789.88,"maximum":2468.71,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":789.88},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1406.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1351.97,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1392.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1446.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1379.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2468.71,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1433.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1445.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1514.21,"additional_payer_notes":"APC"}]}]},{"description":"Spleen imaging","code_information":[{"code":"78185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":817.57,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":483.38},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":817.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Liver image (3d) with flow","code_information":[{"code":"78206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":519.99,"maximum":879.49,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":519.99},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":879.49}]}]},{"description":"Esophageal motility study","code_information":[{"code":"78258","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":764.32,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":451.89},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":764.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"GI protein loss exam","code_information":[{"code":"78282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":764.32,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":451.89},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":764.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Bone imaging (3D)","code_information":[{"code":"78320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":452.11,"maximum":764.69,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":452.11},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":764.69}]}]},{"description":"Ht musc image planar mult","code_information":[{"code":"78454","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1351.97,"maximum":2723.24,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1610.08},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2723.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1406.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1351.97,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1392.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1446.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1379.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2468.71,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1433.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1445.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1514.21,"additional_payer_notes":"APC"}]}]},{"description":"Gated heart planar single","code_information":[{"code":"78472","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":904.35,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":534.68},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":904.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Lung ventilation imaging","code_information":[{"code":"78579","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":762.31,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":427.09},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":722.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Brain image 4+ views","code_information":[{"code":"78605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":567.01,"maximum":1258.63,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":744.14},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1258.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":578.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1035.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":635.05,"additional_payer_notes":"APC"}]}]},{"description":"Cerebrospinal fluid scan","code_information":[{"code":"78647","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":744.14,"maximum":1258.63,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":744.14},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1258.63}]}]},{"description":"K flow/funct image multiple","code_information":[{"code":"78709","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":567.01,"maximum":1035.36,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":582.02},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":984.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":578.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1035.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":635.05,"additional_payer_notes":"APC"}]}]},{"description":"Tumor imaging whole body","code_information":[{"code":"78802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":567.01,"maximum":2044.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":916.91},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1550.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":578.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1035.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":635.05,"additional_payer_notes":"APC"}]}]},{"description":"Pet image skull-thigh","code_information":[{"code":"78812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1493.26,"maximum":3093.81,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1829.17},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3093.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1553.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1493.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1538.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1597.79,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1523.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2726.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1582.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2341.27},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2341.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1596.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":2341.27},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":2341.27},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1672.46,"additional_payer_notes":"APC"}]}]},{"description":"Nuclear rx intracav admin","code_information":[{"code":"79200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":243.67,"maximum":841.98,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":497.81},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":841.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":253.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":243.67,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":250.98,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":260.72,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":248.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":444.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":258.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":405.42},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":260.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":405.42},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":405.42},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":272.91,"additional_payer_notes":"APC"}]}]},{"description":"Dx mammo incl cad uni","code_information":[{"code":"G0206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":135.03,"maximum":228.38,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":135.03},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":228.38}]}]},{"description":"X-ray exam of jaw 4/> views","code_information":[{"code":"70110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":214.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":126.85},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":214.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of eye sockets","code_information":[{"code":"70190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of teeth","code_information":[{"code":"70310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":59.5,"maximum":454.98,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":59.5},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":100.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of neck","code_information":[{"code":"70360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Ct head/brain w/o & w/dye","code_information":[{"code":"70470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":661.91,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":391.35},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":661.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"Ct soft tissue neck w/dye","code_information":[{"code":"70491","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":587.79,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":347.52},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":587.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"Mr Angiography Head W/Dye","code_information":[{"code":"70545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":1006.77,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":595.24},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1006.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Fmri brain by tech","code_information":[{"code":"70554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":695.86,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":411.42},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":695.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Chest x-ray frnt lat lordotc","code_information":[{"code":"71021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":135.38,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38}]}]},{"description":"X-ray exam ribs bil 3 views","code_information":[{"code":"71110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":214.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":126.85},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":214.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Mri chest w/o dye","code_information":[{"code":"71550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":695.86,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":411.42},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":695.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of trunk spine","code_information":[{"code":"72069","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":135.38,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38}]}]},{"description":"X-ray exam l-s spine bending","code_information":[{"code":"72114","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":214.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":126.85},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":214.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Ct lumbar spine w/o dye","code_information":[{"code":"72131","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":298.55,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":176.51},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":298.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Mri lumbar spine w/dye","code_information":[{"code":"72149","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":1006.77,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":595.24},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1006.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Ct pelvis w/dye","code_information":[{"code":"72193","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":587.79,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":347.52},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":587.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"Myelography neck spine","code_information":[{"code":"72240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":818.63,"maximum":1494.82,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":833.79},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1410.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":851.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":818.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":843.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":875.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":835.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1494.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":867.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1159.2},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1159.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":875.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":1159.2},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":1159.2},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":916.87,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of shoulder","code_information":[{"code":"73020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of forearm","code_information":[{"code":"73090","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Ct upper extremity w/o dye","code_information":[{"code":"73200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":298.55,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":176.51},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":298.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Mri joint upr extrem w/dye","code_information":[{"code":"73222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":595.24,"maximum":1494.82,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":595.24},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1006.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":851.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":818.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":843.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":875.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":835.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1494.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":867.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1159.2},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1159.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":875.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":1159.2},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":1159.2},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":916.87,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of knee 1 or 2","code_information":[{"code":"73560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of ankle","code_information":[{"code":"73610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Ct lwr extremity w/o&w/dye","code_information":[{"code":"73702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":661.91,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":391.35},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":661.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of abdomen","code_information":[{"code":"74000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":135.38,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38}]}]},{"description":"Ct angio abdom w/o & w/dye","code_information":[{"code":"74175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":689.2,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":407.48},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":689.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"Contrst x-ray exam of throat","code_information":[{"code":"74210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.14,"maximum":429.66,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":142.14},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":240.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"Contrst x-ray uppr gi tract","code_information":[{"code":"74249","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":211.07,"maximum":356.99,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":211.07},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":356.99}]}]},{"description":"Contrast x-ray exam of colon","code_information":[{"code":"74283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":429.66,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":211.07},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":356.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"Contrst x-ray urinary tract","code_information":[{"code":"74420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":359.53,"maximum":775.83,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":359.53},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":608.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"X-ray control, cath insert","code_information":[{"code":"74475","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1681.51,"maximum":2844.06,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1681.51},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2844.06}]}]},{"description":"Cardiac mri for morph w/dye","code_information":[{"code":"75561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":1163.59,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":687.95},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1163.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-ray of brain","code_information":[{"code":"70015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":818.63,"maximum":1494.82,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":833.79},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1410.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":851.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":818.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":843.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":875.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":835.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1494.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":867.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1159.2},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1159.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":875.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":1159.2},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":1159.2},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":916.87,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of facial bones","code_information":[{"code":"70150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":214.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":126.85},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":214.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of skull","code_information":[{"code":"70250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":199.35,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Magnetic image jaw joint","code_information":[{"code":"70336","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":695.86,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":411.42},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":695.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of salivary duct","code_information":[{"code":"70390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":750.46,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":443.7},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":750.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Ct maxillofacial w/dye","code_information":[{"code":"70487","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":587.79,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":347.52},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":587.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"Mri Orbit/Face/Neck W/Dye","code_information":[{"code":"70542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":1006.77,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":595.24},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1006.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Mri brain stem w/o dye","code_information":[{"code":"70551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":695.86,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":411.42},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":695.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Chest x-ray 1 view frontal","code_information":[{"code":"71010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":135.38,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38}]}]},{"description":"Chest x-ray special views","code_information":[{"code":"71035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":135.38,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38}]}]},{"description":"Ct thorax w/dye","code_information":[{"code":"71260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":587.79,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":347.52},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":587.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam neck spine 2-3 vw","code_information":[{"code":"72040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of trunk spine","code_information":[{"code":"72090","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":135.38,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38}]}]},{"description":"Ct chest spine w/o dye","code_information":[{"code":"72128","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":298.55,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":176.51},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":298.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Mri chest spine w/o dye","code_information":[{"code":"72146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":695.86,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":411.42},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":695.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of pelvis","code_information":[{"code":"72190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":199.35,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam si joints","code_information":[{"code":"72200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":199.35,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"X-ray of lower spine disk","code_information":[{"code":"72295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":6517.65,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":3853.47},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6517.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2737.85},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2737.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":2737.85},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":2737.85},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of elbow","code_information":[{"code":"73070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of hand","code_information":[{"code":"73120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":199.35,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Mri Upper Extremity W/Dye","code_information":[{"code":"73219","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":1006.77,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":595.24},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1006.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-ray of hip","code_information":[{"code":"73525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":801.02,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":473.59},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":801.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of lower leg","code_information":[{"code":"73590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of toe(s)","code_information":[{"code":"73660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Mri jnt of lwr extre w/o dye","code_information":[{"code":"73721","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":695.86,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":411.42},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":695.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Ct abdomen w/dye","code_information":[{"code":"74160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":587.79,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":347.52},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":587.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"Mri Abdomen W/Dye","code_information":[{"code":"74182","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":1006.77,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":595.24},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1006.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"X-ray upper gi&small intest","code_information":[{"code":"74245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":211.07,"maximum":356.99,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":211.07},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":356.99}]}]},{"description":"Ct colonography dx w/dye","code_information":[{"code":"74262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":587.79,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":347.52},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":587.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"Contrst x-ray urinary tract","code_information":[{"code":"74400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":608.09,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":359.53},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":608.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"X-ray urethra/bladder","code_information":[{"code":"74450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":608.09,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":359.53},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":608.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of perineum","code_information":[{"code":"74775","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":194.58,"maximum":608.09,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":359.53},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":608.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Ct angio hrt w/3d image","code_information":[{"code":"75574","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":309.85,"maximum":665.25,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":309.85},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":524.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Contrast exam abdominl aorta","code_information":[{"code":"75625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6081.96,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":3595.87},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6081.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Artery x-rays adrenal gland","code_information":[{"code":"75731","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1041.37,"maximum":6081.96,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":3595.87},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6081.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1041.37},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1041.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":1041.37},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":1041.37},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Lymph vessel x-ray arm/leg","code_information":[{"code":"75801","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":443.7,"maximum":1196.17,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":443.7},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":750.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":668.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1196.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1041.37},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1041.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":1041.37},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":1041.37},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":733.69,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray trunk","code_information":[{"code":"75825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6081.96,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":3595.87},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6081.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray skull epidural","code_information":[{"code":"75872","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":655.08,"maximum":1952.1,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1154.15},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1952.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":668.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1196.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1041.37},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1041.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":1041.37},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":1041.37},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":733.69,"additional_payer_notes":"APC"}]}]},{"description":"Intravascular us","code_information":[{"code":"75945","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.35,"maximum":450.5,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":266.35},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":450.5}]}]},{"description":"Complex body section x-rays","code_information":[{"code":"76102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":443.7,"maximum":750.46,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":443.7},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":750.46}]}]},{"description":"Ophth us b & quant a","code_information":[{"code":"76510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":406.92,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":240.59},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":406.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":178.57},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":178.57},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":178.57},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":178.57},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Us exam of head and neck","code_information":[{"code":"76536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":317.67,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":187.82},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":317.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Us exam spinal canal","code_information":[{"code":"76800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":212.57,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":125.68},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":212.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Fetal biophys profile w/nst","code_information":[{"code":"76818","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":317.67,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":187.82},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":317.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Transvaginal us non-ob","code_information":[{"code":"76830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":317.67,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":187.82},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":317.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Us xtr non-vasc lmtd","code_information":[{"code":"76882","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":212.57,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":125.68},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":212.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Computer Dx Mammogram Add-on","code_information":[{"code":"77051","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.51,"maximum":17.77,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":10.51},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.77}]}]},{"description":"Dx mammo incl cad bi","code_information":[{"code":"77066","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":172.44,"maximum":291.66,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":172.44},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":291.66},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":208.69},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":208.69},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":208.69},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":208.69}]},{"setting":"outpatient","billing_class":"facility","modifier_code":["TC"],"minimum":112.53,"maximum":205.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":117.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.91,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":120.41,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":114.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":205.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":119.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":120.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":126.03,"additional_payer_notes":"APC"}]}]},{"description":"Joint survey single view","code_information":[{"code":"77077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":199.35,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Thyroid imaging w/blood flow","code_information":[{"code":"78014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":400.47,"maximum":762.31,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":400.47},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":677.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Endocrine nuclear procedure","code_information":[{"code":"78099","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":255.97,"maximum":762.31,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":255.97},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":432.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Blood volume","code_information":[{"code":"78122","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":567.01,"maximum":1335.98,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":789.88},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":578.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1035.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":635.05,"additional_payer_notes":"APC"}]}]},{"description":"Blood/lymph nuclear exam","code_information":[{"code":"78199","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":817.57,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":483.38},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":817.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Hepatobil syst image w/drug","code_information":[{"code":"78227","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":519.99,"maximum":1035.36,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":519.99},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":879.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":578.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1035.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":635.05,"additional_payer_notes":"APC"}]}]},{"description":"Vit B-12 absorption exam","code_information":[{"code":"78270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":359.29,"maximum":607.69,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":359.29},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":607.69}]}]},{"description":"Bone imaging limited area","code_information":[{"code":"78300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":764.69,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":452.11},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":764.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Vascular flow imaging","code_information":[{"code":"78445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":762.31,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":443.7},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":750.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Heart muscle imaging (PET)","code_information":[{"code":"78459","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1351.97,"maximum":3093.81,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1829.17},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3093.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1406.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1351.97,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1392.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1446.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1379.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2468.71,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1433.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1445.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1514.21,"additional_payer_notes":"APC"}]}]},{"description":"Heart image (pet) single","code_information":[{"code":"78491","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1493.26,"maximum":3093.81,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1829.17},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3093.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1553.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1493.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1538.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1597.79,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1523.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2726.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1582.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2341.27},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2341.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1596.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":2341.27},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":2341.27},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1672.46,"additional_payer_notes":"APC"}]}]},{"description":"Lung perf&ventilat diferentl","code_information":[{"code":"78598","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":567.01,"maximum":1035.36,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":601.35},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1017.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":578.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1035.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":635.05,"additional_payer_notes":"APC"}]}]},{"description":"Brain flow imaging only","code_information":[{"code":"78610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":567.01,"maximum":1258.63,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":744.14},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1258.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":578.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1035.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":635.05,"additional_payer_notes":"APC"}]}]},{"description":"Kidney imaging morphol","code_information":[{"code":"78700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":984.42,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":582.02},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":984.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Testicular imaging w/flow","code_information":[{"code":"78761","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":984.42,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":582.02},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":984.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Abscess imaging whole body","code_information":[{"code":"78806","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":916.91,"maximum":1550.85,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":916.91},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1550.85}]}]},{"description":"Pet image w/ct full body","code_information":[{"code":"78816","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1493.26,"maximum":3093.81,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1829.17},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3093.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1553.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1493.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1538.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1597.79,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1523.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2726.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1582.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2341.27},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2341.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1596.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":2341.27},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":2341.27},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1672.46,"additional_payer_notes":"APC"}]}]},{"description":"Nuclear rx intra-arterial","code_information":[{"code":"79445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":243.67,"maximum":603.87,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":357.03},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":603.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":253.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":243.67,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":250.98,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":260.72,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":248.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":444.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":258.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":405.42},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":260.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":405.42},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":405.42},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":272.91,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of jaw <4views","code_information":[{"code":"70100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of tear duct","code_information":[{"code":"70170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":750.46,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":443.7},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":750.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of teeth","code_information":[{"code":"70300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":59.5,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":59.5},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":100.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Panoramic x-ray of jaws","code_information":[{"code":"70355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":59.5,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":59.5},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":100.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Ct head/brain w/dye","code_information":[{"code":"70460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":587.79,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":347.52},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":587.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"Ct soft tissue neck w/o dye","code_information":[{"code":"70490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":298.55,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":176.51},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":298.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Mr Angiography Head W/O Dye","code_information":[{"code":"70544","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":695.86,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":411.42},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":695.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Mri brain stem w/o & w/dye","code_information":[{"code":"70553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":1163.59,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":687.95},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1163.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Chest x-ray 2vw frontal&latl","code_information":[{"code":"71020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":135.38,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38}]}]},{"description":"X-ray exam unilat ribs/chest","code_information":[{"code":"71101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":214.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":126.85},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":214.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Ct angiography chest","code_information":[{"code":"71275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":689.2,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":407.48},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":689.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam neck spine 6/>vws","code_information":[{"code":"72052","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":214.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":126.85},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":214.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam l-2 spine 4/>vws","code_information":[{"code":"72110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":214.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":126.85},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":214.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Ct chest spine w/o & w/dye","code_information":[{"code":"72130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":661.91,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":391.35},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":661.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"Mri lumbar spine w/o dye","code_information":[{"code":"72148","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":695.86,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":411.42},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":695.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Ct pelvis w/o dye","code_information":[{"code":"72192","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":298.55,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":176.51},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":298.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam sacrum tailbone","code_information":[{"code":"72220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of shoulder blade","code_information":[{"code":"73010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":199.35,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-ray of elbow","code_information":[{"code":"73085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":801.02,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":473.59},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":801.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of finger(s)","code_information":[{"code":"73140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Mri joint upr extrem w/o dye","code_information":[{"code":"73221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":695.86,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":411.42},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":695.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of thigh","code_information":[{"code":"73550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":135.38,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38}]}]},{"description":"X-ray exam of ankle","code_information":[{"code":"73600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Ct lower extremity w/dye","code_information":[{"code":"73701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":587.79,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":347.52},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":587.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"Mri joint lwr extr w/o&w/dye","code_information":[{"code":"73723","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":1163.59,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":687.95},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1163.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Ct angio abd&pelv w/o&w/dye","code_information":[{"code":"74174","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":920.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":544.49},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":920.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of peritoneum","code_information":[{"code":"74190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":570.61,"maximum":1743.76,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1030.97},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1743.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":582.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1041.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":827.37},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":827.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":609.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":827.37},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":827.37},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":639.08,"additional_payer_notes":"APC"}]}]},{"description":"Contrst x-ray uppr gi tract","code_information":[{"code":"74247","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":211.07,"maximum":356.99,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":211.07},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":356.99}]}]},{"description":"Contrast x-ray exam of colon","code_information":[{"code":"74280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":429.66,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":211.07},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":356.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"Contrst x-ray urinary tract","code_information":[{"code":"74415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":608.09,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":359.53},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":608.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of kidney lesion","code_information":[{"code":"74470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":394.93,"maximum":1743.76,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1030.97},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1743.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":582.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1041.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":609.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":639.08,"additional_payer_notes":"APC"}]}]},{"description":"Cardiac mri w/stress img","code_information":[{"code":"75559","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":394.93,"maximum":1041.93,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":411.42},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":695.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":582.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1041.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":609.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":639.08,"additional_payer_notes":"APC"}]}]},{"description":"Contrast exam thoracic aorta","code_information":[{"code":"75605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3595.87,"maximum":10610.66,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":3595.87},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6081.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":7250.43},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7250.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":7250.43},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":7250.43},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Artery x-rays arm/leg","code_information":[{"code":"75710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6081.96,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":3595.87},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6081.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Artery x-rays lung","code_information":[{"code":"75746","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1154.15,"maximum":6020.85,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1154.15},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1952.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1671.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1671.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":1671.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":1671.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray spleen/liver","code_information":[{"code":"75810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1671.05,"maximum":6081.96,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":3595.87},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6081.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1671.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1671.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":1671.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":1671.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray adrenal glands","code_information":[{"code":"75842","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3595.87,"maximum":6081.96,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":3595.87},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6081.96}]}]},{"description":"Vein x-ray liver","code_information":[{"code":"75891","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6081.96,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":3595.87},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6081.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam breast specimen","code_information":[{"code":"76098","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":443.7,"maximum":1041.93,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":443.7},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":750.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":582.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1041.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":827.37},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":827.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":609.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":827.37},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":827.37},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":639.08,"additional_payer_notes":"APC"}]}]},{"description":"Mri procedure","code_information":[{"code":"76498","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":695.86,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":411.42},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":695.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Echo exam of eye","code_information":[{"code":"76516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":212.57,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":125.68},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":212.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Us exam abdo back wall comp","code_information":[{"code":"76770","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":317.67,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":187.82},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":317.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Ob us limited fetus(s)","code_information":[{"code":"76815","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":317.67,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":187.82},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":317.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Echo exam of fetal heart","code_information":[{"code":"76826","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":591.73,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":349.85},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":591.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Us transrectal","code_information":[{"code":"76872","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":317.67,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":187.82},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":317.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"GI endoscopic ultrasound","code_information":[{"code":"76975","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":266.35},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":450.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Mammogram, Both Breasts","code_information":[{"code":"77056","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":102.74,"maximum":173.77,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":102.74},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":173.77}]}]},{"description":"X-rays bone survey limited","code_information":[{"code":"77074","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":214.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":126.85},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":214.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Magnetic image bone marrow","code_information":[{"code":"77084","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":695.86,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":411.42},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":695.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Parathyrd planar w/wo subtrj","code_information":[{"code":"78071","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":1743.76,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1030.97},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1743.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Plasma volume multiple","code_information":[{"code":"78111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":789.88,"maximum":2468.71,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":789.88},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1406.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1351.97,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1392.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1446.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1379.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2468.71,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1433.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1445.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1514.21,"additional_payer_notes":"APC"}]}]},{"description":"Platelet survival kinetics","code_information":[{"code":"78190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":359.29,"maximum":607.69,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":359.29},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":607.69}]}]},{"description":"Liver and spleen imaging","code_information":[{"code":"78215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":879.49,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":519.99},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":879.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Gastric mucosa imaging","code_information":[{"code":"78261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":764.32,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":451.89},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":764.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Meckels divert exam","code_information":[{"code":"78290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":764.32,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":451.89},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":764.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Musculoskeletal nuclear exam","code_information":[{"code":"78399","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":764.69,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":452.11},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":764.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Acute venous thrombus image","code_information":[{"code":"78456","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1030.97,"maximum":2468.71,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1030.97},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1743.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1406.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1351.97,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1392.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1446.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1379.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2468.71,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1433.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1445.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1514.21,"additional_payer_notes":"APC"}]}]},{"description":"Gated heart multiple","code_information":[{"code":"78473","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":904.35,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":534.68},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":904.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Lung perfusion imaging","code_information":[{"code":"78580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":762.31,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":427.09},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":722.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Brain image w/flow 4 + views","code_information":[{"code":"78606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":567.01,"maximum":1258.63,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":744.14},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1258.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":578.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1035.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":635.05,"additional_payer_notes":"APC"}]}]},{"description":"CSF leakage imaging","code_information":[{"code":"78650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":744.14,"maximum":2468.71,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":744.14},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1258.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1406.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1351.97,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1392.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1446.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1379.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2468.71,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1433.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1445.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1514.21,"additional_payer_notes":"APC"}]}]},{"description":"Kidney imaging (3D)","code_information":[{"code":"78710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":582.02,"maximum":984.42,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":582.02},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":984.42}]}]},{"description":"Tumor imaging (3D)","code_information":[{"code":"78803","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":567.01,"maximum":1550.85,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":916.91},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1550.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":578.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1035.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":635.05,"additional_payer_notes":"APC"}]}]},{"description":"Pet image full body","code_information":[{"code":"78813","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1493.26,"maximum":3093.81,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1829.17},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3093.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1553.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1493.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1538.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1597.79,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1523.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2726.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1582.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2341.27},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2341.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1596.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":2341.27},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":2341.27},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1672.46,"additional_payer_notes":"APC"}]}]},{"description":"Nuclr rx interstit colloid","code_information":[{"code":"79300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":243.67,"maximum":603.87,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":357.03},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":603.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":253.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":243.67,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":250.98,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":260.72,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":248.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":444.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":258.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":405.42},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":260.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":405.42},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":405.42},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":272.91,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of middle ear","code_information":[{"code":"70134","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":1041.93,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":582.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1041.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":609.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":639.08,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of sinuses","code_information":[{"code":"70220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of jaw joints","code_information":[{"code":"70330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-ray of larynx","code_information":[{"code":"70373","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":443.7,"maximum":750.46,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":443.7},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":750.46}]}]},{"description":"Ct orbit/ear/fossa w/o&w/dye","code_information":[{"code":"70482","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":661.91,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":391.35},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":661.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"Ct angiography neck","code_information":[{"code":"70498","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":689.2,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":407.48},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":689.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"Mr Angiography Neck W/Dye","code_information":[{"code":"70548","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":1006.77,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":595.24},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1006.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Mri brain w/dye","code_information":[{"code":"70558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":1006.77,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":595.24},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1006.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"Chest x-ray 4/> views","code_information":[{"code":"71030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":126.85,"maximum":214.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":126.85},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":214.56}]}]},{"description":"X-ray strenoclavic jt 3/>vws","code_information":[{"code":"71130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of spine","code_information":[{"code":"72010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":126.85,"maximum":214.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":126.85},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":214.56}]}]},{"description":"X-ray exam thorac spine4/>vw","code_information":[{"code":"72074","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":199.35,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Ct neck spine w/dye","code_information":[{"code":"72126","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":347.52,"maximum":775.83,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":347.52},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":587.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Mri neck spine w/o dye","code_information":[{"code":"72141","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":695.86,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":411.42},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":695.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Mri lumbar spine w/o & w/dye","code_information":[{"code":"72158","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":1163.59,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":687.95},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1163.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Mri pelvis w/dye","code_information":[{"code":"72196","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":1006.77,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":595.24},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1006.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Myelogphy 2/> spine regions","code_information":[{"code":"72270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":818.63,"maximum":1494.82,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":833.79},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1410.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":851.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":818.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":843.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":875.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":835.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1494.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":867.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1159.2},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1159.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":875.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":1159.2},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":1159.2},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":916.87,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of shoulders","code_information":[{"code":"73050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of wrist","code_information":[{"code":"73110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Ct angio upr extrm w/o&w/dye","code_information":[{"code":"73206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":689.2,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":407.48},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":689.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of hip","code_information":[{"code":"73510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":135.38,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38}]}]},{"description":"X-ray exam of knees","code_information":[{"code":"73565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of foot","code_information":[{"code":"73630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Mri Lower Extremity W/Dye","code_information":[{"code":"73719","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":1006.77,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":595.24},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1006.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam series abdomen","code_information":[{"code":"74022","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":214.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":126.85},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":214.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Ct abd & pelv 1/> regns","code_information":[{"code":"74178","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":920.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":544.49},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":920.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"X-ray upper gi delay w/o kub","code_information":[{"code":"74240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":429.66,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":211.07},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":356.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of small bowel","code_information":[{"code":"74260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.14,"maximum":240.4,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":142.14},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":240.4}]}]},{"description":"X-ray bile ducts/pancreas","code_information":[{"code":"74305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":443.7,"maximum":750.46,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":443.7},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":750.46}]}]},{"description":"X-ray male genital tract","code_information":[{"code":"74440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":608.09,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":359.53},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":608.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"X-ray measurement of pelvis","code_information":[{"code":"74710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":126.85,"maximum":214.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":126.85},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":214.56}]}]},{"description":"Ct hrt w/3d image","code_information":[{"code":"75572","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":309.85,"maximum":665.25,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":309.85},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":524.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Artery x-rays abdomen","code_information":[{"code":"75726","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10654.87,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":6299.53},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10654.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":7250.43},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7250.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":7250.43},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":7250.43},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Angiography, arteriovenous shunt","code_information":[{"code":"75791","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1154.15,"maximum":1952.1,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1154.15},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1952.1}]}]},{"description":"Vein x-ray arms/legs","code_information":[{"code":"75822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1030.97,"maximum":3001.68,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1030.97},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1743.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1676.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3001.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1671.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1671.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1757.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":1671.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":1671.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1841.12,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray skull","code_information":[{"code":"75870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":443.7,"maximum":6020.85,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":443.7},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":750.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1041.37},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1041.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":1041.37},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":1041.37},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Follow-up angiography","code_information":[{"code":"75898","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1154.15,"maximum":6020.85,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1154.15},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1952.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1671.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1671.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":1671.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":1671.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Complex body section x-ray","code_information":[{"code":"76101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":443.7,"maximum":750.46,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":443.7},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":750.46}]}]},{"description":"Echo exam of head","code_information":[{"code":"76506","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":317.67,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":187.82},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":317.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Echo exam of eye","code_information":[{"code":"76529","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":317.67,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":187.82},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":317.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Us exam k transpl w/doppler","code_information":[{"code":"76776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":317.67,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":187.82},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":317.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Transvaginal us obstetric","code_information":[{"code":"76817","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":317.67,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":187.82},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":317.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Echo exam of fetal heart","code_information":[{"code":"76828","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":212.57,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":125.68},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":212.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Us xtr non-vasc complete","code_information":[{"code":"76881","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":317.67,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":187.82},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":317.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Echo examination procedure","code_information":[{"code":"76999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":212.57,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":125.68},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":212.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Dx mammo incl cad uni","code_information":[{"code":"77065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":135.03,"maximum":228.38,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":135.03},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":228.38},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":163.4},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":163.4},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":163.4},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":163.4}]},{"setting":"outpatient","billing_class":"facility","modifier_code":["TC"],"minimum":87.56,"maximum":159.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":91.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":87.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":90.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":93.69,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":89.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":159.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":98.07,"additional_payer_notes":"APC"}]}]},{"description":"X-rays bone survey infant","code_information":[{"code":"77076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":214.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":126.85},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":214.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Thyroid imaging w/blood flow","code_information":[{"code":"78013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":255.97,"maximum":762.31,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":255.97},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":432.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Adrenal cortex & medulla img","code_information":[{"code":"78075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1351.97,"maximum":2732.21,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1615.38},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2732.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1406.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1351.97,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1392.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1446.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1379.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2468.71,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1433.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1445.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1514.21,"additional_payer_notes":"APC"}]}]},{"description":"Red cell mass multiple","code_information":[{"code":"78121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":567.01,"maximum":1335.98,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":789.88},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":578.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1035.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":635.05,"additional_payer_notes":"APC"}]}]},{"description":"Lymph system imaging","code_information":[{"code":"78195","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":483.38,"maximum":1035.36,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":483.38},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":817.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":578.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1035.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":635.05,"additional_payer_notes":"APC"}]}]},{"description":"Hepatobiliary system imaging","code_information":[{"code":"78226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":879.49,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":519.99},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":879.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Gastric emptying imag study","code_information":[{"code":"78264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":764.32,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":451.89},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":764.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"GI nuclear procedure","code_information":[{"code":"78299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":764.32,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":451.89},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":764.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Cardiac shunt imaging","code_information":[{"code":"78428","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":904.35,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":534.68},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":904.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Ven thrombosis images bilat","code_information":[{"code":"78458","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":762.31,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":443.7},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":750.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Heart first pass multiple","code_information":[{"code":"78483","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":567.01,"maximum":2723.24,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1610.08},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2723.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":578.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1035.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":635.05,"additional_payer_notes":"APC"}]}]},{"description":"Lung perfusion differential","code_information":[{"code":"78597","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":762.31,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":427.09},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":722.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Brain imaging (PET)","code_information":[{"code":"78608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1493.26,"maximum":3093.81,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1829.17},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3093.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1553.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1493.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1538.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1597.79,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1523.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2726.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1582.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2341.27},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2341.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1596.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":2341.27},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":2341.27},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1672.46,"additional_payer_notes":"APC"}]}]},{"description":"Nervous system nuclear exam","code_information":[{"code":"78699","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":227.05,"maximum":762.31,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":227.05},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":384.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Ureteral reflux study","code_information":[{"code":"78740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":984.42,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":582.02},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":984.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Abscess imaging ltd area","code_information":[{"code":"78805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":916.91,"maximum":1550.85,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":916.91},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1550.85}]}]},{"description":"Pet image w/ct skull-thigh","code_information":[{"code":"78815","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1493.26,"maximum":3093.81,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1829.17},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3093.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1553.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1493.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1538.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1597.79,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1523.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2726.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1582.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2341.27},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2341.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1596.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":2341.27},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":2341.27},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1672.46,"additional_payer_notes":"APC"}]}]},{"description":"Nuclear rx intra-articular","code_information":[{"code":"79440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":243.67,"maximum":841.98,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":497.81},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":841.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":253.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":243.67,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":250.98,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":260.72,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":248.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":444.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":258.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":405.42},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":260.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":405.42},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":405.42},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":272.91,"additional_payer_notes":"APC"}]}]},{"description":"Artery x-rays arm","code_information":[{"code":"75658","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3595.87,"maximum":6081.96,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":3595.87},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6081.96}]}]},{"description":"Artery x-rays lung","code_information":[{"code":"75741","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6081.96,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":3595.87},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6081.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Lymph vessel x-ray trunk","code_information":[{"code":"75807","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1030.97,"maximum":6020.85,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1030.97},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1743.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray kidneys","code_information":[{"code":"75833","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6081.96,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":3595.87},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6081.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray liver w/o hemodyn","code_information":[{"code":"75887","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1154.15,"maximum":6020.85,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1154.15},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1952.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1671.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1671.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":1671.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":1671.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"X-ray nose to rectum","code_information":[{"code":"76010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Fluoroscopic procedure","code_information":[{"code":"76496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":369.84,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":218.66},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":369.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Echo exam of eye water bath","code_information":[{"code":"76513","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":317.67,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":187.82},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":317.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Us exam abdom complete","code_information":[{"code":"76700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":317.67,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":187.82},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":317.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Ob us detailed sngl fetus","code_information":[{"code":"76811","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":194.58,"maximum":454.98,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":266.35},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":450.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Middle cerebral artery echo","code_information":[{"code":"76821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":212.57,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":125.68},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":212.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Us exam pelvic limited","code_information":[{"code":"76857","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":212.57,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":125.68},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":212.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Echo guide for artery repair","code_information":[{"code":"76936","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":182.92,"maximum":423.01,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":182.92},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":309.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":423.01},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":423.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":423.01},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":423.01},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"X-ray of mammary ducts","code_information":[{"code":"77054","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":750.46,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":443.7},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":750.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"X-Rays for Bone Age","code_information":[{"code":"77072","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":199.35,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Dxa bone density/peripheral","code_information":[{"code":"77081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":71.47,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":71.47},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":120.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Thyroid met imaging body","code_information":[{"code":"78018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":534.22,"maximum":1035.36,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":534.22},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":903.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":578.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1035.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":635.05,"additional_payer_notes":"APC"}]}]},{"description":"Bone marrow imaging body","code_information":[{"code":"78104","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":817.57,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":483.38},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":817.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Red cell sequestration","code_information":[{"code":"78140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":1335.98,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":789.88},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Liver imaging (3D)","code_information":[{"code":"78205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":519.99,"maximum":879.49,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":519.99},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":879.49}]}]},{"description":"Salivary gland function exam","code_information":[{"code":"78232","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":764.32,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":451.89},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":764.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Acute GI blood loss imaging","code_information":[{"code":"78278","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":764.32,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":451.89},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":764.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Bone imaging 3 phase","code_information":[{"code":"78315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":764.69,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":452.11},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":764.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Ht muscle image planar sing","code_information":[{"code":"78453","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1351.97,"maximum":2723.24,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1610.08},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2723.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1406.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1351.97,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1392.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1446.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1379.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2468.71,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1433.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1445.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1514.21,"additional_payer_notes":"APC"}]}]},{"description":"Heart infarct image (3D)","code_information":[{"code":"78469","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":534.68,"maximum":2044.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":534.68},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":904.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":578.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1035.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":635.05,"additional_payer_notes":"APC"}]}]},{"description":"Cardiovascular nuclear exam","code_information":[{"code":"78499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":904.35,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":534.68},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":904.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Brain image w/flow < 4 views","code_information":[{"code":"78601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":1258.63,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":744.14},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1258.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"CSF shunt evaluation","code_information":[{"code":"78645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":567.01,"maximum":1258.63,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":744.14},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1258.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":578.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1035.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":635.05,"additional_payer_notes":"APC"}]}]},{"description":"K flow/funct image w/drug","code_information":[{"code":"78708","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":567.01,"maximum":1035.36,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":582.02},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":984.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":578.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1035.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":635.05,"additional_payer_notes":"APC"}]}]},{"description":"Tumor imaging mult areas","code_information":[{"code":"78801","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":903.57,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":534.22},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":903.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Pet image ltd area","code_information":[{"code":"78811","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1351.97,"maximum":3093.81,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1829.17},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3093.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1406.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1351.97,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1392.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1446.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1379.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2468.71,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1433.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1445.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1514.21,"additional_payer_notes":"APC"}]}]},{"description":"Nuclear rx iv admin","code_information":[{"code":"79101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":243.67,"maximum":603.87,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":357.03},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":603.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":253.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":243.67,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":250.98,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":260.72,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":248.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":444.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":258.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":405.42},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":260.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":405.42},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":405.42},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":272.91,"additional_payer_notes":"APC"}]}]},{"description":"Dx mammo incl cad bi","code_information":[{"code":"G0204","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":172.44,"maximum":291.66,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":172.44},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":291.66}]}]},{"description":"X-ray eye for foreign body","code_information":[{"code":"70030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of nasal bones","code_information":[{"code":"70160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of skull","code_information":[{"code":"70260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":214.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":126.85},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":214.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"X-ray head for orthodontia","code_information":[{"code":"70350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Ct head/brain w/o dye","code_information":[{"code":"70450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":298.55,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":176.51},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":298.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Ct maxillofacial w/o & w/dye","code_information":[{"code":"70488","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":661.91,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":391.35},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":661.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"Mri orbt/fac/nck w/o &w/dye","code_information":[{"code":"70543","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":1163.59,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":687.95},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1163.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Mri brain stem w/dye","code_information":[{"code":"70552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":1006.77,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":595.24},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1006.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Chest x-ray stereo frontal","code_information":[{"code":"71015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":135.38,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38}]}]},{"description":"X-ray exam ribs uni 2 views","code_information":[{"code":"71100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Ct thorax w/o & w/dye","code_information":[{"code":"71270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":661.91,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":391.35},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":661.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam neck spine 4/5vws","code_information":[{"code":"72050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":214.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":126.85},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":214.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam l-s spine 2/3 vws","code_information":[{"code":"72100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":199.35,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Ct chest spine w/dye","code_information":[{"code":"72129","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":587.79,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":347.52},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":587.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"Mri chest spine w/dye","code_information":[{"code":"72147","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":1006.77,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":595.24},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1006.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Ct angiograph pelv w/o&w/dye","code_information":[{"code":"72191","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":689.2,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":407.48},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":689.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam si joints 3/> vws","code_information":[{"code":"72202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":199.35,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of collar bone","code_information":[{"code":"73000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of elbow","code_information":[{"code":"73080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of hand","code_information":[{"code":"73130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Mri uppr extremity w/o&w/dye","code_information":[{"code":"73220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":1163.59,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":687.95},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1163.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of pelvis & hips","code_information":[{"code":"73540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":135.38,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38}]}]},{"description":"X-ray exam of leg infant","code_information":[{"code":"73592","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Ct lower extremity w/o dye","code_information":[{"code":"73700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":298.55,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":176.51},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":298.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Mri Joint Of Lwr Extr W/Dye","code_information":[{"code":"73722","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":595.24,"maximum":1494.82,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":595.24},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1006.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":851.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":818.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":843.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":875.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":835.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1494.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":867.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1159.2},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1159.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":875.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":1159.2},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":1159.2},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":916.87,"additional_payer_notes":"APC"}]}]},{"description":"Ct abdomen w/o & w/dye","code_information":[{"code":"74170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":661.91,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":391.35},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":661.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"Mri abdomen w/o & w/dye","code_information":[{"code":"74183","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":1163.59,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":687.95},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1163.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Contrst x-ray uppr gi tract","code_information":[{"code":"74246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":429.66,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":211.07},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":356.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-ray exam of colon","code_information":[{"code":"74270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":429.66,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":211.07},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":356.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"Contrst x-ray urinary tract","code_information":[{"code":"74410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":608.09,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":359.53},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":608.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"X-ray urethra/bladder","code_information":[{"code":"74455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":608.09,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":359.53},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":608.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Cardiac mri for morph","code_information":[{"code":"75557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":695.86,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":411.42},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":695.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Contrast exam thoracic aorta","code_information":[{"code":"75600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6081.96,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":3595.87},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6081.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Artery x-rays arms/legs","code_information":[{"code":"75716","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6081.96,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":3595.87},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6081.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Artery x-rays chest","code_information":[{"code":"75756","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1154.15,"maximum":6020.85,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1154.15},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1952.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray arm/leg","code_information":[{"code":"75820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1041.37,"maximum":3001.68,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1154.15},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1952.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1676.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3001.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1041.37},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1041.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1757.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":1041.37},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":1041.37},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1841.12,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray neck","code_information":[{"code":"75860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1154.15,"maximum":6020.85,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1154.15},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1952.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Venous sampling by catheter","code_information":[{"code":"75893","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3595.87,"maximum":10610.66,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":3595.87},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6081.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":7250.43},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7250.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":7250.43},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":7250.43},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of body section","code_information":[{"code":"76100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":214.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":126.85},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":214.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Radiographic procedure","code_information":[{"code":"76499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Echo exam of eye","code_information":[{"code":"76519","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":212.57,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":125.68},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":212.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Us exam abdo back wall lim","code_information":[{"code":"76775","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":317.67,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":187.82},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":317.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Ob us follow-up per fetus","code_information":[{"code":"76816","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":212.57,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":125.68},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":212.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Echo exam of fetal heart","code_information":[{"code":"76827","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":212.57,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":125.68},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":212.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Echograp trans r pros study","code_information":[{"code":"76873","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":450.5,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":266.35},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":450.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Us bone density measure","code_information":[{"code":"76977","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":74.58,"maximum":199.35,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":74.58},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":126.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Mammogram, Screening","code_information":[{"code":"77057","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":67.39,"maximum":113.98,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":67.39},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.98}]}]},{"description":"X-rays bone survey complete","code_information":[{"code":"77075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":214.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":126.85},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":214.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Thyroid uptake measurement","code_information":[{"code":"78012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.94,"maximum":762.31,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":195.94},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":331.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Parathyrd planar w/spect&ct","code_information":[{"code":"78072","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":567.01,"maximum":1743.76,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1030.97},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1743.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":578.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1035.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":635.05,"additional_payer_notes":"APC"}]}]},{"description":"Red cell mass single","code_information":[{"code":"78120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":1335.98,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":789.88},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Platelet survival","code_information":[{"code":"78191","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":359.29,"maximum":762.31,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":359.29},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":607.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Liver & spleen image/flow","code_information":[{"code":"78216","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":879.49,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":519.99},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":879.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Gastroesophageal reflux exam","code_information":[{"code":"78262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":764.32,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":451.89},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":764.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Leveen/shunt patency exam","code_information":[{"code":"78291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":764.32,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":451.89},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":764.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Non-imaging heart function","code_information":[{"code":"78414","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":534.68,"maximum":1035.36,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":534.68},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":904.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":578.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1035.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":635.05,"additional_payer_notes":"APC"}]}]},{"description":"Venous thrombosis imaging","code_information":[{"code":"78457","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":443.7,"maximum":2044.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":443.7},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":750.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":578.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1035.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":635.05,"additional_payer_notes":"APC"}]}]},{"description":"Heart first pass single","code_information":[{"code":"78481","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":534.68,"maximum":1035.36,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":534.68},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":904.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":578.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1035.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":635.05,"additional_payer_notes":"APC"}]}]},{"description":"Lung ventilat&perfus imaging","code_information":[{"code":"78582","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":567.01,"maximum":1035.36,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":601.35},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1017.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":578.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1035.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":635.05,"additional_payer_notes":"APC"}]}]},{"description":"Brain imaging (3D)","code_information":[{"code":"78607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1615.38,"maximum":2732.21,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1615.38},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2732.21}]}]},{"description":"Nuclear exam of tear flow","code_information":[{"code":"78660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":227.05,"maximum":762.31,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":227.05},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":384.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Kidney function study","code_information":[{"code":"78725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":359.29,"maximum":762.31,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":359.29},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":607.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Tumor imaging whole body","code_information":[{"code":"78804","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":567.01,"maximum":2732.21,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1615.38},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2732.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":578.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1035.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":635.05,"additional_payer_notes":"APC"}]}]},{"description":"Pet image w/ct lmtd","code_information":[{"code":"78814","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1493.26,"maximum":3093.81,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1829.17},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3093.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1553.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1493.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1538.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1597.79,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1523.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2726.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1582.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2341.27},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2341.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1596.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":2341.27},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":2341.27},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1672.46,"additional_payer_notes":"APC"}]}]},{"description":"Hematopoietic nuclear tx","code_information":[{"code":"79403","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":243.67,"maximum":841.98,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":497.81},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":841.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":253.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":243.67,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":250.98,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":260.72,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":248.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":444.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":258.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":405.42},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":260.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":405.42},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":405.42},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":272.91,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of mastoids","code_information":[{"code":"70130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":199.35,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of sinuses","code_information":[{"code":"70210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of jaw joint","code_information":[{"code":"70328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Speech evaluation complex","code_information":[{"code":"70371","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":218.66,"maximum":454.98,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":218.66},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":369.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Ct orbit/ear/fossa w/dye","code_information":[{"code":"70481","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":587.79,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":347.52},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":587.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"Ct angiography head","code_information":[{"code":"70496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":689.2,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":407.48},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":689.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"Mr Angiography Neck W/O Dye","code_information":[{"code":"70547","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":695.86,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":411.42},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":695.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Mri brain w/o dye","code_information":[{"code":"70557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":394.93,"maximum":1041.93,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":411.42},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":695.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":582.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1041.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":609.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":639.08,"additional_payer_notes":"APC"}]}]},{"description":"Chest x-ray and fluoroscopy","code_information":[{"code":"71023","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":218.66,"maximum":369.84,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":218.66},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":369.84}]}]},{"description":"X-ray exam breastbone 2/>vws","code_information":[{"code":"71120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Mri chest w/o & w/dye","code_information":[{"code":"71552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":1163.59,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":687.95},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1163.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam thorac spine 3vws","code_information":[{"code":"72072","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":214.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":126.85},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":214.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Ct neck spine w/o dye","code_information":[{"code":"72125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":298.55,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":176.51},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":298.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Ct lumbar spine w/o & w/dye","code_information":[{"code":"72133","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":661.91,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":391.35},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":661.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"Mri chest spine w/o & w/dye","code_information":[{"code":"72157","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":1163.59,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":687.95},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1163.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Mri Pelvis W/O Dye","code_information":[{"code":"72195","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":695.86,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":411.42},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":695.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Myelography l-s spine","code_information":[{"code":"72265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":818.63,"maximum":1494.82,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":833.79},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1410.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":851.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":818.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":843.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":875.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":835.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1494.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":867.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1159.2},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1159.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":875.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":1159.2},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":1159.2},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":916.87,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-ray of shoulder","code_information":[{"code":"73040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":801.02,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":473.59},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":801.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of wrist","code_information":[{"code":"73100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Ct uppr extremity w/o&w/dye","code_information":[{"code":"73202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":661.91,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":391.35},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":661.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of hip","code_information":[{"code":"73500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":135.38,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38}]}]},{"description":"X-ray exam knee 4 or more","code_information":[{"code":"73564","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":199.35,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of foot","code_information":[{"code":"73620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Mri Lower Extremity W/O Dye","code_information":[{"code":"73718","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":695.86,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":411.42},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":695.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of abdomen","code_information":[{"code":"74020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":135.38,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38}]}]},{"description":"Ct abd & pelv w/contrast","code_information":[{"code":"74177","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":920.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":544.49},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":920.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Cine/vid x-ray throat/esoph","code_information":[{"code":"74230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.14,"maximum":334.46,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":142.14},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":240.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of small bowel","code_information":[{"code":"74251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":356.99,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":211.07},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":356.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-rays, gallbladder","code_information":[{"code":"74291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.14,"maximum":240.4,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":142.14},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":240.4}]}]},{"description":"Contrast x-ray bladder","code_information":[{"code":"74430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":359.53,"maximum":665.25,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":359.53},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":608.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"X-ray guide gu dilation","code_information":[{"code":"74485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1681.51,"maximum":3986.05,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1681.51},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2844.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2882.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2882.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":2882.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":2882.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Ct hrt w/o dye w/ca test","code_information":[{"code":"75571","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.86,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":30.86},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Ct Angio Abdominal Arteries","code_information":[{"code":"75635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":689.2,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":407.48},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":689.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"Artery x-rays pelvis","code_information":[{"code":"75736","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3595.87,"maximum":10610.66,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":3595.87},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6081.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":7250.43},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7250.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":7250.43},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":7250.43},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Lymph vessel x-ray trunk","code_information":[{"code":"75805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1030.97,"maximum":6020.85,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1030.97},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1743.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1671.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1671.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":1671.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":1671.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray kidney","code_information":[{"code":"75831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6081.96,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":3595.87},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6081.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray liver w/hemodynam","code_information":[{"code":"75885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6081.96,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":3595.87},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6081.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Fluoroscope examination","code_information":[{"code":"76000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":218.66,"maximum":454.98,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":218.66},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":369.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"CAT scan follow-up study","code_information":[{"code":"76380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":187.81,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":111.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":187.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Ophth us b w/non-quant a","code_information":[{"code":"76512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":317.67,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":187.82},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":317.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Echo exam of breast(s)","code_information":[{"code":"76645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":125.68,"maximum":212.57,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":125.68},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":212.57}]}]},{"description":"Ob us >/= 14 wks sngl fetus","code_information":[{"code":"76805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":317.67,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":187.82},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":317.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Umbilical artery echo","code_information":[{"code":"76820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":212.57,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":125.68},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":212.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Us exam pelvic complete","code_information":[{"code":"76856","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":317.67,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":187.82},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":317.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Us exam infant hips static","code_information":[{"code":"76886","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":212.57,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":125.68},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":212.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"X-Ray of Mammary Duct","code_information":[{"code":"77053","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":750.46,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":443.7},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":750.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"X-Ray Stress View","code_information":[{"code":"77071","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Dxa bone density axial","code_information":[{"code":"77080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":212.83,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":125.83},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":212.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Thyroid met imaging/studies","code_information":[{"code":"78016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":903.57,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":534.22},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":903.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Bone marrow imaging mult","code_information":[{"code":"78103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":817.57,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":483.38},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":817.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Red cell survival kinetics","code_information":[{"code":"78135","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":789.88,"maximum":1335.98,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":789.88},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.98}]}]},{"description":"Liver imaging with flow","code_information":[{"code":"78202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":519.99,"maximum":2044.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":519.99},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":879.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":578.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1035.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":635.05,"additional_payer_notes":"APC"}]}]},{"description":"Serial salivary imaging","code_information":[{"code":"78231","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":764.32,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":451.89},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":764.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Vit b-12 absorp combined","code_information":[{"code":"78272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":359.29,"maximum":607.69,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":359.29},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":607.69}]}]},{"description":"Bone imaging whole body","code_information":[{"code":"78306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":764.69,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":452.11},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":764.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Ht muscle image spect mult","code_information":[{"code":"78452","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1351.97,"maximum":2723.24,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1610.08},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2723.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1406.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1351.97,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1392.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1446.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1379.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2468.71,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1433.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1445.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1514.21,"additional_payer_notes":"APC"}]}]},{"description":"Heart infarct image (ef)","code_information":[{"code":"78468","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":534.68,"maximum":1035.36,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":534.68},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":904.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":578.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1035.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":635.05,"additional_payer_notes":"APC"}]}]},{"description":"Heart image spect","code_information":[{"code":"78494","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":904.35,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":534.68},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":904.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Brain image < 4 views","code_information":[{"code":"78600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":227.05,"maximum":762.31,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":227.05},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":384.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"CSF ventriculography","code_information":[{"code":"78635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":567.01,"maximum":1258.63,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":744.14},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1258.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":578.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1035.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":635.05,"additional_payer_notes":"APC"}]}]},{"description":"K flow/funct image w/o drug","code_information":[{"code":"78707","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":567.01,"maximum":1035.36,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":582.02},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":984.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":578.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1035.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":635.05,"additional_payer_notes":"APC"}]}]},{"description":"Tumor imaging limited area","code_information":[{"code":"78800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":903.57,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":534.22},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":903.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Iv inj ra drug dx study","code_information":[{"code":"78808","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":359.29,"maximum":762.31,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":359.29},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":607.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Nuclear rx oral admin","code_information":[{"code":"79005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":243.67,"maximum":603.87,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":357.03},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":603.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":253.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":243.67,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":250.98,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":260.72,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":248.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":444.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":258.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":405.42},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":260.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":405.42},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":405.42},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":272.91,"additional_payer_notes":"APC"}]}]},{"description":"Scr mammo bi incl cad","code_information":[{"code":"G0202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.72,"maximum":241.39,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":142.72},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.39}]}]},{"description":"X-ray exam of mastoids","code_information":[{"code":"70120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":199.35,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of eye sockets","code_information":[{"code":"70200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":199.35,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Full mouth x-ray of teeth","code_information":[{"code":"70320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":59.5,"maximum":454.98,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":59.5},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":100.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Throat x-ray & fluoroscopy","code_information":[{"code":"70370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":369.84,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":218.66},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":369.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Ct orbit/ear/fossa w/o dye","code_information":[{"code":"70480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":298.55,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":176.51},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":298.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Ct sft tsue nck w/o & w/dye","code_information":[{"code":"70492","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":661.91,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":391.35},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":661.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"Mr angiograph head w/o&w/dye","code_information":[{"code":"70546","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":1163.59,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":687.95},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1163.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Fmri brain by phys/psych","code_information":[{"code":"70555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":695.86,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":411.42},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":695.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Chest x-ray frnt lat oblique","code_information":[{"code":"71022","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":135.38,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38}]}]},{"description":"X-ray exam ribs/chest4/> vws","code_information":[{"code":"71111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":214.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":126.85},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":214.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Mri Chest W/Dye","code_information":[{"code":"71551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":595.24,"maximum":1494.82,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":595.24},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1006.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":851.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":818.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":843.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":875.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":835.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1494.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":867.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1159.2},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1159.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":875.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":1159.2},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":1159.2},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":916.87,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam thorac spine 2vws","code_information":[{"code":"72070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":199.35,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"X-ray bend only l-s spine","code_information":[{"code":"72120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":214.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":126.85},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":214.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Ct lumbar spine w/dye","code_information":[{"code":"72132","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":347.52,"maximum":775.83,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":347.52},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":587.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Mri neck spine w/o & w/dye","code_information":[{"code":"72156","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":1163.59,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":687.95},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1163.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Ct pelvis w/o & w/dye","code_information":[{"code":"72194","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":661.91,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":391.35},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":661.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"Myelography thoracic spine","code_information":[{"code":"72255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":818.63,"maximum":1494.82,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":833.79},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1410.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":851.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":818.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":843.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":875.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":835.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1494.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":867.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1159.2},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1159.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":875.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":1159.2},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":1159.2},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":916.87,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of shoulder","code_information":[{"code":"73030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of arm infant","code_information":[{"code":"73092","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":214.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":126.85},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":214.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Ct upper extremity w/dye","code_information":[{"code":"73201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":347.52,"maximum":665.25,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":347.52},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":587.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Mri joint upr extr w/o&w/dye","code_information":[{"code":"73223","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":1163.59,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":687.95},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1163.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of knee 3","code_information":[{"code":"73562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":165.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-ray of ankle","code_information":[{"code":"73615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":801.02,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":473.59},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":801.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Ct angio lwr extr w/o&w/dye","code_information":[{"code":"73706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":689.2,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":407.48},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":689.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of abdomen","code_information":[{"code":"74010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.04,"maximum":135.38,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.38}]}]},{"description":"Ct abd & pelvis w/o contrast","code_information":[{"code":"74176","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":570.77,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":337.46},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":570.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-ray esophagus","code_information":[{"code":"74220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.14,"maximum":429.66,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":142.14},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":240.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of small bowel","code_information":[{"code":"74250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.14,"maximum":334.46,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":142.14},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":240.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"Contrast x-ray gallbladder","code_information":[{"code":"74290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.14,"maximum":429.66,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":142.14},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":240.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"Contrst x-ray urinary tract","code_information":[{"code":"74425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":359.53,"maximum":665.25,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":359.53},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":608.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"X-ray control, cath insert","code_information":[{"code":"74480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1681.51,"maximum":2844.06,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1681.51},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2844.06}]}]},{"description":"Card mri w/stress img & dye","code_information":[{"code":"75563","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":818.63,"maximum":2723.24,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1610.08},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2723.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":851.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":818.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":843.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":875.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":835.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1494.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":867.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1159.2},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1159.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":875.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":1159.2},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":1159.2},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":916.87,"additional_payer_notes":"APC"}]}]},{"description":"X-ray aorta leg arteries","code_information":[{"code":"75630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6081.96,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":3595.87},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6081.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Artery x-rays adrenals","code_information":[{"code":"75733","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6081.96,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":3595.87},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6081.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":4237.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Lymph vessel x-ray arms/legs","code_information":[{"code":"75803","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1030.97,"maximum":3001.68,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1030.97},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1743.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1676.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3001.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1041.37},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1041.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1757.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":1041.37},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":1041.37},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1841.12,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray chest","code_information":[{"code":"75827","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1041.37,"maximum":3001.68,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1154.15},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1952.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1676.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3001.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1041.37},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1041.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1757.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":1041.37},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":1041.37},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1841.12,"additional_payer_notes":"APC"}]}]},{"description":"Vein x-ray eye socket","code_information":[{"code":"75880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":655.08,"maximum":1952.1,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1154.15},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1952.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":668.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1196.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1041.37},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1041.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":1041.37},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":1041.37},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":733.69,"additional_payer_notes":"APC"}]}]},{"description":"Repair venous blockage","code_information":[{"code":"75978","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3973.05,"maximum":6719.91,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":3973.05},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6719.91}]}]},{"description":"Cine/video x-rays","code_information":[{"code":"76120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":369.84,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":218.66},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":369.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Ophth us quant a only","code_information":[{"code":"76511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":317.67,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":187.82},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":317.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Us exam chest","code_information":[{"code":"76604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":317.67,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":187.82},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":317.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Ob us < 14 wks single fetus","code_information":[{"code":"76801","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":317.67,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":187.82},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":317.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Fetal biophys profil w/o nst","code_information":[{"code":"76819","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":317.67,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":187.82},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":317.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Echo exam uterus","code_information":[{"code":"76831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":266.35},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":450.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Us exam infant hips dynamic","code_information":[{"code":"76885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":212.57,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":125.68},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":212.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Computer Screening Mammogram Add-on","code_information":[{"code":"77052","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.51,"maximum":17.77,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":10.51},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.77}]}]},{"description":"Scr mammo bi incl cad","code_information":[{"code":"77067","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.72,"maximum":241.39,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":142.72},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.39},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":172.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":172.58},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":172.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":172.58}]},{"setting":"outpatient","billing_class":"facility","modifier_code":["TC"],"minimum":87.36,"maximum":159.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":90.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":87.36,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":89.98,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":93.48,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":89.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":159.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":93.39,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.84,"additional_payer_notes":"APC"}]}]},{"description":"Ct bone density axial","code_information":[{"code":"77078","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":212.83,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":125.83},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":212.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Thyroid met imaging","code_information":[{"code":"78015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":903.57,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":534.22},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":903.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Bone marrow imaging ltd","code_information":[{"code":"78102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":817.57,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":483.38},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":817.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Red cell survival study","code_information":[{"code":"78130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":1335.98,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":789.88},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Liver imaging","code_information":[{"code":"78201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":519.99,"maximum":2044.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":519.99},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":879.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":578.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1035.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":635.05,"additional_payer_notes":"APC"}]}]},{"description":"Salivary gland imaging","code_information":[{"code":"78230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":764.32,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":451.89},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":764.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Vit b-12 absrp exam int fac","code_information":[{"code":"78271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":359.29,"maximum":607.69,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":359.29},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":607.69}]}]},{"description":"Bone imaging multiple areas","code_information":[{"code":"78305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":764.69,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":452.11},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":764.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Ht muscle image spect sing","code_information":[{"code":"78451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1351.97,"maximum":2723.24,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1610.08},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2723.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1406.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1351.97,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1392.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1446.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1379.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2468.71,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1433.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1445.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":2044.56},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1514.21,"additional_payer_notes":"APC"}]}]},{"description":"Heart infarct image","code_information":[{"code":"78466","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":904.35,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":534.68},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":904.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Heart image (pet) multiple","code_information":[{"code":"78492","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1493.26,"maximum":3093.81,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":1829.17},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3093.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1553.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1493.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1538.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1597.79,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1523.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2726.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1582.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2341.27},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2341.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1596.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":2341.27},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":2341.27},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1672.46,"additional_payer_notes":"APC"}]}]},{"description":"Respiratory nuclear exam","code_information":[{"code":"78599","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":762.31,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":427.09},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":722.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Cerebrospinal fluid scan","code_information":[{"code":"78630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":567.01,"maximum":1258.63,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":744.14},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1258.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":578.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1035.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":635.05,"additional_payer_notes":"APC"}]}]},{"description":"Kidney imaging with flow","code_information":[{"code":"78701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":984.42,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":582.02},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":984.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Genitourinary nuclear exam","code_information":[{"code":"78799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":984.42,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":582.02},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":984.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Nuclear localization/abscess","code_information":[{"code":"78807","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":916.91,"maximum":1550.85,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":916.91},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1550.85}]}]},{"description":"Nuclear diagnostic exam","code_information":[{"code":"78999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":195.94,"maximum":762.31,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":195.94},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":331.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Nuclear medicine therapy","code_information":[{"code":"79999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":243.67,"maximum":603.87,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":357.03},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":603.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":253.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":243.67,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":250.98,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":260.72,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":248.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":444.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":258.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":405.42},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":260.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":405.42},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":405.42},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":272.91,"additional_payer_notes":"APC"}]}]},{"description":"B1 str & fx rsk assessment","code_information":[{"code":"0556T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":391.95},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":391.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":391.95},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":391.95},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Mrs disc pain alg alys data","code_information":[{"code":"0611T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":391.22},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":391.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":391.22},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":391.22},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Wrls skn snr anisotropy meas","code_information":[{"code":"0639T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.95,"maximum":142.95,"payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":142.95},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":142.95},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":142.95},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":142.95}]}]},{"description":"Compre ful bdy 3d mtn alys","code_information":[{"code":"0693T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":358.26,"maximum":654.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":372.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":358.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":369.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":383.34,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":365.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":654.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":379.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":595.85},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":595.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":382.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":595.85},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":595.85},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":401.25,"additional_payer_notes":"APC"}]}]},{"description":"Qmrcp w/o dx mri sm anat ses","code_information":[{"code":"0723T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.54,"maximum":1774.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1010.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1000.69,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1039.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":990.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1774.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1029.84,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1615.85},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1615.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1038.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":1615.85},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":1615.85},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1088.13,"additional_payer_notes":"APC"}]}]},{"description":"RSA lower extr exam","code_information":[{"code":"0350T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"B1 matrl qual tst mcrind tib","code_information":[{"code":"0547T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":447.25,"maximum":447.25,"payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":447.25},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":447.25},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":447.25},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":447.25}]}]},{"description":"Antmc guide 3d print 1st gd","code_information":[{"code":"0561T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":95.03,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":95.03},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":95.03},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":95.03},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":95.03},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Rem oct rta phys/qhp ea 30d","code_information":[{"code":"0606T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.23,"maximum":49.23,"payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":49.23},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49.23},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":49.23},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":49.23}]}]},{"description":"Ct breast w/3d bi c-","code_information":[{"code":"0636T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":391.22},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":391.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":391.22},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":391.22},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Quan us tis charac w/o dx us","code_information":[{"code":"0689T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":140.44},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":140.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":140.44},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":140.44},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Molec fluor img sus nev ea","code_information":[{"code":"0701T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.87,"maximum":17.87,"payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17.87},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.87},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":17.87},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":17.87}]}]},{"description":"Pulm tiss vntj alys prev ct","code_information":[{"code":"0807T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":247.23},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":247.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":247.23},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":247.23},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Ortho impl mvmt alys pair ct","code_information":[{"code":"0946T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":180.78},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":180.78},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":180.78},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":180.78},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Ct thorax lung cancer scr c-","code_information":[{"code":"71271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":137.53},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":137.53},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":137.53},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":137.53},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam entire spi 4/5 vw","code_information":[{"code":"72083","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Mr angio spine w/o&w/dye","code_information":[{"code":"72159","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":552.02,"maximum":552.02,"payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":552.02},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":552.02},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":552.02},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":552.02}]}]},{"description":"Mr angio upr extr w/o&w/dye","code_information":[{"code":"73225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":558.14,"maximum":558.14,"payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":558.14},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":558.14},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":558.14},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":558.14}]}]},{"description":"X-ray exam of femur 1","code_information":[{"code":"73551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Ct colonography screening","code_information":[{"code":"74263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":1122.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1122.39},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1122.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":1122.39},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":1122.39},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Quan&char c athrosclrtc plaq","code_information":[{"code":"75577","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.54,"maximum":1774.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1010.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1000.69,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1039.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":990.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1774.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1029.84,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1615.85},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1615.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1038.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":1615.85},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":1615.85},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1088.13,"additional_payer_notes":"APC"}]}]},{"description":"Use parenchyma","code_information":[{"code":"76981","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":191.27},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":191.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":191.27},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":191.27},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Mri breast c-+ w/cad bi","code_information":[{"code":"77049","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":498.1,"maximum":498.1,"payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":498.1},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":498.1},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":498.1},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":498.1}]}]},{"description":"Tbs techl calculation only","code_information":[{"code":"77091","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":140.44},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":140.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":140.44},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":140.44},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Breath tst attain/anal c-14","code_information":[{"code":"78267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.06,"maximum":20.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.83,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18.8},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":18.8},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":18.8},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.39,"additional_payer_notes":"APC"}]}]},{"description":"Myocrd img pet 1 std w/ct","code_information":[{"code":"78429","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1493.26,"maximum":2726.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1553.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1493.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1538.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1597.79,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1523.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2726.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1582.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2453.1},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2453.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1596.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":2453.1},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":2453.1},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1672.46,"additional_payer_notes":"APC"}]}]},{"description":"Liver elastography","code_information":[{"code":"91200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":235.2},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":235.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":235.2},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":235.2},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Mri w/cont, breast,  bi","code_information":[{"code":"C8906","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":775.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"MRA w/cont, pelvis","code_information":[{"code":"C8918","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":665.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"MRA, w/o&w/dye, upper extr","code_information":[{"code":"C8936","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":665.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam chest 1 view","code_information":[{"code":"71045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam hip uni 4/> views","code_information":[{"code":"73503","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam abdomen 1 view","code_information":[{"code":"74018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Ultrasound breast limited","code_information":[{"code":"76642","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Breast tomosynthesis uni","code_information":[{"code":"77061","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":159.9,"maximum":159.9,"payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":159.9},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":159.9},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":159.9},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":159.9}]}]},{"description":"Bone mineral single photon","code_information":[{"code":"78350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.56,"maximum":38.56,"payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":38.56},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38.56},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":38.56},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":38.56}]}]},{"description":"Myocrd img pet 2rtracer","code_information":[{"code":"78432","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1584.83,"maximum":4675.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1648.22,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1584.83,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1632.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1695.77,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1616.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2893.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1679.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":4675.85},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4675.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1694.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":4675.85},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":4675.85},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1775.01,"additional_payer_notes":"APC"}]}]},{"description":"Rp loclzj tum spect w/ct 1","code_information":[{"code":"78830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1351.97,"maximum":2468.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1406.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1351.97,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1392.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1446.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1379.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2468.71,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1433.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2162.49},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2162.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1445.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":2162.49},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":2162.49},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1514.21,"additional_payer_notes":"APC"}]}]},{"description":"Mra w/cont, abd","code_information":[{"code":"C8900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":665.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"MRA w/o cont, chest","code_information":[{"code":"C8910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"MRA, w/dye, spinal canal","code_information":[{"code":"C8931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":775.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"PET not otherwise specified","code_information":[{"code":"G0235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":762.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":641.1},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":641.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":641.1},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":641.1},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"RSA upper extr exam","code_information":[{"code":"0349T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Rem oct rta techl sprt min 8","code_information":[{"code":"0605T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.63,"maximum":61.63,"payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":61.63},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":61.63},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":61.63},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":61.63}]}]},{"description":"Ct breast w/3d uni c-/c+","code_information":[{"code":"0635T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":334.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":303.54},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":303.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":303.54},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":303.54},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"Histotripsy mal hepatcel tis","code_information":[{"code":"0686T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17887.96,"maximum":32663.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18603.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17887.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18424.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19140.12,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18245.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32663.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18961.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21250.85},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21250.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19122.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":21250.85},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":21250.85},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20034.52,"additional_payer_notes":"APC"}]}]},{"description":"Molec fluor img sus nev 1st","code_information":[{"code":"0700T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":60.49,"maximum":60.49,"payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":60.49},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60.49},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":60.49},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":60.49}]}]},{"description":"Smmg cncrnt appl imu snr","code_information":[{"code":"0778T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":247.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":247.23},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":247.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":247.23},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":247.23},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"3d cntr simula trgt lvr les","code_information":[{"code":"0944T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":410.92},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":410.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":410.92},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":410.92},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam entire spi 2/3 vw","code_information":[{"code":"72082","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"RSA spine exam","code_information":[{"code":"0348T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Tactile breast img uni/bi","code_information":[{"code":"0422T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Antmc mdl 3d print 1st cmpnt","code_information":[{"code":"0559T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":95.03,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":95.03},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":95.03},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":95.03},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":95.03},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Rem oct rta dev setup&educaj","code_information":[{"code":"0604T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":197.08,"maximum":197.08,"payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":197.08},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":197.08},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":197.08},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":197.08}]}]},{"description":"Ct breast w/3d uni c+","code_information":[{"code":"0634T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":334.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":303.54},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":303.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":303.54},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":303.54},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"Elec impd spectrsc 1+skn les","code_information":[{"code":"0658T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":94.62},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":94.62},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":94.62},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"B1 str & fx rsk vrt fx assmt","code_information":[{"code":"0743T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":410.92},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":410.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":410.92},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":410.92},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Histotripsy mal renal tissue","code_information":[{"code":"0888T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17887.96,"maximum":32663.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18603.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17887.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18424.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19140.12,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18245.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32663.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18961.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29750.85},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29750.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19122.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":29750.85},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":29750.85},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20034.52,"additional_payer_notes":"APC"}]}]},{"description":"Raman spectroscopy 1+skn les","code_information":[{"code":"1020T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":102.46},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":102.46},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":102.46},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":102.46},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Oct brst/node i&r per spec","code_information":[{"code":"0352T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1651.41,"maximum":1651.41,"payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1651.41},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1651.41},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":1651.41},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":1651.41}]}]},{"description":"B1 str&fx rsk transmis data","code_information":[{"code":"0555T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.19,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29.19},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":29.19},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":29.19},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"Ncntc r-t fluor wnd img 1st","code_information":[{"code":"0598T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":430.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":430.27},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":430.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":430.27},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":430.27},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Mrs disc pain transmis data","code_information":[{"code":"0610T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":291.84,"maximum":291.84,"payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":291.84},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":291.84},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":291.84},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":291.84}]}]},{"description":"Ct breast w/3d bi c-/c+","code_information":[{"code":"0638T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":665.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":625.8},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":625.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":625.8},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":625.8},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Auto alys xst ct std vrt fx","code_information":[{"code":"0691T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.4,"maximum":14.4,"payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14.4},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.4},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":14.4},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":14.4}]}]},{"description":"Opto-acoustic img breast uni","code_information":[{"code":"0857T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":178.08},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":178.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":178.08},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":178.08},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Mr angio pelvis w/o & w/dye","code_information":[{"code":"72198","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":539.78,"maximum":539.78,"payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":539.78},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":539.78},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":539.78},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":539.78}]}]},{"description":"X-ray exam hip uni 2-3 views","code_information":[{"code":"73502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Mr ang lwr ext w or w/o dye","code_information":[{"code":"73725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":538.56,"maximum":538.56,"payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":538.56},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":538.56},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":538.56},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":538.56}]}]},{"description":"Mri angio abdom w orw/o dye","code_information":[{"code":"74185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":543.46,"maximum":543.46,"payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":543.46},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":543.46},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":543.46},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":543.46}]}]},{"description":"Ct cere prfu aly c+wo ct/cta","code_information":[{"code":"70473","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":334.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":304.64},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":304.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":304.64},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":304.64},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam chest 4+ views","code_information":[{"code":"71048","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam entire spi 1 vw","code_information":[{"code":"72081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam hips bi 5/> views","code_information":[{"code":"73523","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"X-ray xm esophagus 2cntrst","code_information":[{"code":"74221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":334.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":309.74},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":309.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":309.74},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":309.74},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"Mr safety implant elec prepj","code_information":[{"code":"76018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.28,"maximum":181.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":103.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":99.28,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":102.26,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":106.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":101.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":181.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":105.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":156.04},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":156.04},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":106.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":156.04},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":156.04},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":111.19,"additional_payer_notes":"APC"}]}]},{"description":"Us abdl aorta screen aaa","code_information":[{"code":"76706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Us trgt dyn mbubb 1st les","code_information":[{"code":"76978","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":342.96,"maximum":665.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":342.96},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.96},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":342.96},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":342.96},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Mri breast c- bilateral","code_information":[{"code":"77047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":391.95},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":391.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":391.95},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":391.95},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Tbs dxa cal w/i&r fx risk","code_information":[{"code":"77089","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":70.6,"maximum":70.6,"payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":70.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":70.6},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":70.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":70.6}]}]},{"description":"Mr safety implt pos&/immoblj","code_information":[{"code":"76019","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":100.98},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":100.98},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":100.98},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":100.98},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Us nrv&acc strux 1xtr compre","code_information":[{"code":"76883","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":181.7},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.7},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":181.7},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":181.7},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Mri breast c-+ w/cad uni","code_information":[{"code":"77048","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":500.55,"maximum":500.55,"payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":500.55},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":500.55},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":500.55},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":500.55}]}]},{"description":"Tbs techl prep&transmis data","code_information":[{"code":"77090","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":140.44},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":140.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":140.44},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":140.44},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Oct breast surg cavity i&r","code_information":[{"code":"0354T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1651.41,"maximum":1651.41,"payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1651.41},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1651.41},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":1651.41},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":1651.41}]}]},{"description":"B1 str & fx rsk i&r","code_information":[{"code":"0557T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.56,"maximum":16.56,"payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16.56},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.56},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":16.56},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":16.56}]}]},{"description":"Transdermal gfr measurements","code_information":[{"code":"0602T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":342.26,"maximum":342.26,"payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":342.26},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.26},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":342.26},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":342.26}]}]},{"description":"Mrs discogenic pain i&r","code_information":[{"code":"0612T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.04,"maximum":48.04,"payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":48.04},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48.04},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":48.04},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":48.04}]}]},{"description":"Quan mr alys tiss w/o mri","code_information":[{"code":"0648T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":391.22,"maximum":1774.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1010.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1000.69,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1039.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":990.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1774.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1029.84,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":391.22},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":391.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1038.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":391.22},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":391.22},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1088.13,"additional_payer_notes":"APC"}]}]},{"description":"Quan mri alys brn w/o dx mri","code_information":[{"code":"0865T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":396.9},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":396.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":396.9},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":396.9},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Gastric emptying imag study","code_information":[{"code":"78266","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":567.01,"maximum":1035.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":578.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1035.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":606.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":770.24},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":635.05,"additional_payer_notes":"APC"}]}]},{"description":"Mri w/o fol w/cont, brst, un","code_information":[{"code":"C8905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":775.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Mra w/o fol w/cont, lwr ext","code_information":[{"code":"C8914","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":775.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"MRA, w/o dye, upper extr","code_information":[{"code":"C8935","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Cardiac MRI seg dys stress","code_information":[{"code":"C9763","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":570.61,"maximum":1041.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":582.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1041.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":818.69},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":818.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":609.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":818.69},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":818.69},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":639.08,"additional_payer_notes":"APC"}]}]},{"description":"Mri fetal sngl/1st gestation","code_information":[{"code":"74712","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Mr sfty implt&/fb asmt stf 1","code_information":[{"code":"76014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.2,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":41.63},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.63},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":41.63},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":41.63},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"Mr elastography","code_information":[{"code":"76391","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":391.95},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":391.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":391.95},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":391.95},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Ultrasound breast complete","code_information":[{"code":"76641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Cta h&n c+ w/noncontrast img","code_information":[{"code":"70471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":665.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":605.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":605.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":605.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":605.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam chest 2 views","code_information":[{"code":"71046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam hips bi 2 views","code_information":[{"code":"73521","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam abdomen 2 views","code_information":[{"code":"74019","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Myocrd img pet rst&strs ct","code_information":[{"code":"78431","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2300.33,"maximum":4200.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2392.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2369.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2461.35,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2346.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":4200.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2438.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":3825.85},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3825.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2459.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":3825.85},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":3825.85},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2576.37,"additional_payer_notes":"APC"}]}]},{"description":"3d anat seg imaging preop","code_information":[{"code":"C8001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":149.69},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":149.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":149.69},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":149.69},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"MRA w/cont, chest","code_information":[{"code":"C8909","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":665.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Mra w/o fol w/cont, pelvis","code_information":[{"code":"C8920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":775.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Single energy x-ray study","code_information":[{"code":"G0130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Mr safety deter phys/qhp","code_information":[{"code":"76016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":149.69},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":149.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":149.69},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":149.69},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Breast tomosynthesis bi","code_information":[{"code":"77062","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":204.63,"maximum":204.63,"payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":204.63},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":204.63},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":204.63},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":204.63}]}]},{"description":"Dxa bone density study","code_information":[{"code":"77085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Bone mineral dual photon","code_information":[{"code":"78351","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.93,"maximum":26.93,"payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.93},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":26.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":26.93}]}]},{"description":"Myocrd img pet 2rtracer ct","code_information":[{"code":"78433","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2300.33,"maximum":4675.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2392.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2300.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2369.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2461.35,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2346.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":4200.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2438.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":4675.85},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4675.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2459.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":4675.85},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":4675.85},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2576.37,"additional_payer_notes":"APC"}]}]},{"description":"Rp loclzj tum spect 2 areas","code_information":[{"code":"78831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1351.97,"maximum":2468.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1406.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1351.97,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1392.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1446.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1379.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2468.71,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1433.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2162.49},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2162.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1445.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":2162.49},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":2162.49},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1514.21,"additional_payer_notes":"APC"}]}]},{"description":"Mra w/o cont, abd","code_information":[{"code":"C8901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"MRA w/o fol w/cont, chest","code_information":[{"code":"C8911","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":775.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"MRA, w/o dye, spinal canal","code_information":[{"code":"C8932","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"3d bn img algor drvd fr mri","code_information":[{"code":"G0566","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":265.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":265.98},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":265.98},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":265.98},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":265.98},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Gastric emptying imag study","code_information":[{"code":"78265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":762.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":594.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Mri w/cont, breast,  uni","code_information":[{"code":"C8903","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.17,"maximum":429.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":334.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.15,"additional_payer_notes":"APC"}]}]},{"description":"Mra w/o cont, lwr ext","code_information":[{"code":"C8913","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"MRA, w/dye, upper extremity","code_information":[{"code":"C8934","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":665.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Cardiac MRI seg dys strain","code_information":[{"code":"C9762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":570.61,"maximum":1041.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":582.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1041.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":818.69},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":818.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":609.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":818.69},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":818.69},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":639.08,"additional_payer_notes":"APC"}]}]},{"description":"Ct scan f/biomchn ct alys","code_information":[{"code":"0558T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.91},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.91},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.91},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.91},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Transdermal gfr monitoring","code_information":[{"code":"0603T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":863.67,"maximum":863.67,"payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":863.67},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":863.67},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":863.67},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":863.67}]}]},{"description":"Ct breast w/3d uni c-","code_information":[{"code":"0633T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":185.25},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.25},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":185.25},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":185.25},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Quan mr tis wo mri mlt orgn","code_information":[{"code":"0697T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":399.5,"maximum":1774.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1010.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1000.69,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1039.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":990.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1774.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1029.84,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":399.5},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":399.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1038.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":399.5},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":399.5},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1088.13,"additional_payer_notes":"APC"}]}]},{"description":"Quan mri alys brn w/dx mri","code_information":[{"code":"0866T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":396.9},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":396.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":396.9},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":396.9},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam chest 3 views","code_information":[{"code":"71047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Mri angio chest w or w/o dye","code_information":[{"code":"71555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":536.72,"maximum":536.72,"payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":536.72},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":536.72},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":536.72},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":536.72}]}]},{"description":"X-ray exam hips bi 3-4 views","code_information":[{"code":"73522","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam abdomen 3+ views","code_information":[{"code":"74021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"B1 str & fx rsk analysis","code_information":[{"code":"0554T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":66.27,"maximum":66.27,"payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":66.27},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":66.27},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":66.27},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":66.27}]}]},{"description":"Mrs disc pain acquisj data","code_information":[{"code":"0609T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":391.22},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":391.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":391.22},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":391.22},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Ct breast w/3d bi c+","code_information":[{"code":"0637T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":665.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":625.8},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":625.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":625.8},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":625.8},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Quan ct tiss charac w/o ct","code_information":[{"code":"0721T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":664.9,"maximum":1214.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":691.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":664.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":684.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":711.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":678.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1214.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":704.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1105.85},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1105.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":710.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":1105.85},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":1105.85},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":744.69,"additional_payer_notes":"APC"}]}]},{"description":"Pulm tiss vntj alys w/ct","code_information":[{"code":"0808T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":476.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":476.1},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":476.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":476.1},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":476.1},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam entire spi 6/> vw","code_information":[{"code":"72084","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":194.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam hip uni 1 view","code_information":[{"code":"73501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"X-ray exam of femur 2/>","code_information":[{"code":"73552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"N-invas est c ffr sw aly cta","code_information":[{"code":"75580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":896.76,"maximum":1693.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":932.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":896.76,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":923.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":959.54,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":914.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1637.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":950.57,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1693.51},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1693.51},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":958.64,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":1693.51},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":1693.51},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1004.38,"additional_payer_notes":"APC"}]}]},{"description":"Mr spectroscopy","code_information":[{"code":"76390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":656.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":656.68},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":656.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":656.68},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":656.68},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Use 1st target lesion","code_information":[{"code":"76982","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":191.27},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":191.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":191.27},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":191.27},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Tbs i&r fx rsk qhp","code_information":[{"code":"77092","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.65,"maximum":17.65,"payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17.65},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.65},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":17.65},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":17.65}]}]},{"description":"Breath test analysis c-14","code_information":[{"code":"78268","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":94.41,"maximum":172.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":98.19,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94.41,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":172.39,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":100.07,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":160.5},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":160.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":100.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":160.5},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":160.5},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.74,"additional_payer_notes":"APC"}]}]},{"description":"Myocrd img pet rst/strs w/ct","code_information":[{"code":"78430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1493.26,"maximum":2726.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1553.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1493.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1538.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1597.79,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1523.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2726.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1582.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2453.1},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2453.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1596.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":2453.1},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":2453.1},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1672.46,"additional_payer_notes":"APC"}]}]},{"description":"Cptrz oph img pst sg rta oct","code_information":[{"code":"92137","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":529.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":529.38},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":529.38},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":529.38},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":529.38},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Mri w/o fol w/cont, breast,","code_information":[{"code":"C8908","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":775.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Mr sfty med physics xm cstmz","code_information":[{"code":"76017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":410.92},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":410.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":410.92},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":410.92},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Med physic dos eval rad exps","code_information":[{"code":"76145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":215.68},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":215.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":215.68},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":215.68},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Mri breast c- unilateral","code_information":[{"code":"77046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":391.95},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":391.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":391.95},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":391.95},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Breast tomosynthesis bi","code_information":[{"code":"77063","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":43.45,"maximum":43.45,"payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":43.45},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.45},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":43.45},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":43.45}]},{"setting":"outpatient","billing_class":"facility","modifier_code":["TC"],"minimum":23.68,"maximum":43.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.34,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":43.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.52,"additional_payer_notes":"APC"}]}]},{"description":"Fracture assessment via dxa","code_information":[{"code":"77086","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":105.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Rp loclzj tum spect w/ct 2","code_information":[{"code":"78832","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1493.26,"maximum":2726.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1553.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1493.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1538.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1597.79,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1523.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2726.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1582.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2453.1},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2453.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1596.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":2453.1},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":2453.1},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1672.46,"additional_payer_notes":"APC"}]}]},{"description":"Mra w/o fol w/cont, abd","code_information":[{"code":"C8902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":775.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"MRA w/o cont, pelvis","code_information":[{"code":"C8919","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Mri hyperpolarized xenon129","code_information":[{"code":"C9791","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1278.19,"maximum":2333.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1329.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1278.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1316.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1367.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1303.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2333.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1354.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2125.85},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2125.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1366.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":2125.85},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":2125.85},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1431.57,"additional_payer_notes":"APC"}]}]},{"description":"Mra w/cont, lwr ext","code_information":[{"code":"C8912","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":775.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":775.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"MRA, w/o&w/dye, spinal canal","code_information":[{"code":"C8933","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":665.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":429.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Non-ophthalmic FVA","code_information":[{"code":"C9733","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":665.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":394.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Tomosynthesis, mammo","code_information":[{"code":"G0279","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":43.45,"maximum":43.45,"payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":43.45},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.45},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":43.45},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":43.45}]},{"setting":"outpatient","billing_class":"facility","modifier_code":["TC"],"minimum":12.86,"maximum":23.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.37,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.75,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.4,"additional_payer_notes":"APC"}]}]},{"description":"Liver Transplant With Mcc Or Intestinal Transplant","code_information":[{"code":"005","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":77552.27,"maximum":502997.74,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":191383.5},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":156307.18},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":304675.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80654.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77552.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":175752.78},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":324368.33},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":162792.48},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":267526.54},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":79878.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":79878.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":150956.03},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":502997.74},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":381797.82},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":82980.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":79103.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":190053.45},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":77552.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":79103.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":155662.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":82205.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":170092.32},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":240832.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":82903.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":223974.99},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":170092.32},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":77552.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":86858.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77552.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allogeneic Bone Marrow Transplant","code_information":[{"code":"014","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":90288.87,"maximum":586293.25,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":223076.26},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":182191.36},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":355128.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":93900.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90288.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":204857.12},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":378083.13},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":189750.62},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":311828.45},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92997.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":92997.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":175954.07},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":586293.25},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":445022.84},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":96609.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92094.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":221525.95},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":90288.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92094.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":181227.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":95706.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":198259.3},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":280714.11},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":96518.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":261064.84},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":198259.3},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":90288.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101123.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90288.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","code_information":[{"code":"023","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43385.58,"maximum":279552.69,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":106365.83},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":86871.35},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":169330.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45121.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43385.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":97678.69},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":180275.24},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":90475.71},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":148684.09},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44687.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":44687.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":83897.32},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":279552.69},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":212193.01},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46422.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44253.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":105626.62},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43385.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44253.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":87083.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":45988.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":94532.76},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":133848.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46379.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":124479.31},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":94532.76},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43385.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48591.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43385.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Mcc","code_information":[{"code":"031","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34062.5,"maximum":218581.19,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":83167.04},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":67924.38},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":132398.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35425.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34062.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":76374.6},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":140956.53},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":70742.61},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":116255.53},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35084.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":35084.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":65599.0},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":218581.19},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":165912.92},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36446.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34743.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":82589.06},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34062.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34743.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":68370.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36106.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":73914.81},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":104655.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36412.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":97329.9},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":73914.81},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34062.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38150.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34062.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures Without Cc/Mcc","code_information":[{"code":"039","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9408.36,"maximum":57346.77,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":21819.63},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17820.58},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34736.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9784.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9408.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":20037.57},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":36981.23},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":18559.97},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":30500.7},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9690.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9690.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":17210.5},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":57346.77},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":43528.77},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10066.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9596.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21667.99},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9408.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9596.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18884.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9972.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19392.22},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27457.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10057.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":25535.39},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":19392.22},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9408.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10537.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9408.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9828.9,"10th_percentile":9828.9,"90th_percentile":9828.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders With Mcc","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17969.05,"maximum":113332.43,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":43121.38},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":35218.2},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":68647.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18687.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17969.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":39599.56},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":73084.73},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":36679.43},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":60277.48},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18508.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":18508.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":34012.51},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":113332.43},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":86024.39},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19226.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18328.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42821.7},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17969.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18328.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36067.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19047.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":38324.18},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54262.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19208.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":50464.7},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":38324.18},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17969.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20125.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17969.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9758.84,"10th_percentile":9758.84,"90th_percentile":9758.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11942.67,"10th_percentile":11942.67,"90th_percentile":11942.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15640.9,"maximum":98106.64,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":37328.18},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30486.76},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":59425.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16266.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15640.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":34279.51},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":63266.06},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":31751.68},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":52179.42},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16110.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":16110.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":29443.05},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":98106.64},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":74467.33},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16735.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15953.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37068.76},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15640.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15953.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":31394.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16579.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":33175.47},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46972.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16720.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":43684.95},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":33175.47},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15640.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17517.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15640.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16068.14,"10th_percentile":16068.14,"90th_percentile":16068.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"1 through 10","median_amount":13593.09,"10th_percentile":13593.09,"90th_percentile":13593.09},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15094.14,"10th_percentile":15094.14,"90th_percentile":15094.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders Without Cc/Mcc","code_information":[{"code":"072","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6280.53,"maximum":36891.22,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":14036.58},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11463.99},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22345.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6531.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6280.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":12890.19},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":23790.05},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":11939.64},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":19621.12},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6468.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6468.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":11071.52},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":36891.22},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28002.09},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6720.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6406.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13939.03},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6280.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6406.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12606.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6657.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12475.03},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17663.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6713.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":16426.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":12475.03},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6280.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7034.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6280.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Cc","code_information":[{"code":"083","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11051.72,"maximum":68094.1,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":25908.84},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21160.33},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41245.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11493.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11051.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":23792.81},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":43911.87},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":22038.29},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":36216.82},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11383.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11383.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":20435.91},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":68094.1},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":51686.47},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11825.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11272.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25728.78},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11051.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11272.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22183.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11714.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23026.51},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32603.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11814.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":30320.96},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":23026.51},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11051.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12377.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11051.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Mcc","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13740.18,"maximum":85676.22,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":32598.58},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26623.99},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51895.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14289.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13740.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":29936.19},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":55250.05},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":27728.64},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":45568.12},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14152.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14152.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":25712.52},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":85676.22},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":65032.09},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14701.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14014.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32372.03},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13740.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14014.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27579.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14564.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28972.03},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41021.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14688.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":38149.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":28972.03},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13740.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15389.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13740.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11887.0,"10th_percentile":11887.0,"90th_percentile":11887.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","code_information":[{"code":"099","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10802.57,"maximum":66464.68,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":25288.87},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20653.98},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40258.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11234.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10802.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":23223.47},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":42861.1},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":21510.93},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":35350.19},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11126.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11126.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":19946.9},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":66464.68},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":50449.67},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11558.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11018.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25113.12},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10802.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11018.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21682.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11450.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22475.51},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31822.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11547.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":29595.42},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":22475.51},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10802.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12098.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10802.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures With Cc/Mcc","code_information":[{"code":"116","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14127.33,"maximum":88208.16,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":33561.95},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27410.8},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53429.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14692.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14127.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":30820.87},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":56882.83},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":28548.09},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":46914.77},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14551.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14551.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":26472.39},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":88208.16},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":66953.94},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15116.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14409.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33328.71},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14127.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14409.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28356.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14974.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29828.23},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42233.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15102.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":39277.36},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":29828.23},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14127.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15822.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14127.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures Without Cc/Mcc","code_information":[{"code":"136","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8213.32,"maximum":49531.41,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":18846.0},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15391.95},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30002.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8541.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8213.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":17306.8},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":31941.34},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":16030.57},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":26343.99},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8459.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8459.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":14865.01},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":49531.41},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37596.56},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8788.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8377.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18715.02},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8213.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8377.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16485.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8706.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16749.4},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23715.38},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8780.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":22055.36},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":16749.4},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8213.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9198.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8213.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","code_information":[{"code":"144","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13566.37,"maximum":84539.53,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":32166.09},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26270.76},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51207.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14109.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13566.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":29539.01},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":54517.03},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":27360.76},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":44963.56},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13973.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":13973.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":25371.39},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":84539.53},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":64169.29},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14516.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13837.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31942.55},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13566.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13837.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27230.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14380.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28587.65},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40477.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14502.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":37643.79},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":28587.65},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13566.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15194.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13566.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri With Mcc","code_information":[{"code":"152","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9458.34,"maximum":57673.63,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":21944.0},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17922.15},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34934.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9836.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9458.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":20151.78},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":37192.01},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":18665.76},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":30674.54},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9742.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9742.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":17308.59},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":57673.63},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":43776.87},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10120.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9647.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21791.49},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9458.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9647.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18984.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10025.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19502.75},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27613.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10110.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":25680.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":19502.75},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9458.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10593.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9458.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":9258.58,"10th_percentile":9258.58,"90th_percentile":9258.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Mcc","code_information":[{"code":"163","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34072.2,"maximum":218644.61,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":83191.17},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":67944.09},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":132437.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35435.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34072.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":76396.76},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":140997.43},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":70763.14},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":116289.26},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35094.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":35094.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":65618.03},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":218644.61},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":165961.05},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36457.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34753.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":82613.02},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34072.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34753.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":68389.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36116.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":73936.25},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":104685.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36423.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":97358.14},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":73936.25},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34072.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38160.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34072.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33311.38,"10th_percentile":33311.38,"90th_percentile":33311.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":141217.13,"10th_percentile":141217.13,"90th_percentile":141217.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32567.38,"10th_percentile":32567.38,"90th_percentile":32567.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33301.75,"10th_percentile":33301.75,"90th_percentile":33301.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":101329.02,"10th_percentile":101329.02,"90th_percentile":101329.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19911.05,"10th_percentile":19911.05,"90th_percentile":19911.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism Without Mcc","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6644.56,"maximum":39271.93,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":14942.41},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12203.8},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23787.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6910.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6644.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":13722.03},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":25325.3},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":12710.15},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":20887.34},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6843.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6843.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":11786.01},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":39271.93},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29809.15},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7109.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6777.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14838.57},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6644.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6777.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13336.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7043.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13280.09},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18803.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7103.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":17487.02},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":13280.09},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6644.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7441.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6644.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":13679.37,"10th_percentile":13679.37,"90th_percentile":13679.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6495.68,"10th_percentile":6495.68,"90th_percentile":6495.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":20011.5,"10th_percentile":20011.5,"90th_percentile":20011.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5620.28,"10th_percentile":5620.28,"90th_percentile":5620.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Cc","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8577.35,"maximum":51912.12,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":19751.82},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16131.76},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31444.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8920.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8577.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":18138.65},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":33476.59},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":16801.07},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":27610.2},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8834.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8834.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":15579.49},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":51912.12},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39403.62},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9177.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8748.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19614.56},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8577.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8748.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17216.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9091.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17554.46},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24855.25},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9169.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":23115.44},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":17554.46},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8577.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9606.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8577.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6385.79,"10th_percentile":6385.79,"90th_percentile":6385.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8555.79,"10th_percentile":8555.79,"90th_percentile":8555.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6615.77,"10th_percentile":6615.77,"90th_percentile":6615.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5428.64,"maximum":31319.97,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":11916.8},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9732.72},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18971.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5645.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5428.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":10943.53},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":20197.32},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":10136.54},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":16657.97},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5591.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":5591.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":9399.52},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":31319.97},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23773.26},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5808.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11833.99},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5428.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10896.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5754.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10591.07},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14995.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5803.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":13946.17},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":10591.07},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5428.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6080.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5428.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4748.71,"10th_percentile":4748.71,"90th_percentile":4748.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":3685.26,"10th_percentile":3685.26,"90th_percentile":3685.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"1 through 10","median_amount":24245.46,"10th_percentile":24245.46,"90th_percentile":24245.46},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":12433.83,"10th_percentile":12433.83,"90th_percentile":12433.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":277.99,"10th_percentile":277.99,"90th_percentile":277.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Cc","code_information":[{"code":"200","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8839.93,"maximum":53629.35,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":20405.21},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16665.39},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32484.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9193.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8839.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":18738.67},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":34583.98},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":17356.85},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":28523.54},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9105.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9105.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":16094.85},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":53629.35},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40707.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9458.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9016.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20263.4},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8839.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9016.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17743.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9370.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18135.15},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25677.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9449.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":23880.09},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":18135.15},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8839.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9900.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8839.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support <=96 Hours","code_information":[{"code":"208","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21143.88,"maximum":134095.33,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":51021.37},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":41670.29},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":81224.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21989.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21143.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":46854.34},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":86474.1},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":43399.22},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":71320.52},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21778.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":21778.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":40243.72},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":134095.33},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":101784.36},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22623.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21566.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50666.79},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21143.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21566.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":42440.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22412.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":45345.3},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64204.13},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22602.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":59710.01},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":45345.3},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21143.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23681.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21143.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":107410.71,"10th_percentile":107410.71,"90th_percentile":107410.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20158.17,"10th_percentile":20158.17,"90th_percentile":20158.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21720.82,"10th_percentile":21720.82,"90th_percentile":21720.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18608.41,"10th_percentile":18608.41,"90th_percentile":18608.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":7998.29,"10th_percentile":7998.29,"90th_percentile":7998.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":64204.13,"10th_percentile":64204.13,"90th_percentile":64204.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18901.75,"10th_percentile":18901.75,"90th_percentile":21724.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","code_information":[{"code":"219","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":57916.97,"maximum":374585.87,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":142524.6},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":116403.03},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":226893.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60233.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57916.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":130884.3},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":241559.32},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":121232.68},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":199228.85},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":59654.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":59654.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":112417.99},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":374585.87},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":284327.45},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":61971.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":59075.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":141534.1},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57916.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":59075.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":116250.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":61391.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":126668.92},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":179349.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":61913.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":166795.71},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":126668.92},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57916.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64867.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57916.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":53846.59,"10th_percentile":53846.59,"90th_percentile":53846.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","code_information":[{"code":"234","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41389.37,"maximum":266497.82,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":101398.64},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":82814.53},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":161422.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43044.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41389.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":93117.18},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":171856.54},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":86250.57},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":141740.68},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":42631.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":42631.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":79979.39},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":266497.82},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":202283.78},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44286.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":42217.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":100693.95},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41389.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":42217.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":83076.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43872.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":90118.16},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":127597.75},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44245.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":118666.23},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":90118.16},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41389.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46356.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41389.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":666.1,"10th_percentile":666.1,"90th_percentile":666.1},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40012.08,"10th_percentile":40012.08,"90th_percentile":40012.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","code_information":[{"code":"244","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14122.86,"maximum":88178.89,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":33550.82},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27401.7},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53411.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14687.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14122.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":30810.65},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":56863.95},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":28538.62},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":46899.2},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14546.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14546.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":26463.61},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":88178.89},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":66931.73},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15111.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14405.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33317.65},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14122.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14405.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28347.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14970.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29818.33},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42219.59},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15097.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":39264.32},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":29818.33},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14122.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15817.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14122.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13810.47,"10th_percentile":13810.47,"90th_percentile":13810.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":98247.69,"10th_percentile":98247.69,"90th_percentile":98247.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13559.51,"10th_percentile":13559.51,"90th_percentile":13559.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24071.22,"10th_percentile":24071.22,"90th_percentile":24071.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","code_information":[{"code":"256","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13305.28,"maximum":82832.05,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":31516.42},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25740.16},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50172.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13837.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13305.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":28942.4},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":53415.93},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":26808.14},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":44055.41},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13704.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":13704.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":24858.95},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":82832.05},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":62873.24},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14236.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13571.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31297.39},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13305.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13571.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26706.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14103.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28010.26},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39659.55},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14223.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":36883.48},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":28010.26},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13305.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14901.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13305.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System O.R. Procedures","code_information":[{"code":"264","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25559.25,"maximum":162971.17,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":62008.22},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":50643.5},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":98714.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26581.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25559.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":56943.87},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":105095.28},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":52744.73},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":86678.55},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26326.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":26326.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":48909.72},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":162971.17},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":123702.42},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27348.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26070.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":61577.28},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25559.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26070.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":51302.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27092.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":55109.88},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":78029.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27322.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":72567.85},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":55109.88},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25559.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28626.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25559.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures Without Cc/Mcc","code_information":[{"code":"272","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19684.03,"maximum":124548.11,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":47388.79},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":38703.48},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":75441.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20471.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19684.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":43518.44},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":80317.38},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":40309.32},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":66242.69},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20274.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":20274.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":37378.47},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":124548.11},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":94537.59},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21061.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20077.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47059.45},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19684.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20077.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":39509.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20865.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":42116.84},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":59632.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21042.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":55458.82},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":42116.84},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19684.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22046.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19684.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18063.63,"10th_percentile":18063.63,"90th_percentile":18063.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":11383.94,"10th_percentile":11383.94,"90th_percentile":11383.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Mcc","code_information":[{"code":"280","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12605.57,"maximum":78256.02,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":29775.3},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24318.16},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47401.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13109.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12605.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":27343.49},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":50464.99},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":25327.13},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":41621.58},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12983.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12983.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":23485.63},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":78256.02},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":59399.82},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13487.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12857.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29568.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12605.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12857.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25301.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13361.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26462.84},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37468.57},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13475.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":34845.86},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":26462.84},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12605.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14118.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12605.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12344.8,"10th_percentile":12344.8,"90th_percentile":12811.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":24737.65,"10th_percentile":24737.65,"90th_percentile":24737.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12946.84,"10th_percentile":12946.84,"90th_percentile":12946.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"1 through 10","median_amount":16746.57,"10th_percentile":16746.57,"90th_percentile":16746.57},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11700.45,"10th_percentile":11609.23,"90th_percentile":12402.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4961.28,"10th_percentile":4961.28,"90th_percentile":4961.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9643.42,"10th_percentile":8596.96,"90th_percentile":11495.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18151.52,"10th_percentile":18151.52,"90th_percentile":18151.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3074.57,"10th_percentile":3074.57,"90th_percentile":3074.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":31012.94,"10th_percentile":31012.94,"90th_percentile":31012.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":10742.82,"10th_percentile":8213.66,"90th_percentile":12076.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Mcc","code_information":[{"code":"288","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20826.85,"maximum":132021.97,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":50232.48},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":41025.99},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":79968.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21659.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20826.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":46129.89},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":85137.05},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":42728.19},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":70217.77},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21451.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":21451.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":39621.47},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":132021.97},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":100210.59},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22284.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21243.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49883.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20826.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21243.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":41803.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22076.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":44644.18},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":63211.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22263.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":58786.78},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":44644.18},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20826.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23326.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20826.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained Without Cc/Mcc","code_information":[{"code":"298","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4034.43,"maximum":22202.05,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":8447.57},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":6899.32},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13448.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4195.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4034.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":7757.63},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":14317.45},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":7185.57},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":11808.48},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4155.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":4155.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":6663.12},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":22202.05},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":16852.35},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4316.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4115.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8388.86},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4034.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4115.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":8097.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4276.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":7507.78},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10630.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4312.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":9886.14},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":7507.78},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4034.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4518.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4034.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders With Mcc","code_information":[{"code":"306","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12394.46,"maximum":76875.4,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":29250.0},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23889.13},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46564.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12890.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12394.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":26861.09},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":49574.67},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":24880.31},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":40887.28},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12766.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12766.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":23071.29},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":76875.4},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":58351.87},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13262.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12642.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29046.72},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12394.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12642.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24878.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13138.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25995.97},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36807.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13249.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":34231.1},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":25995.97},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12394.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13881.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12394.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12135.27,"10th_percentile":12135.27,"90th_percentile":12135.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Mcc","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16194.4,"maximum":101726.48,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":38705.48},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31611.63},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":61617.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16842.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16194.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":35544.32},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":65600.39},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":32923.22},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":54104.68},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16680.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":16680.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":30529.41},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":101726.48},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":77214.96},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17328.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16518.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38436.49},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16194.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16518.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32505.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17166.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34399.54},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48706.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17311.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":45296.8},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":34399.54},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16194.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18137.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16194.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12970.4,"10th_percentile":12970.4,"90th_percentile":12970.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":65600.39,"10th_percentile":65600.39,"90th_percentile":65600.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15829.1,"10th_percentile":15829.1,"90th_percentile":15829.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","code_information":[{"code":"322","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13790.9,"maximum":86007.96,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":32724.81},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26727.08},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52096.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14342.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13790.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":30052.1},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":55463.98},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":27836.01},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":45744.56},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14204.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14204.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":25812.08},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":86007.96},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":65283.89},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14756.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14066.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32497.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13790.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14066.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27681.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14618.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29084.21},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41180.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14742.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":38297.65},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":29084.21},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13790.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15445.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13790.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":29958.66,"10th_percentile":29958.66,"90th_percentile":29958.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13485.87,"10th_percentile":12777.07,"90th_percentile":13503.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":55535.99,"10th_percentile":55535.99,"90th_percentile":55535.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":25946.17,"10th_percentile":25946.17,"90th_percentile":27462.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13755.17,"10th_percentile":13755.17,"90th_percentile":14164.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":89389.54,"10th_percentile":89389.54,"90th_percentile":89389.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13363.82,"10th_percentile":13363.82,"90th_percentile":13363.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13487.07,"10th_percentile":13112.57,"90th_percentile":14656.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":41180.15,"10th_percentile":41180.15,"90th_percentile":41180.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"1 through 10","median_amount":39859.67,"10th_percentile":39859.67,"90th_percentile":39859.67},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12745.07,"10th_percentile":12304.57,"90th_percentile":13489.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Cc","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18521.81,"maximum":116947.4,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":44496.83},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":36341.55},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":70837.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19262.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18521.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":40862.67},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":75415.91},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":37849.39},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":62200.15},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19077.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":19077.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":35097.41},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":116947.4},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":88768.32},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19818.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18892.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44187.59},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18521.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18892.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":37176.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19633.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":39546.61},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":55993.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19799.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":52074.38},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":39546.61},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18521.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20744.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18521.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":4555.27,"10th_percentile":4555.27,"90th_percentile":4555.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16688.57,"10th_percentile":16393.71,"90th_percentile":16957.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":350.0,"10th_percentile":350.0,"90th_percentile":350.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":38892.59,"10th_percentile":38892.59,"90th_percentile":38892.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17343.27,"10th_percentile":17343.27,"90th_percentile":17343.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15359.77,"10th_percentile":10841.46,"90th_percentile":18130.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":7905.39,"10th_percentile":7905.39,"90th_percentile":7905.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18113.67,"10th_percentile":17163.27,"90th_percentile":18153.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Mcc","code_information":[{"code":"344","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19906.33,"maximum":126001.9,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":47941.93},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":39155.25},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":76321.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20702.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19906.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":44026.41},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":81254.89},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":40779.83},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":67015.91},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20503.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":20503.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":37814.77},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":126001.9},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":95641.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21299.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20304.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47608.75},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19906.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20304.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":39955.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21100.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":42608.45},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60329.04},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21279.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":56106.16},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":42608.45},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19906.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22295.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19906.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","code_information":[{"code":"352","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9350.92,"maximum":56971.12,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":21676.7},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17703.85},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34508.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9724.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9350.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":19906.32},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":36738.99},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":18438.39},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":30300.91},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9631.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9631.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":17097.76},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":56971.12},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":43243.63},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10005.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9537.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21526.06},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9350.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9537.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18769.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9911.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19265.2},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27277.47},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9996.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":25368.12},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":19265.2},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9350.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10473.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9350.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7161.11,"10th_percentile":7161.11,"90th_percentile":7161.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","code_information":[{"code":"360","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18649.37,"maximum":117781.63,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":44814.24},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":36600.79},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":71342.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19395.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18649.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":41154.16},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":75953.88},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":38119.38},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":62643.84},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19208.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":19208.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":35347.77},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":117781.63},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":89401.53},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19954.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19022.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44502.79},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18649.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19022.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":37433.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19768.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":39828.71},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56393.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19936.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":52445.84},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":39828.71},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18649.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20887.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18649.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18245.84,"10th_percentile":18245.84,"90th_percentile":18245.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":126039.99,"10th_percentile":126039.99,"90th_percentile":126039.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16302.74,"10th_percentile":16302.74,"90th_percentile":16302.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Cc","code_information":[{"code":"375","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9662.73,"maximum":59010.34,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":22452.6},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18337.54},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35743.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10049.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9662.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":20618.84},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":38054.02},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":19098.37},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":31385.49},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9952.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9952.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":17709.75},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":59010.34},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":44791.49},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10339.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9855.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22296.56},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9662.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9855.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19395.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10242.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19954.77},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28253.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10329.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":26276.14},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":19954.77},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9662.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10822.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9662.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9477.81,"10th_percentile":9477.81,"90th_percentile":9477.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":16723.37,"10th_percentile":16723.37,"90th_percentile":16723.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"1 through 10","median_amount":14479.65,"10th_percentile":14479.65,"90th_percentile":14479.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer With Mcc","code_information":[{"code":"383","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10939.08,"maximum":67357.45,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":25628.55},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20931.41},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40799.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11376.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10939.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":23535.41},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":43436.82},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":21799.87},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":35825.02},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11267.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11267.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":20214.83},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":67357.45},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":51127.32},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11704.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11157.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25450.44},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10939.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11157.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21956.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11595.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22777.41},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32250.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11693.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":29992.95},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":22777.41},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10939.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12251.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10939.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","code_information":[{"code":"391","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10100.61,"maximum":61874.02,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":23542.18},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19227.43},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37478.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10504.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10100.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":21619.44},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":39900.72},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":20025.19},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":32908.58},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10403.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":10403.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":18569.18},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":61874.02},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":46965.15},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10807.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10302.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23378.57},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10100.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10302.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20273.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10706.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20923.15},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29624.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10797.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":27551.28},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":20923.15},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10100.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11312.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10100.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":21552.22,"10th_percentile":21552.22,"90th_percentile":21552.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9020.81,"10th_percentile":8844.69,"90th_percentile":9873.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10377.16,"10th_percentile":10377.16,"90th_percentile":10377.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4740.92,"10th_percentile":4740.92,"90th_percentile":9726.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3989.26,"10th_percentile":3989.26,"90th_percentile":3989.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":22239.18,"10th_percentile":22239.18,"90th_percentile":22239.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9390.65,"10th_percentile":7571.26,"90th_percentile":9870.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","code_information":[{"code":"402","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30631.07,"maximum":196140.09,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":74628.52},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":60950.78},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":118805.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31856.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30631.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":68533.44},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":126484.93},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":63479.67},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":104319.91},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31550.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":31550.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":58864.14},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":196140.09},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":148879.12},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32775.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31243.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":74109.88},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30631.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31243.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":61482.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32468.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":66326.19},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":93910.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32744.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":87337.32},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":66326.19},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30631.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34306.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30631.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Cc","code_information":[{"code":"412","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16323.46,"maximum":102570.46,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":39026.61},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31873.9},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":62128.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16976.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16323.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":35839.22},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":66144.65},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":33196.37},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":54553.57},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16813.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":16813.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":30782.7},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":102570.46},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":77855.58},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17466.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16649.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38755.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16323.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16649.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32764.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17302.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34684.94},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49110.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17449.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":45672.61},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":34684.94},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16323.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18282.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16323.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Mcc","code_information":[{"code":"420","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26055.32,"maximum":166215.37,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":63242.59},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":51651.64},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":100679.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27097.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26055.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":58077.43},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":107187.37},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":53794.7},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":88404.02},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26836.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":26836.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":49883.35},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":166215.37},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":126164.91},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27879.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26576.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62803.07},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26055.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26576.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":52298.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27618.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":56206.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":79583.04},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27853.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":74012.43},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":56206.93},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26055.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29181.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26055.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","code_information":[{"code":"428","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42577.7,"maximum":274269.27,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":104355.56},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":85229.52},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":166130.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44280.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42577.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":95832.61},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":176868.12},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":88765.76},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":145874.03},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43855.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":43855.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":82311.7},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":274269.27},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":208182.66},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45558.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43429.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":103630.33},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42577.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43429.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":85461.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":45132.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":92746.13},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":131318.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45515.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":122126.71},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":92746.13},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42577.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47687.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42577.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","code_information":[{"code":"437","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7004.86,"maximum":41628.24,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":15838.95},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12936.03},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25215.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7285.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7004.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":14545.35},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":26844.82},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":13472.75},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":22140.58},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7215.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7215.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":12493.17},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":41628.24},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31597.7},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7495.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7144.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15728.88},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7004.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7144.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14060.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7425.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14076.89},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19931.38},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7488.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":18536.24},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":14076.89},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7004.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7845.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7004.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5965.82,"10th_percentile":5965.82,"90th_percentile":5965.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Cc","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8803.38,"maximum":53390.3,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":20314.25},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16591.1},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32339.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9155.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8803.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":18655.14},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":34429.82},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":17279.48},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":28396.4},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9067.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9067.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":16023.11},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":53390.3},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40525.63},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9419.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8979.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20173.08},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8803.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8979.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17670.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9331.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18054.32},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25563.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9410.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":23773.65},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":18054.32},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8803.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9859.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8803.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8011.02,"10th_percentile":8011.02,"90th_percentile":8011.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8605.57,"10th_percentile":8605.57,"90th_percentile":8605.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5895.45,"10th_percentile":5895.45,"90th_percentile":5895.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"458","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31765.68,"maximum":203560.29,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":77451.8},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":63256.62},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":123300.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33036.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31765.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":71126.14},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":131270.0},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":65881.18},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":108266.45},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32718.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":32718.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":61091.04},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":203560.29},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":154511.38},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33989.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32400.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76913.54},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31765.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32400.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":63760.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33671.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":68835.38},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97463.59},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33957.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":90641.39},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":68835.38},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31765.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35577.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31765.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement Without Cc/Mcc","code_information":[{"code":"468","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21138.66,"maximum":134061.18,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":51008.38},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":41659.68},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":81203.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21984.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21138.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":46842.41},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":86452.08},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":43388.17},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":71302.36},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21772.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":21772.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":40233.47},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":134061.18},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":101758.44},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22618.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21561.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50653.88},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21138.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21561.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":42429.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22406.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":45333.76},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64187.78},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22597.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":59694.8},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":45333.76},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21138.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23675.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21138.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"476","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9443.42,"maximum":57576.06,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":21906.87},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17891.83},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34874.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9821.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9443.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":20117.69},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":37129.09},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":18634.18},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":30622.65},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9726.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9726.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":17279.31},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":57576.06},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":43702.81},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10104.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9632.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21754.63},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9443.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9632.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18954.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10010.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19469.76},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27567.11},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10095.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":25637.48},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":19469.76},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9443.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10576.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9443.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Mcc","code_information":[{"code":"485","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24712.58,"maximum":157434.07,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":59901.43},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":48922.84},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":95360.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25701.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24712.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":55009.15},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":101524.57},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":50952.68},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":83733.56},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25453.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":25453.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":47247.97},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":157434.07},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":119499.51},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26442.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25206.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59485.13},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24712.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25206.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":49603.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26195.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":53237.47},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":75378.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26417.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":70102.29},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":53237.47},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24712.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27678.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24712.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","code_information":[{"code":"495","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27686.0,"maximum":176879.77,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":67300.24},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":54965.61},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":107139.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28793.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27686.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":61803.68},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":114064.52},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":57246.18},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":94076.04},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28516.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":28516.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":53083.87},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":176879.77},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":134259.67},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29624.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28239.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":66832.53},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27686.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28239.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55571.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29347.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":59813.17},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":84689.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29596.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":78761.08},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":59813.17},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27686.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31008.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27686.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"1 through 10","median_amount":413934.47,"10th_percentile":413934.47,"90th_percentile":413934.47},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Mcc","code_information":[{"code":"503","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21460.17,"maximum":136163.81,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":51808.4},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":42313.08},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":82477.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22318.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21460.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":47577.09},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":87808.01},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":44068.68},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":72420.67},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22103.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":22103.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":40864.5},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":136163.81},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":103354.43},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22962.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21889.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51448.35},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21460.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21889.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":43074.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22747.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":46044.78},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65194.51},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22940.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":60631.07},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":46044.78},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21460.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24035.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21460.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19044.18,"10th_percentile":19044.18,"90th_percentile":19044.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","code_information":[{"code":"512","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12988.25,"maximum":80758.69,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":30727.53},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25095.86},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48917.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13507.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12988.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":28217.95},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":52078.88},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":26137.11},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":42952.66},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13377.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":13377.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":24236.71},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":80758.69},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":61299.46},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13897.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13248.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30513.99},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12988.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13248.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26070.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13767.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27309.13},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38666.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13884.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":35960.25},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":27309.13},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12988.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14546.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12988.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":28130.21,"10th_percentile":28130.21,"90th_percentile":28130.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12707.1,"10th_percentile":12707.1,"90th_percentile":12707.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12712.61,"10th_percentile":12712.61,"90th_percentile":12712.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","code_information":[{"code":"520","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11783.51,"maximum":72879.91,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":27729.77},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22647.52},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44144.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12254.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11783.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":25465.02},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":46998.09},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":23587.19},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":38762.22},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12137.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12137.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":21872.19},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":72879.91},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":55319.12},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12608.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12019.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27537.06},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11783.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12019.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23651.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12490.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24644.87},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34894.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12596.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":32451.99},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":24644.87},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11783.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13197.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11783.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","code_information":[{"code":"538","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6012.73,"maximum":35139.84,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":13370.21},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10919.75},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21284.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6253.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6012.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":12278.23},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":22660.64},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":11372.82},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":18689.62},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6193.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6193.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":10545.91},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":35139.84},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26672.71},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6433.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6132.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13277.29},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6012.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6132.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12068.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6373.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11882.79},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16824.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6427.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":15647.08},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":11882.79},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6012.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6734.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6012.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Cc","code_information":[{"code":"546","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9243.5,"maximum":56268.62,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":21409.41},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17485.54},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34082.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9613.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9243.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":19660.86},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":36285.96},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":18211.03},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":29927.27},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9520.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9520.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":16886.93},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":56268.62},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42710.4},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9890.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9428.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21260.62},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9243.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9428.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18553.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9798.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19027.64},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26941.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9881.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":25055.31},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":19027.64},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9243.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10352.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9243.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies Without Mcc","code_information":[{"code":"554","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6831.8,"maximum":40496.43,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":15408.32},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12584.32},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24529.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7105.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6831.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":14149.88},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":26114.95},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":13106.45},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":21538.6},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7036.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7036.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":12153.49},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":40496.43},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30738.6},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7310.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6968.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15301.23},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6831.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6968.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13712.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7241.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13694.16},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19389.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7303.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":18032.26},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":13694.16},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6831.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7651.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6831.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2442.1,"10th_percentile":2442.1,"90th_percentile":2442.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","code_information":[{"code":"562","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11268.05,"maximum":69508.87,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":26447.14},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21599.97},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42102.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11718.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11268.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":24287.14},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":44824.21},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":22496.17},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":36969.29},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11606.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11606.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":20860.5},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":69508.87},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":52760.34},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12056.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11493.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26263.34},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11268.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11493.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22617.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11944.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23504.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33280.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12045.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":30950.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":23504.93},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11268.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12620.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11268.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11014.39,"10th_percentile":11014.39,"90th_percentile":11014.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"573","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":49510.69,"maximum":319610.05,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":121607.09},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":99319.22},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":193593.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51491.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49510.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":111675.16},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":206107.04},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":103440.05},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":169989.18},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":50996.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":50996.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":95919.05},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":319610.05},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":242598.34},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52976.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":50500.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":120761.96},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49510.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":50500.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":99377.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":52481.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":108078.45},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":153027.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52926.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":142316.06},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":108078.45},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49510.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":55451.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49510.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","code_information":[{"code":"581","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11404.56,"maximum":70401.63,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":26786.82},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21877.4},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42643.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11860.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11404.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":24599.08},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":45399.93},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":22785.11},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":37444.12},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11746.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11746.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":21128.43},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":70401.63},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":53437.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12202.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11632.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26600.66},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11404.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11632.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22891.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12088.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23806.82},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33707.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12191.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":31348.46},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":23806.82},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11404.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12773.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11404.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders With Mcc","code_information":[{"code":"595","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16459.22,"maximum":103458.35,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":39364.43},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":32149.81},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":62666.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17117.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16459.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":36149.45},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":66717.22},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":33483.73},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":55025.8},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16953.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":16953.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":31049.17},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":103458.35},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":78529.52},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17611.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16788.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39090.86},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16459.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16788.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33036.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17446.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34985.19},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49535.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17594.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":46067.97},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":34985.19},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16459.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18434.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16459.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14407.22,"10th_percentile":14407.22,"90th_percentile":14407.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis Without Mcc","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7136.15,"maximum":42486.86,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":16165.65},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13202.84},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25735.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7421.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7136.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":14845.36},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":27398.51},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":13750.64},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":22597.24},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7350.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7350.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":12750.85},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":42486.86},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32249.43},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7635.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7278.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16053.3},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7136.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7278.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14323.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7564.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14367.24},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20342.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7628.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":18918.56},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":14367.24},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7136.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7992.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7136.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6974.37,"10th_percentile":6974.37,"90th_percentile":6974.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":9401.9,"10th_percentile":9401.9,"90th_percentile":9401.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7330.2,"10th_percentile":7330.2,"90th_percentile":7330.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7330.2,"10th_percentile":7330.2,"90th_percentile":7330.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6584.13,"10th_percentile":6241.13,"90th_percentile":6979.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8716.9,"10th_percentile":8716.9,"90th_percentile":8716.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2571.18,"10th_percentile":2571.18,"90th_percentile":2571.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3490.41,"10th_percentile":3490.41,"90th_percentile":3490.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":19914.01,"10th_percentile":19914.01,"90th_percentile":19914.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5217.03,"10th_percentile":277.99,"90th_percentile":6489.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"617","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14591.32,"maximum":91242.59,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":34716.51},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":28353.75},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":55267.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15174.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14591.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":31881.13},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":58839.64},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":29530.17},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":48528.67},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15029.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":15029.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":27383.06},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":91242.59},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":69257.21},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15612.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14883.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34475.24},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14591.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14883.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":29287.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15466.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30854.34},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43686.47},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15598.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":40628.53},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":30854.34},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14591.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16342.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14591.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":18094.95,"10th_percentile":18094.95,"90th_percentile":18094.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","code_information":[{"code":"625","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23168.43,"maximum":147335.58,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":56059.1},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":45784.72},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":89243.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24095.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23168.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":51480.62},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":95012.35},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":47684.36},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":78362.53},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23863.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":23863.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":44217.28},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":147335.58},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":111834.3},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24790.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23631.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":55669.5},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23168.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23631.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":46503.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24558.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":49822.59},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":70543.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24767.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":65605.63},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":49822.59},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23168.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25948.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23168.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes Without Cc/Mcc","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5273.47,"maximum":30305.24,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":11530.71},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9417.39},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18356.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5484.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5273.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":10588.98},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":19542.95},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":9808.13},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":16118.28},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5431.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":5431.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":9094.99},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":30305.24},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23003.04},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5642.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5378.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11450.58},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5273.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5378.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10584.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5589.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10247.94},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14509.99},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5637.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":13494.33},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":10247.94},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5273.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5906.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5273.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9417.39,"10th_percentile":9417.39,"90th_percentile":9417.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis Without Mcc","code_information":[{"code":"651","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28283.51,"maximum":180787.45,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":68787.06},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":56179.93},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":109506.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29414.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28283.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":63169.07},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":116584.47},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":58510.88},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":96154.39},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29132.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":29132.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":54256.62},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":180787.45},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":137225.77},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30263.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28849.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":68309.01},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28283.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28849.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":56770.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29980.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":61134.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":86560.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30235.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":80501.09},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":61134.58},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28283.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31677.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28283.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","code_information":[{"code":"659","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19593.77,"maximum":123957.81,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":47164.19},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":38520.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":75083.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20377.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19593.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":43312.18},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":79936.71},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":40118.27},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":65928.73},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20181.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":20181.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":37201.32},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":123957.81},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":94089.53},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20965.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19985.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46836.41},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19593.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19985.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":39328.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20769.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":41917.23},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":59350.34},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20945.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":55195.97},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":41917.23},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19593.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21945.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19593.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy Without Cc/Mcc","code_information":[{"code":"667","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8891.41,"maximum":53965.97,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":20533.28},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16769.99},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32688.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9247.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8891.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":18856.29},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":34801.05},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":17465.79},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":28702.57},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9158.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9158.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":16195.87},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":53965.97},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40962.59},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9513.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9069.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20390.58},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8891.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9069.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17846.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9424.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18248.98},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25838.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9504.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":24029.98},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":18248.98},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8891.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9958.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8891.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","code_information":[{"code":"675","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12883.81,"maximum":80075.7,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":30467.67},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24883.62},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48503.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13399.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12883.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":27979.3},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":51638.44},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":25916.06},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":42589.41},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13270.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":13270.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":24031.74},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":80075.7},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":60781.04},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13785.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13141.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30255.93},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12883.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13141.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25860.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13656.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27078.18},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38339.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13772.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":35656.13},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":27078.18},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12883.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14429.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12883.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections Without Mcc","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6678.13,"maximum":39491.46,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":15025.94},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12272.02},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23920.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6945.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6678.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":13798.74},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":25466.87},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":12781.2},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":21004.1},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6878.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6878.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":11851.89},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":39491.46},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29975.79},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7145.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6811.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14921.51},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6678.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6811.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13404.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7078.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13354.32},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18908.3},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7138.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":17584.77},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":13354.32},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6678.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7479.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6678.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":13147.13,"10th_percentile":13147.13,"90th_percentile":13147.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6526.84,"10th_percentile":6526.84,"90th_percentile":6528.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6861.56,"10th_percentile":6861.56,"90th_percentile":6861.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6859.84,"10th_percentile":6859.84,"90th_percentile":6859.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"1 through 10","median_amount":7742.17,"10th_percentile":7742.17,"90th_percentile":7742.17},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6536.28,"10th_percentile":6536.28,"90th_percentile":6536.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5352.48,"10th_percentile":4371.44,"90th_percentile":6542.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2755.57,"10th_percentile":2755.57,"90th_percentile":2755.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":18708.3,"10th_percentile":18708.3,"90th_percentile":18708.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"1 through 10","median_amount":18301.99,"10th_percentile":18301.99,"90th_percentile":18301.99},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5326.34,"10th_percentile":2685.67,"90th_percentile":6538.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"1 through 10","median_amount":18301.99,"10th_percentile":18301.99,"90th_percentile":18301.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","code_information":[{"code":"700","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5785.95,"maximum":33656.77,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":12805.92},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10458.88},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20386.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6017.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5785.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":11760.04},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":21704.25},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":10892.83},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":17900.84},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5959.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":5959.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":10100.83},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":33656.77},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25547.0},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6190.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5901.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12716.93},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5785.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5901.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11613.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6133.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11381.28},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16114.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6185.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":14986.7},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":11381.28},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5785.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6480.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5785.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5662.53,"10th_percentile":5662.53,"90th_percentile":5662.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy Without Cc/Mcc","code_information":[{"code":"714","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8527.37,"maximum":51585.26,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":19627.46},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16030.18},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31246.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8868.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8527.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":18024.44},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":33265.8},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":16695.29},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":27436.36},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8783.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8783.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":15481.39},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":51585.26},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39155.52},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9124.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8697.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19491.05},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8527.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8697.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17116.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9039.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17443.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24698.75},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9115.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":22969.9},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":17443.93},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8527.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9550.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8527.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":22559.03,"10th_percentile":22559.03,"90th_percentile":22559.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy With Mcc","code_information":[{"code":"725","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9368.82,"maximum":57088.21,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":21721.25},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17740.23},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34579.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9743.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9368.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":19947.23},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":36814.49},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":18476.29},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":30363.18},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9649.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9649.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":17132.9},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":57088.21},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":43332.51},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10024.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9556.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21570.3},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9368.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9556.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18805.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9930.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19304.79},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27333.53},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10015.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":25420.25},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":19304.79},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9368.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10493.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9368.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5644.1,"10th_percentile":5644.1,"90th_percentile":5644.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","code_information":[{"code":"736","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27304.06,"maximum":174381.98,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":66349.87},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":54189.42},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105626.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28396.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27304.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":60930.93},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":112453.77},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":56437.78},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":92747.55},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28123.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":28123.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":52334.25},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":174381.98},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":132363.74},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29215.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27850.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65888.76},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27304.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27850.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":54804.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28942.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":58968.53},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":83493.17},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29188.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":77648.86},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":58968.53},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27304.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30580.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27304.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","code_information":[{"code":"744","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15925.11,"maximum":99965.34,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":38035.39},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31064.36},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60550.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16562.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15925.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":34928.96},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":64464.69},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":32353.24},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":53168.0},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16402.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":16402.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":30000.87},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":99965.34},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":75878.17},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17039.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16243.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37771.06},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15925.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16243.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":31964.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16880.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":33804.0},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47862.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17023.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":44512.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":33804.0},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15925.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17836.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15925.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15003.15,"10th_percentile":15003.15,"90th_percentile":15003.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Cc","code_information":[{"code":"755","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8754.15,"maximum":53068.32,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":20191.74},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16491.05},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32144.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9104.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8754.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":18542.64},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":34222.19},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":17175.27},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":28225.15},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9016.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9016.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":15926.48},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":53068.32},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40281.23},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9366.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8929.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20051.42},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8754.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8929.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17571.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9279.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17945.44},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25408.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9358.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":23630.28},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":17945.44},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8754.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9804.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8754.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses With O.R. Procedures","code_information":[{"code":"769","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13244.86,"maximum":82436.89,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":31366.07},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25617.37},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49933.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13774.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13244.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":28804.33},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":53161.11},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":26680.25},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":43845.24},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13642.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":13642.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":24740.36},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":82436.89},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":62573.29},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14172.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13509.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31148.08},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13244.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13509.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26585.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14039.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27876.63},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39470.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14158.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":36707.53},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":27876.63},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13244.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14834.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13244.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Cc","code_information":[{"code":"787","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8970.48,"maximum":54483.09,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":20730.04},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16930.69},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33001.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9329.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8970.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":19036.97},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":35134.53},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":17633.16},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":28977.61},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9239.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9239.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":16351.07},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":54483.09},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":41355.1},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9598.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9149.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20585.97},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8970.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9149.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18005.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9508.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18423.85},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26086.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9589.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":24260.25},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":18423.85},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8970.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10046.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8970.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13081.87,"10th_percentile":13081.87,"90th_percentile":13081.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":18637.97,"10th_percentile":18637.97,"90th_percentile":18637.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"1 through 10","median_amount":66756.83,"10th_percentile":66756.83,"90th_percentile":66756.83},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3275.55,"10th_percentile":3275.55,"90th_percentile":3275.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3399.15,"10th_percentile":3399.15,"90th_percentile":4343.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Normal Newborn","code_information":[{"code":"795","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2129.98,"maximum":9747.24,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":3708.69},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":3028.97},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5904.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2215.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2129.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":3405.79},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":6285.71},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":3154.64},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":5184.21},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2193.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":2193.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":2925.27},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":9747.24},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":7398.59},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2279.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2172.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3682.91},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2129.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2172.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":4275.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2257.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":3296.1},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4666.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2276.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":4340.26},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":3296.1},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2129.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2385.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2129.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1999.12,"10th_percentile":1999.12,"90th_percentile":2185.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":2895.2,"10th_percentile":1823.15,"90th_percentile":3395.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":4874.37,"10th_percentile":2190.0,"90th_percentile":6285.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":3022.37,"10th_percentile":3022.37,"90th_percentile":3154.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":5184.21,"10th_percentile":5184.21,"90th_percentile":5184.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":6576.52,"10th_percentile":6576.52,"90th_percentile":6576.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"1 through 10","median_amount":4481.69,"10th_percentile":4481.69,"90th_percentile":4481.69},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"1 through 10","median_amount":697.52,"10th_percentile":690.0,"90th_percentile":697.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":655.83,"10th_percentile":655.83,"90th_percentile":673.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4083.95,"10th_percentile":4083.95,"90th_percentile":4083.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":684.06,"10th_percentile":629.16,"90th_percentile":691.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"49","median_amount":707.81,"10th_percentile":697.38,"90th_percentile":715.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":1253.0,"10th_percentile":1253.0,"90th_percentile":2506.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","code_information":[{"code":"803","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14506.28,"maximum":90686.44,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":34504.9},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":28180.92},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54930.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15086.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14506.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":31686.81},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":58480.99},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":29350.17},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":48232.88},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14941.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14941.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":27216.15},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":90686.44},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":68835.07},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15521.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14796.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34265.1},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14506.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14796.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":29117.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15376.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30666.27},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43420.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15507.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":40380.88},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":30666.27},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14506.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16247.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14506.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13042.45,"10th_percentile":13042.45,"90th_percentile":13042.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":10738.16,"10th_percentile":10738.16,"90th_percentile":10738.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":10191.35,"10th_percentile":10191.35,"90th_percentile":10191.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders With Mcc","code_information":[{"code":"811","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11115.13,"maximum":68508.78,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":26066.62},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21289.19},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41497.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11559.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11115.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":23937.7},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":44179.28},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":22172.49},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":36437.37},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11448.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11448.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":20560.36},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":68508.78},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":52001.23},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11893.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11337.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25885.46},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11115.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11337.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22310.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11782.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23166.74},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32801.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11882.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":30505.61},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":23166.74},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11115.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12448.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11115.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10864.92,"10th_percentile":10864.92,"90th_percentile":10864.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":14786.5,"10th_percentile":14786.5,"90th_percentile":14786.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18407.62,"10th_percentile":18407.62,"90th_percentile":18407.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1748.06,"10th_percentile":1748.06,"90th_percentile":1748.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10875.72,"10th_percentile":10875.72,"90th_percentile":10875.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8885.32,"10th_percentile":8885.32,"90th_percentile":8885.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"819","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7054.09,"maximum":41950.22,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":15961.46},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13036.08},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25410.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7336.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7054.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":14657.86},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":27052.45},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":13576.96},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":22311.83},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7265.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7265.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":12589.8},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":41950.22},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31842.1},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7547.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7195.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15850.54},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7054.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7195.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14158.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7477.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14185.77},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20085.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7540.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":18679.61},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":14185.77},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7054.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7900.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7054.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"1 through 10","median_amount":96233.8,"10th_percentile":96233.8,"90th_percentile":96233.8},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","code_information":[{"code":"827","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17880.28,"maximum":112751.89,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":42900.49},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":35037.79},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":68295.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18595.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17880.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":39396.72},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":72710.35},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":36491.54},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":59968.71},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18416.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":18416.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":33838.28},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":112751.89},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":85583.74},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19131.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18237.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42602.35},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17880.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18237.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":35889.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18953.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":38127.87},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53985.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19114.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":50206.2},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":38127.87},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17880.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20025.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17880.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Cc","code_information":[{"code":"835","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16198.88,"maximum":101755.75,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":38716.62},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31620.73},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":61635.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16846.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16198.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":35554.55},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":65619.27},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":32932.7},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":54120.25},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16684.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":16684.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":30538.2},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":101755.75},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":77237.17},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17332.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16522.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38447.55},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16198.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16522.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32514.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17170.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34409.44},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48720.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17316.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":45309.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":34409.44},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16198.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18142.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16198.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15760.97,"10th_percentile":15760.97,"90th_percentile":15760.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","code_information":[{"code":"843","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15520.05,"maximum":97316.32,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":37027.48},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30241.17},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58946.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16140.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15520.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":34003.36},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":62756.41},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":31495.9},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":51759.08},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15985.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":15985.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":29205.87},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":97316.32},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":73867.44},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16606.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15830.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36770.15},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15520.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15830.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":31151.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16451.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32908.22},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46594.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16590.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":43333.04},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":32908.22},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15520.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17382.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15520.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6233.08,"10th_percentile":6233.08,"90th_percentile":6233.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","code_information":[{"code":"853","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37479.77,"maximum":240929.6,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":91670.29},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":74869.18},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145935.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38978.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37479.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":84183.38},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":155368.36},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":77975.56},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":128141.85},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38604.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":38604.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":72306.04},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":240929.6},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":182876.36},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40103.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38229.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":91033.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37479.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38229.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":75229.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39728.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":81472.08},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":115355.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40065.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":107281.21},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":81472.08},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37479.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41977.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37479.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36660.11,"10th_percentile":36660.11,"90th_percentile":36660.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":152512.4,"10th_percentile":152512.4,"90th_percentile":152512.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":41219.69,"10th_percentile":41219.69,"90th_percentile":41219.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":57266.95,"10th_percentile":57266.95,"90th_percentile":57266.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33878.1,"10th_percentile":18819.86,"90th_percentile":35652.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38933.36,"10th_percentile":38933.36,"90th_percentile":38933.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fever And Inflammatory Conditions","code_information":[{"code":"864","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7261.47,"maximum":43306.44,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":16477.49},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13457.53},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26231.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7551.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7261.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":15131.73},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":27927.04},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":14015.9},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":23033.15},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7479.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7479.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":12996.82},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":43306.44},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32871.53},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7769.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7406.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16362.97},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7261.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7406.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14575.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7697.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14644.39},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20734.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7762.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":19283.51},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":14644.39},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7261.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8132.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7261.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7243.48,"10th_percentile":7243.48,"90th_percentile":7243.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6906.61,"10th_percentile":6906.61,"90th_percentile":6906.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","code_information":[{"code":"872","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8273.0,"maximum":49921.69,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":18994.49},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15513.23},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30238.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8603.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8273.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":17443.17},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":32193.02},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":16156.88},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":26551.57},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8521.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8521.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":14982.14},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":49921.69},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37892.8},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8852.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8438.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18862.49},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8273.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8438.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16605.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8769.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16881.38},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23902.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8843.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":22229.15},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":16881.38},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8273.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9265.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8273.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7398.0,"10th_percentile":7398.0,"90th_percentile":7398.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":29472.17,"10th_percentile":29472.17,"90th_percentile":29472.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":13339.25,"10th_percentile":13339.25,"90th_percentile":13339.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":23392.7,"10th_percentile":23392.7,"90th_percentile":23392.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8497.64,"10th_percentile":8497.64,"90th_percentile":8497.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5352.48,"10th_percentile":4112.72,"90th_percentile":7020.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3818.5,"10th_percentile":3818.5,"90th_percentile":3818.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7619.84,"10th_percentile":6328.1,"90th_percentile":7705.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"1 through 10","median_amount":18719.8,"10th_percentile":18719.8,"90th_percentile":18719.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Behavioral And Developmental Disorders","code_information":[{"code":"886","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16120.55,"maximum":101243.51,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":38521.72},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31461.55},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":61325.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16765.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16120.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":35375.56},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":65288.94},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":32766.91},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":53847.81},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16604.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":16604.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":30384.47},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":101243.51},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":76848.36},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17248.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16442.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38254.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16120.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16442.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32357.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17087.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34236.22},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48474.86},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17232.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":45081.74},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":34236.22},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16120.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18055.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16120.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries Without Cc/Mcc","code_information":[{"code":"903","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9364.35,"maximum":57058.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":21710.12},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17731.14},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34561.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9738.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9364.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":19937.0},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":36795.62},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":18466.81},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":30347.61},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9645.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9645.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":17124.11},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":57058.94},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":43310.29},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10019.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9551.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21559.24},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9364.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9551.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18796.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9926.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19294.89},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27319.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10010.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":25407.22},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":19294.89},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9364.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10488.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9364.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury Without Mcc","code_information":[{"code":"914","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7245.06,"maximum":43199.12,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":16436.65},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13424.18},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26166.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7534.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7245.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":15094.23},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":27857.83},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":13981.16},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":22976.07},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7462.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7462.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":12964.61},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":43199.12},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32790.07},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7752.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7389.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16322.42},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7245.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7389.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14542.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7679.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14608.09},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20683.51},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7744.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":19235.72},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":14608.09},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7245.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8114.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7245.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","code_information":[{"code":"922","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13689.45,"maximum":85344.48,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":32472.36},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26520.9},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51694.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14237.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13689.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":29820.27},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":55036.12},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":27621.28},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":45391.68},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14100.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14100.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":25612.97},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":85344.48},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":64780.28},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14647.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13963.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32246.69},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13689.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13963.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27477.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14510.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28859.85},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40862.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14634.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":38002.22},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":28859.85},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13689.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15332.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13689.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","code_information":[{"code":"939","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27706.88,"maximum":177016.37,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":67352.22},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":55008.06},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":107222.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28815.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27706.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":61851.41},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":114152.61},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":57290.39},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":94148.69},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28538.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":28538.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":53124.87},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":177016.37},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":134363.36},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29646.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28261.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":66884.14},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27706.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28261.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55613.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29369.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":59859.36},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":84754.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29618.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":78821.91},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":59859.36},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27706.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31031.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27706.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare Without Cc/Mcc","code_information":[{"code":"950","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5321.96,"maximum":30622.34,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":11651.37},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9515.93},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18548.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5534.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5321.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":10699.77},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":19747.44},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":9910.76},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":16286.93},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5481.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":5481.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":9190.16},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":30622.34},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23243.73},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5694.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5428.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11570.39},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5321.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5428.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10682.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5641.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10355.17},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14661.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5689.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":13635.53},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":10355.17},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5321.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5960.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5321.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Cc","code_information":[{"code":"964","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12072.2,"maximum":74767.89,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":28448.12},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23234.22},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45288.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12555.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12072.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":26124.7},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":48215.6},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":24198.22},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":39766.37},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12434.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12434.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":22438.8},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":74767.89},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":56752.18},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12917.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12313.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28250.42},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12072.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12313.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24231.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12796.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25283.3},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35798.47},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12905.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":33292.67},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":25283.3},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12072.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13520.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12072.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"981","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35638.73,"maximum":228889.46,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":87089.19},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":71127.69},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138642.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37064.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35638.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":79976.42},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":147604.03},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":74078.83},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":121738.13},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36707.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":36707.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":68692.64},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":228889.46},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":173737.35},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38133.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36351.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":86483.95},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35638.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36351.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71534.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37777.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":77400.62},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":109591.06},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38097.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":101919.97},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":77400.62},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35638.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39915.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35638.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34832.77,"10th_percentile":34832.77,"90th_percentile":34832.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36599.98,"10th_percentile":36599.98,"90th_percentile":36599.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16219.14,"10th_percentile":11404.6,"90th_percentile":34823.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33117.77,"10th_percentile":33117.77,"90th_percentile":43006.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant","code_information":[{"code":"008","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42447.9,"maximum":273420.41,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":104032.59},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":84965.74},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":165615.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44145.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42447.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":95536.01},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":176320.72},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":88491.03},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":145422.56},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43721.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":43721.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":82056.95},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":273420.41},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":207538.34},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45419.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43296.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":103309.59},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42447.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43296.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":85201.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44994.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":92459.09},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":130912.25},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45376.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":121748.73},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":92459.09},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42447.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47541.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42447.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","code_information":[{"code":"018","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":322768.14,"maximum":2106672.9,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":801559.13},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":654651.25},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1276051.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":335678.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":322768.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":736094.01},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":1358530.89},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":681813.23},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":1120464.11},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":332451.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":332451.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":632239.37},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":2106672.9},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":1599059.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":345361.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":329223.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":795988.55},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":322768.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":329223.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":647860.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":342134.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":712386.65},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1008663.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":345039.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":938059.96},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":712386.65},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":322768.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":361500.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":322768.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Cc","code_information":[{"code":"026","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23833.09,"maximum":151682.32,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":57712.97},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":47135.47},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":91876.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24786.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23833.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":52999.42},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":97815.43},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":49091.16},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":80674.41},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24548.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":24548.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":45521.8},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":151682.32},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":115133.68},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25501.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24309.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57311.88},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23833.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24309.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":47837.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25263.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":51292.47},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":72624.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25477.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":67541.15},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":51292.47},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23833.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26693.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23833.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Mcc","code_information":[{"code":"034","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29513.61,"maximum":188832.1,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":71847.93},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":58679.81},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":114379.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30694.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29513.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":65979.95},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":121772.22},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":61114.48},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":100433.05},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30399.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":30399.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":56670.92},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":188832.1},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":143332.02},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31579.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30103.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":71348.61},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29513.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30103.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":59239.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31284.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":63854.94},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":90411.81},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31550.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":84083.22},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":63854.94},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29513.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33055.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29513.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28856.36,"10th_percentile":28856.36,"90th_percentile":28856.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","code_information":[{"code":"042","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13527.58,"maximum":84285.84,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":32069.57},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26191.93},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51053.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14068.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13527.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":29450.37},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":54353.44},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":27278.66},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":44828.63},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13933.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":13933.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":25295.26},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":84285.84},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":63976.73},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14474.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13798.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31846.69},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13527.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13798.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27152.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14339.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28501.87},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40355.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14460.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":37530.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":28501.87},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13527.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15150.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13527.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13492.57,"10th_percentile":13492.57,"90th_percentile":13492.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Cc","code_information":[{"code":"059","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9896.22,"maximum":60537.31,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":23033.59},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18812.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36668.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10292.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9896.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":21152.38},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":39038.71},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":19592.57},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":32197.63},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10193.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":10193.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":18168.02},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":60537.31},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":45950.53},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10588.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10094.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22873.51},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9896.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10094.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19863.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10489.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20471.13},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28984.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10579.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":26956.07},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":20471.13},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9896.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11083.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9896.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction With Mcc","code_information":[{"code":"067","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11595.53,"maximum":71650.53,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":27262.01},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22265.49},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43400.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12059.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11595.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":25035.46},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":46205.3},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":23189.3},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":38108.36},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11943.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11943.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":21503.24},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":71650.53},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":54385.96},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12407.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11827.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27072.55},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11595.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11827.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23274.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12291.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24229.14},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34305.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12395.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":31904.57},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":24229.14},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11595.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12986.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11595.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12113.36,"10th_percentile":12113.36,"90th_percentile":12113.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis With Cc/Mcc","code_information":[{"code":"075","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14943.42,"maximum":93545.24,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":35592.64},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29069.3},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56662.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15541.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14943.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":32685.71},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":60324.55},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":30275.41},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":49753.37},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15391.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":15391.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":28074.12},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":93545.24},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":71005.03},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15989.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15242.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35345.28},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14943.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15242.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":29994.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15840.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":31633.0},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44788.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15974.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":41653.85},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":31633.0},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14943.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16736.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14943.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Cc","code_information":[{"code":"086","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10357.23,"maximum":63552.22,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":24180.72},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19748.93},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38494.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10771.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10357.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":22205.82},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":40982.94},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":20568.33},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":33801.16},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10667.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":10667.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":19072.83},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":63552.22},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":48238.98},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11082.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10564.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24012.67},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10357.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10564.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20789.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10978.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21490.64},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30428.47},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11071.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":28298.55},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":21490.64},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10357.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11600.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10357.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Mcc","code_information":[{"code":"094","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26893.03,"maximum":171693.93,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":65327.1},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":53354.1},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":103998.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27968.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26893.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":59991.69},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":110720.32},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":55567.81},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":91317.87},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27699.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":27699.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":51527.54},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":171693.93},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":130323.38},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28775.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27430.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64873.1},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26893.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27430.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":53979.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28506.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":58059.54},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":82206.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28748.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":76451.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":58059.54},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26893.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30120.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26893.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches With Mcc","code_information":[{"code":"102","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9001.06,"maximum":54683.11,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":20806.15},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16992.84},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33122.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9361.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9001.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":19106.86},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":35263.51},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":17697.89},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":29083.99},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9271.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9271.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":16411.1},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":54683.11},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":41506.93},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9631.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9181.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20661.55},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9001.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9181.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18066.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9541.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18491.49},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26181.98},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9622.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":24349.31},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":18491.49},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9001.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10081.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9001.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections Without Cc/Mcc","code_information":[{"code":"122","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6501.33,"maximum":38335.25,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":14586.02},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11912.73},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23220.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6761.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6501.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":13394.75},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":24721.27},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":12407.0},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":20389.15},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6696.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6696.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":11504.9},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":38335.25},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29098.17},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6956.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6631.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14484.65},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6501.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6631.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13049.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6891.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12963.34},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18354.72},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6949.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":17069.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":12963.34},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6501.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7281.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6501.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures","code_information":[{"code":"139","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9857.43,"maximum":60283.62,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":22937.06},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18733.21},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36514.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10251.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9857.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":21063.74},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":38875.12},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":19510.47},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":32062.71},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10153.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":10153.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":18091.88},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":60283.62},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":45757.97},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10547.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10054.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22777.66},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9857.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10054.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19785.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10448.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20385.34},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28863.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10537.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":26843.11},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":20385.34},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9857.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11040.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9857.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Cc","code_information":[{"code":"147","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10124.49,"maximum":62030.13,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":23601.58},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19275.94},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37572.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10529.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10124.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":21673.99},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":40001.39},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":20075.71},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":32991.61},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10428.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":10428.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":18616.03},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":62030.13},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":47083.65},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10833.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10326.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23437.56},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10124.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10326.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20321.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10731.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20975.94},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29699.7},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10823.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":27620.79},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":20975.94},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10124.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11339.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10124.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","code_information":[{"code":"155","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7476.31,"maximum":44711.45,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":17012.07},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13894.14},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27082.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7775.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7476.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":15622.66},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":28833.09},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":14470.62},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":23780.43},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7700.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7700.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":13418.48},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":44711.45},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33938.0},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7999.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7625.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16893.84},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7476.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7625.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15006.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7924.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15119.5},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21407.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7992.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":19909.13},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":15119.5},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7476.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8373.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7476.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Mcc","code_information":[{"code":"166","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28521.48,"maximum":182343.69,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":69379.19},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":56663.53},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":110449.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29662.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28521.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":63712.83},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":117588.04},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":59014.55},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":96982.1},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29377.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":29377.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":54723.67},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":182343.69},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":138407.03},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30517.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29091.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":68897.02},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28521.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29091.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":57248.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30232.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":61660.84},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":87305.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30489.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":81194.06},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":61660.84},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28521.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31944.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28521.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26171.61,"10th_percentile":26171.61,"90th_percentile":26171.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28445.72,"10th_percentile":28445.72,"90th_percentile":28445.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21277.21,"10th_percentile":21277.21,"90th_percentile":21277.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":112574.29,"10th_percentile":112574.29,"90th_percentile":112574.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26916.41,"10th_percentile":26916.41,"90th_percentile":26916.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations Without Cc/Mcc","code_information":[{"code":"179","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6271.58,"maximum":36832.68,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":14014.31},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11445.8},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22310.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6522.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6271.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":12869.73},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":23752.3},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":11920.7},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":19589.99},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6459.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6459.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":11053.96},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":36832.68},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27957.65},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6710.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6397.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13916.92},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6397.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12588.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6647.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12455.24},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17635.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6704.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":16400.87},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":12455.24},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7024.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6271.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5012.43,"10th_percentile":5012.43,"90th_percentile":5012.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":16512.41,"10th_percentile":16512.41,"90th_percentile":16512.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Cc","code_information":[{"code":"187","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8017.88,"maximum":48253.24,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":18359.67},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14994.76},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29227.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8338.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8017.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":16860.2},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":31117.09},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":15616.9},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":25664.18},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8258.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8258.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":14481.41},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":48253.24},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36626.37},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8579.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8178.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18232.08},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8017.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8178.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16093.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8498.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16317.18},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23103.4},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8571.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":21486.22},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":16317.18},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8017.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8980.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8017.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy Without Cc/Mcc","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5327.93,"maximum":30661.37,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":11666.22},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9528.06},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18572.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5541.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5327.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":10713.41},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":19772.61},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":9923.39},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":16307.69},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5487.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":5487.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":9201.87},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":30661.37},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23273.36},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5700.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5434.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11585.14},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5327.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5434.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10694.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5647.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10368.36},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14680.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5695.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":13652.91},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":10368.36},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5327.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5967.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5327.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4355.01,"10th_percentile":4355.01,"90th_percentile":4355.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":15211.78,"10th_percentile":15211.78,"90th_percentile":15211.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5232.27,"10th_percentile":5232.27,"90th_percentile":5232.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2308.89,"10th_percentile":2308.89,"90th_percentile":2308.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma Without Cc/Mcc","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5637.51,"maximum":32685.95,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":12436.54},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10157.2},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19798.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5863.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5637.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":11420.82},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":21078.2},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":10578.63},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":17384.49},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5806.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":5806.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":9809.47},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":32685.95},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":24810.1},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6032.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5750.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12350.11},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5637.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5750.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11315.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5975.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11052.99},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15649.86},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6026.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":14554.41},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":11052.99},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5637.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6314.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5637.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5792.65,"10th_percentile":5792.65,"90th_percentile":5792.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Abdominal Aorta With Iliac Branch Procedures","code_information":[{"code":"213","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43211.02,"maximum":278411.12,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":105931.48},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":86516.6},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":168638.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44939.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43211.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":97279.82},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":179539.07},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":90106.24},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":148076.93},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44507.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":44507.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":83554.72},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":278411.12},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":211326.51},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46235.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44075.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":105195.29},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43211.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44075.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":86733.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":45803.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":94146.73},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":133301.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46192.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":123970.99},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":94146.73},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43211.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48396.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43211.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45140.24,"10th_percentile":45140.24,"90th_percentile":45140.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures With Mcc","code_information":[{"code":"228","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37545.42,"maximum":241358.91,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":91833.64},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":75002.58},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146195.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39047.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37545.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":84333.38},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":155645.2},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":78114.5},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":128370.19},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38671.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":38671.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":72434.88},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":241358.91},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":183202.22},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40173.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38296.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":91195.42},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37545.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38296.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":75361.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39798.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":81617.26},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":115561.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40136.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":107472.37},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":81617.26},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37545.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42050.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37545.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36713.65,"10th_percentile":36713.65,"90th_percentile":36713.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43824.05,"10th_percentile":43824.05,"90th_percentile":43824.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","code_information":[{"code":"239","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37353.7,"maximum":240105.13,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":91356.6},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":74612.97},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145436.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38847.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37353.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":83895.3},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":154836.68},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":77708.72},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":127703.35},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38474.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":38474.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":72058.61},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":240105.13},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":182250.55},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39968.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38100.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":90721.7},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37353.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38100.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":74976.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39594.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":81193.28},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":114961.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39931.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":106914.09},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":81193.28},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37353.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41836.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37353.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36508.87,"10th_percentile":36508.87,"90th_percentile":36508.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40836.82,"10th_percentile":40836.82,"90th_percentile":40836.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","code_information":[{"code":"251","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11787.99,"maximum":72909.18,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":27740.91},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22656.62},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44162.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12259.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11787.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":25475.25},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":47016.97},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":23596.66},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":38777.79},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12141.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12141.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":21880.97},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":72909.18},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":55341.34},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12613.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12023.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27548.12},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11787.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12023.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23660.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12495.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24654.77},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34908.53},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12601.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":32465.02},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":24654.77},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11787.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13202.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11787.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":25396.04,"10th_percentile":25396.04,"90th_percentile":25396.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11527.13,"10th_percentile":11527.13,"90th_percentile":11527.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement Without Mcc","code_information":[{"code":"259","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15723.7,"maximum":98648.15,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":37534.22},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30655.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":59753.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16352.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15723.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":34468.72},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":63615.27},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":31926.94},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":52467.43},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16195.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":16195.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":29605.57},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":98648.15},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":74878.36},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16824.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16038.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37273.37},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15723.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16038.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":31560.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16667.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":33358.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47232.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16808.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":43926.08},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":33358.58},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15723.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17610.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15723.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","code_information":[{"code":"267","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36153.44,"maximum":232255.63,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":88369.97},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":72173.73},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":140681.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37599.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36153.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":81152.6},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":149774.77},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":75168.27},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":123528.48},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37238.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":37238.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":69702.87},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":232255.63},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":176292.42},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38684.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36876.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":87755.83},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36153.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36876.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":72567.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38322.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":78538.92},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":111202.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38648.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":103418.86},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":78538.92},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36153.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40491.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36153.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35340.81,"10th_percentile":35335.81,"90th_percentile":36743.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":209.62,"10th_percentile":209.62,"90th_percentile":209.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":179462.79,"10th_percentile":179462.79,"90th_percentile":179462.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35861.21,"10th_percentile":35861.21,"90th_percentile":36036.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35351.81,"10th_percentile":35339.41,"90th_percentile":35435.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35340.81,"10th_percentile":35336.09,"90th_percentile":37771.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","code_information":[{"code":"275","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":53829.83,"maximum":347856.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":132354.48},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":108096.86},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":210703.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":55983.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53829.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":121544.8},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":224322.38},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":112581.89},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":185012.49},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55444.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":55444.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":104396.19},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":347856.56},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":264038.71},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57597.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":54906.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":131434.66},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53829.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":54906.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":108047.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":57059.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":117630.21},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":166551.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57544.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":154893.68},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":117630.21},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53829.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60289.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53829.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":139689.08,"10th_percentile":139689.08,"90th_percentile":139689.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Mcc","code_information":[{"code":"283","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15415.62,"maximum":96633.33,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":36767.61},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30028.93},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58532.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16032.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15415.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":33764.72},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":62315.97},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":31274.85},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":51395.82},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15878.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":15878.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":29000.89},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":96633.33},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":73349.02},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16494.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15723.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36512.09},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15415.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15723.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30942.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16340.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32677.26},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46267.53},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16479.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":43028.92},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":32677.26},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15415.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17265.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15415.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13201.07,"10th_percentile":13201.07,"90th_percentile":13201.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Mcc","code_information":[{"code":"291","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10216.24,"maximum":62630.18,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":23829.9},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19462.41},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37936.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10624.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10216.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":21883.65},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":40388.35},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":20269.92},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":33310.76},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10522.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":10522.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":18796.12},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":62630.18},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":47539.11},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10931.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10420.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23664.29},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10216.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10420.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20506.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10829.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21178.85},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29987.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10921.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":27887.99},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":21178.85},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10216.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11442.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10216.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9586.96,"10th_percentile":2077.74,"90th_percentile":10015.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":17372.6,"10th_percentile":17372.6,"90th_percentile":17372.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":19420.04,"10th_percentile":19420.04,"90th_percentile":19420.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":10190.22,"10th_percentile":10190.22,"90th_percentile":10190.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10493.2,"10th_percentile":10190.22,"90th_percentile":10495.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":9066.19,"10th_percentile":9066.19,"90th_percentile":9066.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9879.67,"10th_percentile":9643.42,"90th_percentile":10101.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9594.42,"10th_percentile":8418.42,"90th_percentile":10031.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":29025.43,"10th_percentile":29025.43,"90th_percentile":29025.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8882.64,"10th_percentile":8214.92,"90th_percentile":10672.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders Without Cc/Mcc","code_information":[{"code":"301","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6008.25,"maximum":35110.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":13359.07},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10910.65},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21267.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6248.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6008.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":12268.01},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":22641.76},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":11363.34},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":18674.06},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6188.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6188.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":10537.13},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":35110.56},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26650.49},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6428.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6128.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13266.23},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6008.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6128.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12059.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6368.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11872.89},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16810.75},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6422.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":15634.04},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":11872.89},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6008.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6729.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6008.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2474.91,"10th_percentile":2474.91,"90th_percentile":2474.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2811.59,"10th_percentile":2811.59,"90th_percentile":2811.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Cc","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6127.6,"maximum":35891.12,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":13656.06},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11153.21},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21739.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6372.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6127.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":12540.74},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":23145.12},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":11615.97},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":19089.21},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6311.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6311.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":10771.38},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":35891.12},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27242.97},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6556.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6250.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13561.16},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6127.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6250.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12299.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6495.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12136.84},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17184.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6550.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":15981.61},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":12136.84},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6127.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6862.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6127.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"1 through 10","median_amount":13751.7,"10th_percentile":13751.7,"90th_percentile":13751.7},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":12301.75,"10th_percentile":12301.75,"90th_percentile":12301.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4469.76,"10th_percentile":4283.75,"90th_percentile":4871.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":19749.88,"10th_percentile":19749.88,"90th_percentile":19749.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":8635.3,"10th_percentile":8635.3,"90th_percentile":8635.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5802.69,"10th_percentile":5802.69,"90th_percentile":5802.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6112.69,"10th_percentile":6112.69,"90th_percentile":6296.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5990.44,"10th_percentile":5300.96,"90th_percentile":6038.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2648.83,"10th_percentile":2648.83,"90th_percentile":2648.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4946.89,"10th_percentile":4946.89,"90th_percentile":4946.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4357.29,"10th_percentile":4357.29,"90th_percentile":4357.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","code_information":[{"code":"317","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50518.49,"maximum":326200.9,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":124114.81},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":101367.34},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":197586.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52539.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50518.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":113978.08},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":210357.29},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":105573.15},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":173494.62},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":52034.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":52034.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":97897.05},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":326200.9},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":247601.1},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54054.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":51528.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":123252.25},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50518.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":51528.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":101400.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":53549.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":110307.19},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":156183.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54004.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":145250.84},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":110307.19},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50518.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56580.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50518.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":50382.97,"10th_percentile":50382.97,"90th_percentile":50382.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":51937.4,"10th_percentile":51937.4,"90th_percentile":51937.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49383.31,"10th_percentile":49383.31,"90th_percentile":49383.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24627.71,"10th_percentile":24627.71,"90th_percentile":24627.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy Without Intraluminal Device","code_information":[{"code":"325","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24588.0,"maximum":156619.36,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":59591.44},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":48669.66},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94867.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25571.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24588.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":54724.48},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":100999.18},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":50689.01},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":83300.25},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25325.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":25325.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":47003.47},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":156619.36},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":118881.11},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26309.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25079.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59177.3},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24588.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25079.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":49353.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26063.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":52961.97},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":74988.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26284.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":69739.52},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":52961.97},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24588.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27538.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24588.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24044.08,"10th_percentile":24044.08,"90th_percentile":24044.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Cc","code_information":[{"code":"333","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18111.53,"maximum":114264.23,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":43475.92},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":35507.75},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69212.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18835.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18111.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":39925.14},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":73685.61},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":36981.0},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":60773.06},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18654.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":18654.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":34292.15},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":114264.23},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":86731.67},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19379.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18473.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43173.77},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18111.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18473.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36353.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19198.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":38639.27},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54709.11},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19361.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":50879.61},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":38639.27},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18111.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20284.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18111.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Mcc","code_information":[{"code":"347","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17763.91,"maximum":111990.85,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":42610.93},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":34801.3},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":67834.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18474.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17763.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":39130.8},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":72219.58},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":36245.23},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":59563.93},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18296.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":18296.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":33609.88},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":111990.85},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":85006.07},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19007.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18119.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42314.79},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17763.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18119.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":35655.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18829.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":37870.51},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53620.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18989.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":49867.32},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":37870.51},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17763.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19895.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17763.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":49124.54,"10th_percentile":49124.54,"90th_percentile":49124.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","code_information":[{"code":"355","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10672.77,"maximum":65615.83,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":24965.89},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20390.2},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39744.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11099.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10672.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":22926.87},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":42313.7},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":21236.21},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":34898.72},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10992.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":10992.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":19692.15},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":65615.83},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":49805.35},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11419.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10886.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24792.39},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10672.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10886.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21422.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11313.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22188.47},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31416.51},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11409.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":29217.44},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":22188.47},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10672.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11953.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10672.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":7512.26,"10th_percentile":7512.26,"90th_percentile":7512.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":34733.29,"10th_percentile":34733.29,"90th_percentile":34733.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10645.51,"10th_percentile":10645.51,"90th_percentile":10645.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":69480.9,"10th_percentile":69480.9,"90th_percentile":69480.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10440.6,"10th_percentile":10440.6,"90th_percentile":10440.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum HealthCare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10638.48,"10th_percentile":10638.48,"90th_percentile":10638.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10436.45,"10th_percentile":10436.45,"90th_percentile":10436.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders Without Cc/Mcc","code_information":[{"code":"370","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5867.26,"maximum":34188.53,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":13008.25},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10624.13},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20708.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6101.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5867.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":11945.84},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":22047.17},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":11064.93},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":18183.66},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6043.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6043.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":10260.41},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":34188.53},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25950.62},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6277.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5984.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12917.85},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5867.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5984.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11776.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6219.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11561.1},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16369.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6272.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":15223.48},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":11561.1},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5867.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6571.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5867.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Cc","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7955.22,"maximum":47843.45,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":18203.75},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14867.41},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28979.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8273.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7955.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":16717.01},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":30852.82},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":15484.27},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":25446.22},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8193.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8193.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":14358.43},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":47843.45},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36315.32},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8512.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8114.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18077.24},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7955.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8114.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15967.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8432.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16178.61},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22907.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8504.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":21303.75},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":16178.61},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7955.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8909.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7955.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":10712.39,"10th_percentile":10712.39,"90th_percentile":10712.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7598.04,"10th_percentile":6527.14,"90th_percentile":7799.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7935.35,"10th_percentile":7935.35,"90th_percentile":8171.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":15968.79,"10th_percentile":15968.79,"90th_percentile":15968.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7937.95,"10th_percentile":7937.95,"90th_percentile":7937.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7776.64,"10th_percentile":7634.64,"90th_percentile":7776.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4932.03,"10th_percentile":4932.03,"90th_percentile":4932.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":21922.65,"10th_percentile":21922.65,"90th_percentile":21922.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7106.45,"10th_percentile":7106.45,"90th_percentile":8311.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6610.89,"10th_percentile":6610.89,"90th_percentile":6610.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Inflammatory Bowel Disease With Cc","code_information":[{"code":"386","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7922.4,"maximum":47628.8,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":18122.08},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14800.71},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28849.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8239.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7922.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":16642.01},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":30714.4},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":15414.8},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":25332.06},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8160.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8160.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":14294.01},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":47628.8},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36152.39},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8476.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8080.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17996.14},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7922.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8080.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15901.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8397.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16106.02},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22804.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8469.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":21208.16},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":16106.02},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7922.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8873.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7922.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":13272.22,"10th_percentile":13272.22,"90th_percentile":13272.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":7262.13,"10th_percentile":7262.13,"90th_percentile":7262.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"1 through 10","median_amount":16160.69,"10th_percentile":16160.69,"90th_percentile":16160.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":20307.14,"10th_percentile":20307.14,"90th_percentile":20307.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Cc","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7619.54,"maximum":45648.12,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":17368.46},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14185.21},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27649.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7924.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7619.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":15949.94},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":29437.12},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":14773.77},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":24278.61},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7848.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7848.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":13699.58},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":45648.12},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34648.97},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8152.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7771.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17247.76},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7619.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7771.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15293.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8076.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15436.24},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21856.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8145.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":20326.21},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":15436.24},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7619.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8533.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7619.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":15900.35,"10th_percentile":15900.35,"90th_percentile":15900.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7058.57,"10th_percentile":7058.57,"90th_percentile":7058.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":8773.77,"10th_percentile":8773.77,"90th_percentile":8773.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"1 through 10","median_amount":24457.78,"10th_percentile":24457.78,"90th_percentile":24457.78},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7448.57,"10th_percentile":7448.57,"90th_percentile":7480.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13359.38,"10th_percentile":13359.38,"90th_percentile":13359.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3161.6,"10th_percentile":3161.6,"90th_percentile":3161.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":16873.57,"10th_percentile":16873.57,"90th_percentile":16873.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4856.54,"10th_percentile":4856.54,"90th_percentile":4856.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","code_information":[{"code":"407","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17196.98,"maximum":108283.19,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":41200.22},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":33649.14},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65589.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17884.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17196.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":37835.3},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":69828.62},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":35045.26},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":57591.96},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17712.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":17712.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":32497.16},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":108283.19},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":82191.79},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18400.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17540.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40913.89},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17196.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17540.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34517.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18228.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":36616.74},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51845.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18383.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":48216.37},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":36616.74},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17196.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19260.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17196.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","code_information":[{"code":"415","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16056.4,"maximum":100823.96,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":38362.09},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31331.17},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":61070.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16698.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16056.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":35228.97},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":65018.38},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":32631.13},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":53624.66},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16538.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":16538.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":30258.55},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":100823.96},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":76529.9},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17180.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16377.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38095.48},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16056.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16377.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32228.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17019.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34094.35},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48273.98},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17164.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":44894.92},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":34094.35},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16056.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17983.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16056.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","code_information":[{"code":"423","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31619.47,"maximum":202604.11,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":77087.99},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":62959.48},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122721.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32884.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31619.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":70792.04},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":130653.38},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":65571.72},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":107757.89},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32568.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":32568.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":60804.07},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":202604.11},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":153785.59},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33832.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32251.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76552.25},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31619.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32251.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":63466.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33516.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":68512.04},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97005.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33801.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":90215.62},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":68512.04},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31619.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35413.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31619.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Mcc","code_information":[{"code":"432","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15321.62,"maximum":96018.64,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":36533.73},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29837.91},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58160.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15934.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15321.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":33549.94},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":61919.57},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":31075.91},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":51068.89},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15781.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":15781.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":28816.42},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":96018.64},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":72882.45},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16394.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15628.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36279.83},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15321.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15628.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30753.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16240.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32469.4},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45973.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16378.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":42755.21},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":32469.4},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15321.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17160.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15321.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":60425.83,"10th_percentile":60425.83,"90th_percentile":60425.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":31075.91,"10th_percentile":31075.91,"90th_percentile":31075.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15020.7,"10th_percentile":15020.7,"90th_percentile":15020.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":5464.09,"10th_percentile":5464.09,"90th_percentile":5464.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5274.97,"maximum":30315.0,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":11534.43},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9420.42},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18362.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5485.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5274.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":10592.38},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":19549.24},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":9811.28},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":16123.47},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5433.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":5433.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":9097.92},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":30315.0},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23010.44},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5644.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11454.27},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5274.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10587.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5591.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10251.24},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14514.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5638.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":13498.67},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":10251.24},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5274.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5907.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5274.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5157.11,"10th_percentile":5157.11,"90th_percentile":5157.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":5500.0,"10th_percentile":5500.0,"90th_percentile":5500.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":277.99,"10th_percentile":277.99,"90th_percentile":277.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"1 through 10","median_amount":15313.85,"10th_percentile":15313.85,"90th_percentile":15313.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"448","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32274.43,"maximum":206887.43,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":78717.73},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":64290.53},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":125315.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33565.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32274.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":72288.68},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":133415.57},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":66957.99},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":110036.04},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33242.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":33242.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":62089.55},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":206887.43},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":157036.82},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34533.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32919.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":78170.67},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32274.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32919.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64781.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34210.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":69960.48},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":99056.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34501.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":92122.9},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":69960.48},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32274.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36147.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32274.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"463","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43155.82,"maximum":278050.11,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":105794.12},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":86404.42},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":168420.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44882.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43155.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":97153.68},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":179306.27},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":89989.41},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":147884.93},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44450.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":44450.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":83446.38},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":278050.11},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":211052.49},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46176.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44018.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":105058.88},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43155.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44018.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":86622.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":45745.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":94024.65},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":133128.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46133.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":123810.24},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":94024.65},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43155.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48334.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43155.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Mcc","code_information":[{"code":"471","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36659.95,"maximum":235568.13,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":89630.33},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":73203.09},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":142688.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38126.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36659.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":82310.02},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":151910.9},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":76240.34},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":125290.28},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37759.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":37759.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":70697.0},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":235568.13},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":178806.76},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39226.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37393.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":89007.43},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36659.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37393.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":73583.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38859.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":79659.06},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":112788.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39189.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":104893.85},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":79659.06},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36659.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41059.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36659.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"479","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14506.28,"maximum":90686.44,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":34504.9},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":28180.92},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54930.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15086.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14506.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":31686.81},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":58480.99},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":29350.17},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":48232.88},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14941.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14941.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":27216.15},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":90686.44},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":68835.07},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15521.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14796.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34265.1},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14506.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14796.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":29117.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15376.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30666.27},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43420.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15507.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":40380.88},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":30666.27},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14506.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16247.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14506.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12494.78,"10th_percentile":12494.78,"90th_percentile":12494.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","code_information":[{"code":"488","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13834.92,"maximum":86295.79,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":32834.32},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26816.52},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52271.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14388.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13834.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":30152.67},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":55649.59},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":27929.16},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":45897.65},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14249.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14249.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":25898.46},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":86295.79},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":65502.37},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14803.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14111.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32606.13},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13834.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14111.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27769.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14665.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29181.54},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41317.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14789.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":38425.81},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":29181.54},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13834.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15495.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13834.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","code_information":[{"code":"498","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23143.81,"maximum":147174.59,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":55997.84},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":45734.69},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":89146.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24069.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23143.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":51424.37},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":94908.53},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":47632.26},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":78276.91},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23838.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":23838.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":44168.97},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":147174.59},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":111712.1},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24763.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23606.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":55608.67},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23143.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23606.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":46454.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24532.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":49768.15},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":70466.41},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24740.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":65533.95},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":49768.15},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23143.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25921.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23143.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22614.93,"10th_percentile":22614.93,"90th_percentile":22630.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22641.03,"10th_percentile":22641.03,"90th_percentile":22641.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Thumb Or Joint Procedures","code_information":[{"code":"506","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10704.1,"maximum":65820.72,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":25043.85},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20453.87},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39868.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11132.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10704.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":22998.46},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":42445.83},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":21302.52},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":35007.69},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11025.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11025.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":19753.64},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":65820.72},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":49960.88},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11453.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10918.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24869.8},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10704.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10918.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21485.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11346.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22257.75},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31514.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11442.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":29308.67},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":22257.75},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10704.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11988.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10704.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","code_information":[{"code":"515","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24412.7,"maximum":155472.92,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":59155.24},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":48313.4},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94172.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25389.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24412.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":54323.9},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":100259.87},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":50317.96},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":82690.49},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25145.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":25145.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":46659.4},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":155472.92},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":118010.91},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26121.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24900.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58744.13},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24412.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24900.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":49001.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25877.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":52574.29},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":74439.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26097.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":69229.03},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":52574.29},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24412.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27342.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24412.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum HealthCare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23861.15,"10th_percentile":23861.15,"90th_percentile":23861.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23910.65,"10th_percentile":23910.65,"90th_percentile":23910.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur With Mcc","code_information":[{"code":"533","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12334.03,"maximum":76480.24,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":29099.65},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23766.33},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46325.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12827.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12334.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":26723.01},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":49319.84},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":24752.42},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":40677.11},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12704.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12704.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":22952.7},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":76480.24},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":58051.93},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13197.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12580.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28897.41},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12334.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12580.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24756.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13074.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25862.35},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36618.34},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13185.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":34055.15},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":25862.35},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12334.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13814.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12334.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis Without Cc/Mcc","code_information":[{"code":"541","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6513.27,"maximum":38413.31,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":14615.72},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11936.98},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23267.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6773.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6513.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":13422.02},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":24771.6},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":12432.26},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":20430.67},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6708.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6708.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":11528.32},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":38413.31},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29157.42},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6969.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6643.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14514.14},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6513.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6643.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13073.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6904.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12989.74},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18392.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6962.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":17104.69},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":12989.74},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6513.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7294.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6513.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Cc","code_information":[{"code":"549","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9644.83,"maximum":58893.25,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":22408.05},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18301.15},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35672.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10030.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9644.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":20577.93},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":37978.51},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":19060.48},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":31323.22},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9934.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9934.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":17674.62},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":58893.25},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":44702.62},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10319.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9837.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22252.32},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9644.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9837.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19359.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10223.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19915.18},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28197.78},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10310.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":26224.01},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":19915.18},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9644.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10802.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9644.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis With Mcc","code_information":[{"code":"557","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11731.29,"maximum":72538.42,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":27599.84},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22541.4},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43937.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12200.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11731.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":25345.7},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":46777.87},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":23476.66},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":38580.59},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12083.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12083.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":21769.7},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":72538.42},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":55059.91},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12552.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11965.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27408.03},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11731.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11965.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23547.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12435.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24529.39},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34731.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12540.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":32299.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":24529.39},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11731.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13139.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11731.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10511.64,"10th_percentile":10511.64,"90th_percentile":10511.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","code_information":[{"code":"565","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7908.22,"maximum":47536.1,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":18086.81},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14771.9},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28793.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8224.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7908.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":16609.62},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":30654.62},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":15384.8},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":25282.76},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8145.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8145.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":14266.19},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":47536.1},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36082.03},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8461.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8066.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17961.12},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7908.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8066.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15873.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8382.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16074.68},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22760.04},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8453.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":21166.89},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":16074.68},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7908.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8857.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7908.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7290.48,"10th_percentile":7290.48,"90th_percentile":7290.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6050.01,"10th_percentile":6050.01,"90th_percentile":6050.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"576","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37200.78,"maximum":239105.04,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":90976.07},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":74302.19},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144830.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38688.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37200.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":83545.86},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":154191.75},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":77385.05},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":127171.44},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38316.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":38316.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":71758.47},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":239105.04},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":181491.44},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39804.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37944.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":90343.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37200.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37944.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":74669.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39432.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":80855.1},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":114482.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39767.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":106468.77},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":80855.1},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37200.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41664.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37200.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","code_information":[{"code":"584","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16608.41,"maximum":104434.05,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":39735.67},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":32453.01},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":63257.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17272.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16608.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":36490.37},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":67346.42},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":33799.51},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":55544.74},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17106.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":17106.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":31341.99},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":104434.05},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":79270.12},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17771.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16940.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39459.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16608.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16940.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33336.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17604.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":35315.13},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50002.47},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17754.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":46502.43},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":35315.13},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16608.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18601.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16608.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Cc","code_information":[{"code":"598","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9078.64,"maximum":55190.47,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":20999.19},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17150.51},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33429.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9441.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9078.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":19284.14},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":35590.7},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":17862.1},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":29353.84},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9351.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9351.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":16563.36},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":55190.47},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":41892.04},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9714.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9260.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20853.25},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9078.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9260.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18222.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9623.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18663.06},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26424.91},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9705.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":24575.23},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":18663.06},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9078.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10168.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9078.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders With Mcc","code_information":[{"code":"606","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11927.48,"maximum":73821.46,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":28088.02},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22940.11},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44715.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12404.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11927.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":25794.01},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":47605.27},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":23891.91},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":39263.0},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12285.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12285.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":22154.76},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":73821.46},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":56033.8},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12762.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12166.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27892.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11927.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12166.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23940.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12643.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24963.26},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35345.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12750.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":32871.24},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":24963.26},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11927.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13358.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11927.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Cc","code_information":[{"code":"620","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12577.22,"maximum":78070.64,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":29704.77},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24260.55},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47288.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13080.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12577.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":27278.71},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":50345.44},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":25267.14},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":41522.98},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12954.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12954.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":23429.99},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":78070.64},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":59259.11},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13457.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12828.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29498.33},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12577.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12828.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25245.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13331.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26400.15},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37379.81},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13445.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":34763.32},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":26400.15},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12577.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14086.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12577.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","code_information":[{"code":"628","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28440.17,"maximum":181811.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":69176.86},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":56498.29},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":110126.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29577.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28440.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":63527.03},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":117245.13},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":58842.45},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":96699.28},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29293.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":29293.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":54564.08},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":181811.94},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":138003.4},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30430.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29008.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":68696.1},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28440.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29008.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":57085.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30146.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":61481.02},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":87050.59},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30402.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":80957.28},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":61481.02},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28440.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31852.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28440.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27789.81,"10th_percentile":27789.81,"90th_percentile":27789.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inborn And Other Disorders Of Metabolism","code_information":[{"code":"642","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11247.91,"maximum":69377.15,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":26397.02},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21559.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42023.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11697.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11247.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":24241.12},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":44739.27},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":22453.54},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":36899.23},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11585.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11585.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":20820.97},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":69377.15},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":52660.36},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12035.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11472.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26213.57},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11247.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11472.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22576.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11922.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23460.38},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33217.41},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12024.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":30892.28},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":23460.38},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11247.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12597.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11247.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10994.71,"10th_percentile":10994.71,"90th_percentile":10994.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Cc","code_information":[{"code":"654","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21521.34,"maximum":136563.85,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":51960.61},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":42437.39},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":82719.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22382.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21521.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":47716.87},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":88065.98},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":44198.15},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":72633.44},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22166.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":22166.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":40984.55},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":136563.85},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":103658.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23027.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21951.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51599.5},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21521.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21951.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":43197.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22812.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":46180.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65386.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23006.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":60809.19},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":46180.05},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21521.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24103.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21521.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Mcc","code_information":[{"code":"662","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23477.26,"maximum":149355.28,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":56827.56},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":46412.34},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":90467.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24416.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23477.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":52186.33},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":96314.79},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":48338.02},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":79436.74},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24181.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":24181.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":44823.42},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":149355.28},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":113367.35},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25120.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23946.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56432.63},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23477.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23946.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":47123.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24885.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":50505.57},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":71510.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25097.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":66504.96},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":50505.57},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23477.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26294.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23477.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures Without Cc/Mcc","code_information":[{"code":"670","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7929.86,"maximum":47677.58,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":18140.64},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14815.87},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28879.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8247.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7929.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":16659.06},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":30745.86},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":15430.59},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":25358.0},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8167.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8167.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":14308.65},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":47677.58},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36189.42},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8484.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8088.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18014.57},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7929.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8088.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15916.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8405.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16122.52},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22827.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8477.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":21229.89},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":16122.52},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7929.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8881.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7929.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure Without Cc/Mcc","code_information":[{"code":"684","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5117.57,"maximum":29285.64,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":11142.77},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9100.55},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17738.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5322.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5117.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":10232.71},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":18885.44},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":9478.14},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":15575.98},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5271.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":5271.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":8788.99},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":29285.64},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":22229.11},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5475.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5219.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11065.33},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5117.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5219.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10271.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5424.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":9903.15},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14021.81},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5470.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":13040.32},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":9903.15},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5117.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5731.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5117.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":9478.14,"10th_percentile":9478.14,"90th_percentile":9478.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5105.4,"10th_percentile":5105.4,"90th_percentile":5105.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms With Mcc","code_information":[{"code":"695","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9171.89,"maximum":55800.28,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":21231.22},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17340.01},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33799.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9538.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9171.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":19497.21},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":35983.95},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":18059.46},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":29678.18},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9447.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9447.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":16746.38},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":55800.28},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42354.91},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9813.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9355.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21083.67},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9171.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9355.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18409.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9722.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18869.27},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26716.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9804.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":24846.77},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":18869.27},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9171.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10272.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9171.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures With Cc/Mcc","code_information":[{"code":"709","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17998.89,"maximum":113527.57,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":43195.63},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":35278.84},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":68765.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18718.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17998.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":39667.75},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":73210.57},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":36742.58},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":60381.26},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18538.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":18538.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":34071.07},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":113527.57},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":86172.51},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19258.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18358.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42895.43},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17998.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18358.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36127.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19078.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":38390.17},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54356.4},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19240.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":50551.59},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":38390.17},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17998.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20158.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17998.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","code_information":[{"code":"717","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14742.01,"maximum":92228.04,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":35091.46},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":28659.98},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":55864.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15331.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14742.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":32225.46},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":59475.13},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":29849.1},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":49052.8},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15184.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":15184.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":27678.81},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":92228.04},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":70005.22},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15773.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15036.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34847.59},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14742.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15036.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":29590.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15626.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":31187.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44158.3},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15759.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":41067.33},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":31187.58},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14742.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16511.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14742.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System Without Mcc","code_information":[{"code":"728","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6690.81,"maximum":39574.39,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":15057.49},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12297.79},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23970.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6958.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6690.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":13827.72},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":25520.35},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":12808.04},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":21048.21},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6891.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6891.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":11876.78},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":39574.39},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30038.74},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7159.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6824.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14952.85},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6690.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6824.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13429.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7092.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13382.37},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18948.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7152.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":17621.7},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":13382.37},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6690.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7493.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6690.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11890.8,"10th_percentile":11890.8,"90th_percentile":11890.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5805.87,"10th_percentile":5805.87,"90th_percentile":5805.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","code_information":[{"code":"739","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27365.98,"maximum":174786.9,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":66503.93},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":54315.25},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105871.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28460.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27365.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":61072.41},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":112714.89},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":56568.83},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":92962.91},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28186.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":28186.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":52455.77},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":174786.9},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":132671.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29281.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27913.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":66041.75},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27365.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27913.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":54929.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29007.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":59105.45},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":83687.04},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29254.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":77829.16},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":59105.45},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27365.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30649.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27365.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","code_information":[{"code":"747","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7052.6,"maximum":41940.46,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":15957.75},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13033.05},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25404.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7334.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7052.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":14654.45},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":27046.16},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":13573.8},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":22306.64},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7264.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7264.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":12586.87},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":41940.46},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31834.69},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7546.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7193.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15846.85},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7052.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7193.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14155.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7475.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14182.47},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20080.87},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7539.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":18675.26},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":14182.47},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7052.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7898.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7052.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Cc","code_information":[{"code":"758","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7942.54,"maximum":47760.52,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":18172.2},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14841.64},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28929.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8260.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7942.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":16688.03},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":30799.34},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":15457.43},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":25402.11},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8180.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8180.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":14333.54},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":47760.52},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36252.37},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8498.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8101.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18045.91},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7942.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8101.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15942.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8419.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16150.56},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22867.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8490.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":21266.82},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":16150.56},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7942.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8895.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7942.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":21024.11,"10th_percentile":21024.11,"90th_percentile":21024.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion Without D&C","code_information":[{"code":"779","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6915.34,"maximum":41042.82,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":15616.21},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12754.11},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24860.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7191.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6915.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":14340.8},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":26467.3},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":13283.29},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":21829.21},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7122.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7122.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":12317.47},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":41042.82},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31153.34},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7399.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7053.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15507.68},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6915.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7053.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13880.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7330.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13878.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19651.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7392.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":18275.56},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":13878.93},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6915.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7745.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6915.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":9566.6,"10th_percentile":9566.6,"90th_percentile":9566.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"1 through 10","median_amount":2784.29,"10th_percentile":2784.29,"90th_percentile":2784.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","code_information":[{"code":"790","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44975.97,"maximum":289953.65,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":110323.25},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":90103.46},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":175630.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46775.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44975.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":101312.9},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":186982.51},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":93841.92},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":154215.99},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":46325.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":46325.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":87018.78},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":289953.65},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":220087.81},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48124.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":45875.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":109556.54},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44975.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":45875.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":90275.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":47674.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":98049.92},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138828.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48079.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":129110.65},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":98049.92},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44975.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50373.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44975.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":12098.6,"10th_percentile":12098.6,"90th_percentile":12098.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":27360.64,"10th_percentile":27360.64,"90th_percentile":27360.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":7205.44,"10th_percentile":7205.44,"90th_percentile":7205.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":7482.79,"10th_percentile":7482.79,"90th_percentile":7482.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","code_information":[{"code":"798","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7779.17,"maximum":46692.12,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":17765.69},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14509.64},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28282.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8090.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7779.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":16314.73},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":30110.37},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":15111.65},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":24833.87},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8012.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8012.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":14012.9},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":46692.12},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35441.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8323.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7934.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17642.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7779.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7934.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15614.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8245.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15789.28},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22355.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8315.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":20791.08},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":15789.28},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7779.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8712.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7779.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Cc","code_information":[{"code":"806","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6264.12,"maximum":36783.89,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":13995.75},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11430.64},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22280.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6514.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6264.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":12852.68},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":23720.84},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":11904.91},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":19564.04},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6452.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6452.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":11039.31},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":36783.89},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27920.62},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6702.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6389.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13898.48},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6264.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6389.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12573.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6639.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12438.74},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17611.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6696.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":16379.14},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":12438.74},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6264.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7015.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6264.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":12812.72,"10th_percentile":12812.72,"90th_percentile":12812.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6134.36,"10th_percentile":6134.36,"90th_percentile":6134.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":23720.84,"10th_percentile":23720.84,"90th_percentile":23720.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":1998.0,"10th_percentile":1998.0,"90th_percentile":1998.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":19064.04,"10th_percentile":19064.04,"90th_percentile":19064.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":2260.99,"10th_percentile":2260.99,"90th_percentile":33847.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"1 through 10","median_amount":39726.35,"10th_percentile":39726.35,"90th_percentile":39726.35},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"1 through 10","median_amount":2282.32,"10th_percentile":2282.32,"90th_percentile":2282.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2260.99,"10th_percentile":2260.99,"90th_percentile":2260.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2346.31,"10th_percentile":2025.46,"90th_percentile":2346.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":10679.35,"10th_percentile":10679.35,"90th_percentile":10679.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Mcc","code_information":[{"code":"814","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16503.98,"maximum":103751.06,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":39475.81},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":32240.77},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":62843.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17164.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16503.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":36251.73},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":66905.98},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":33578.47},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":55181.48},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16999.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":16999.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":31137.01},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":103751.06},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":78751.7},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17659.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16834.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39201.46},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16503.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16834.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33126.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17494.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":35084.17},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49675.46},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17642.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":46198.3},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":35084.17},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16503.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18484.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16503.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13926.67,"10th_percentile":13926.67,"90th_percentile":13926.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","code_information":[{"code":"822","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9620.96,"maximum":58737.14,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":22348.65},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18252.64},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35578.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10005.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9620.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":20523.38},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":37877.84},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":19009.96},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":31240.19},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9909.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9909.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":17627.76},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":58737.14},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":44584.12},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10294.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9813.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22193.33},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9620.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9813.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19311.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10198.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19862.39},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28123.03},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10284.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":26154.49},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":19862.39},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9620.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10775.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9620.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","code_information":[{"code":"830","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11866.31,"maximum":73421.43,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":27935.81},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22815.8},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44472.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12340.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11866.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":25654.23},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":47347.3},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":23762.45},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":39050.24},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12222.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12222.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":22034.71},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":73421.43},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":55730.15},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12696.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12103.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27741.67},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12103.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23818.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12578.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24827.99},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35153.79},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12685.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":32693.12},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":24827.99},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13290.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11866.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","code_information":[{"code":"838","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16210.81,"maximum":101833.81,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":38746.32},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31644.98},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":61682.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16859.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16210.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":35581.82},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":65669.6},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":32957.96},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":54161.77},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16697.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":16697.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":30561.62},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":101833.81},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":77296.42},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17345.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16535.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38477.04},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16210.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16535.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32538.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17183.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34435.84},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48757.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17329.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":45344.59},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":34435.84},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16210.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18156.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16210.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","code_information":[{"code":"846","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19978.68,"maximum":126475.11,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":48121.99},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":39302.3},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":76608.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20777.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19978.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":44191.76},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":81560.05},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":40932.98},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":67267.6},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20578.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":20578.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":37956.79},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":126475.11},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":96000.28},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21377.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20378.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47787.55},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19978.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20378.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":40101.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21177.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":42768.47},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60555.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21357.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":56316.88},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":42768.47},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19978.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22376.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19978.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","code_information":[{"code":"856","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34571.25,"maximum":221908.33,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":84432.97},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":68958.29},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":134414.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35954.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34571.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":77537.14},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":143102.1},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":71819.42},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":118025.12},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35608.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":35608.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":66597.52},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":221908.33},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":168438.36},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36991.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35262.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":83846.19},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34571.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35262.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":69391.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36645.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":75039.9},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":106248.53},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36956.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":98811.41},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":75039.9},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34571.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38719.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34571.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31982.72,"10th_percentile":31982.72,"90th_percentile":31982.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Mcc","code_information":[{"code":"867","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16254.08,"maximum":102116.76,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":38853.98},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31732.91},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":61854.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16904.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16254.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":35680.69},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":65852.07},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":33049.53},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":54312.26},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16741.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":16741.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":30646.54},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":102116.76},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":77511.2},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17391.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16579.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38583.96},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16254.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16579.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32625.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17229.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34531.52},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48892.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17375.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":45470.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":34531.52},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16254.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18204.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16254.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Depressive Neuroses","code_information":[{"code":"881","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7658.33,"maximum":45901.81,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":17464.99},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14264.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27803.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7964.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7658.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":16038.58},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":29600.71},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":14855.87},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":24413.53},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7888.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7888.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":13775.72},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":45901.81},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34841.53},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8194.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7811.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17343.61},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7658.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7811.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15371.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8117.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15522.03},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21977.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8186.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":20439.17},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":15522.03},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7658.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8577.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7658.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","code_information":[{"code":"895","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11199.42,"maximum":69060.05,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":26276.37},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21460.5},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41830.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11647.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11199.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":24130.32},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":44534.78},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":22350.91},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":36730.57},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11535.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11535.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":20725.8},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":69060.05},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":52419.67},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11983.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11423.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26093.75},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11199.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11423.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22479.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11871.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23353.15},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33065.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11972.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":30751.08},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":23353.15},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11199.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12543.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11199.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Procedures For Injuries","code_information":[{"code":"906","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15292.53,"maximum":95828.38,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":36461.34},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29778.79},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58045.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15904.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15292.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":33483.46},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":61796.88},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":31014.33},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":50967.69},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15751.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":15751.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":28759.32},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":95828.38},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":72738.03},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16363.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15598.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36207.94},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15292.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15598.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30695.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16210.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32405.06},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45882.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16347.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":42670.49},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":32405.06},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15292.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17127.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15292.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs With Mcc","code_information":[{"code":"917","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12339.26,"maximum":76514.39,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":29112.64},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23776.94},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46346.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12832.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12339.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":26734.95},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":49341.86},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":24763.47},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":40695.27},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12709.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12709.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":22962.94},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":76514.39},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":58077.85},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13203.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12586.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28910.32},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12339.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12586.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24767.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13079.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25873.89},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36634.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13190.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":34070.35},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":25873.89},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12339.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13819.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12339.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12072.72,"10th_percentile":12072.72,"90th_percentile":12072.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":9798.37,"10th_percentile":9798.37,"90th_percentile":9798.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10590.15,"10th_percentile":10590.15,"90th_percentile":10590.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","code_information":[{"code":"928","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":54145.38,"maximum":349920.17,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":133139.66},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":108738.13},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":211953.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56311.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54145.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":122265.84},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":225653.14},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":113249.76},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":186110.05},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55769.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":55769.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":105015.5},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":349920.17},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":265605.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57935.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55228.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":132214.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54145.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55228.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":108680.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":57394.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":118328.03},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":167539.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57881.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":155812.56},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":118328.03},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54145.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60642.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54145.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation With Cc/Mcc","code_information":[{"code":"945","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12191.55,"maximum":75548.45,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":28745.11},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23476.78},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45761.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12679.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12191.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":26397.44},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":48718.96},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":24450.85},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":40181.52},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12557.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12557.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":22673.05},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":75548.45},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":57344.66},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13044.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12435.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28545.34},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12191.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12435.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24470.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12923.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25547.25},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36172.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13032.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":33640.24},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":25547.25},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12191.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13654.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12191.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","code_information":[{"code":"956","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28710.21,"maximum":183577.96,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":69848.81},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":57047.08},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":111196.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29858.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28710.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":64144.1},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":118383.98},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":59414.01},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":97638.56},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29571.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":29571.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":55094.08},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":183577.96},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":139343.89},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30719.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29284.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":69363.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28710.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29284.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":57627.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30432.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":62078.21},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":87896.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30691.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":81743.65},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":62078.21},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28710.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32155.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28710.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures Without Mcc","code_information":[{"code":"970","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20313.62,"maximum":128665.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":48955.42},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":39982.98},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":77935.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21126.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20313.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":44957.12},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":82972.6},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":41641.91},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":68432.62},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20923.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":20923.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":38614.17},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":128665.56},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":97662.92},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21735.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20719.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48615.19},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20313.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20719.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":40773.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21532.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":43509.19},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":61604.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21715.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":57292.24},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":43509.19},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20313.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22751.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20313.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"987","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26214.21,"maximum":167254.49,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":63637.96},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":51974.54},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101309.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27262.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26214.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":58440.51},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":107857.46},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":54131.01},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":88956.69},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27000.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":27000.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":50195.2},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":167254.49},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":126953.65},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28049.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26738.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":63195.7},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26214.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26738.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":52617.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27787.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":56558.31},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80080.57},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28022.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":74475.13},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":56558.31},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26214.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29359.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26214.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10257.56,"10th_percentile":10257.56,"90th_percentile":10257.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23906.82,"10th_percentile":23906.82,"90th_percentile":23906.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System With Mcc","code_information":[{"code":"001","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":209688.04,"maximum":1367145.96,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":520179.63},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":424842.32},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828106.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":218075.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209688.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":477695.4},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":881631.89},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":442469.36},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":727136.13},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215978.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":215978.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":410297.92},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":1367145.96},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":1037725.02},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224366.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213881.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":516564.55},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":209688.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213881.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":420885.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222269.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":462310.28},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":654582.26},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224156.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":608763.18},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":462310.28},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":209688.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234850.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209688.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas Transplant","code_information":[{"code":"010","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":54167.75,"maximum":350066.52,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":133195.34},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":108783.61},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":212041.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56334.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54167.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":122316.98},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":225747.52},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":113297.13},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":186187.89},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55792.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":55792.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":105059.42},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":350066.52},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":265716.17},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57959.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55251.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":132269.68},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54167.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55251.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":108725.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":57417.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":118377.52},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":167610.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57905.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":155877.73},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":118377.52},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54167.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60667.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54167.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","code_information":[{"code":"019","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":53861.16,"maximum":348061.46,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":132432.45},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":108160.54},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":210827.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56015.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53861.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":121616.39},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":224454.52},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":112648.2},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":185121.47},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55476.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":55476.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":104457.68},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":348061.46},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":264194.24},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57631.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":54938.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":131512.08},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53861.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":54938.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":108110.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":57092.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":117699.5},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":166649.99},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57577.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":154984.92},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":117699.5},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53861.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60324.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53861.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","code_information":[{"code":"027","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19459.49,"maximum":123079.68,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":46830.07},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":38247.16},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":74551.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20237.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19459.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":43005.35},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":79370.43},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":39834.07},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":65461.69},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20043.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":20043.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":36937.78},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":123079.68},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":93422.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20821.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19848.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46504.62},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19459.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19848.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":39059.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20627.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":41620.28},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58929.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20802.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":54804.96},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":41620.28},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19459.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21794.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19459.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Cc","code_information":[{"code":"035","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18471.83,"maximum":116620.54,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":44372.46},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":36239.98},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":70639.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19210.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18471.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":40748.46},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":75205.13},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":37743.6},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":62026.3},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19025.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":19025.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":34999.31},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":116620.54},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":88520.22},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19764.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18841.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44064.09},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18471.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18841.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":37076.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19580.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":39436.08},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":55837.3},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19746.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":51928.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":39436.08},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18471.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20688.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18471.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14792.79,"10th_percentile":14792.79,"90th_percentile":14792.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18086.92,"10th_percentile":18086.92,"90th_percentile":18086.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18059.82,"10th_percentile":18059.82,"90th_percentile":18062.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries With Cc/Mcc","code_information":[{"code":"052","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14151.21,"maximum":88364.27,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":33621.35},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27459.31},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53523.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14717.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14151.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":30875.42},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":56983.5},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":28598.62},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":46997.8},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14575.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14575.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":26519.24},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":88364.27},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":67072.44},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15141.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14434.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33387.69},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14151.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14434.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28404.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15000.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29881.02},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42308.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15127.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":39346.87},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":29881.02},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14151.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15849.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14151.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","code_information":[{"code":"060","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7500.93,"maximum":44872.44,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":17073.33},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13944.17},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27180.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7800.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7500.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":15678.91},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":28936.91},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":14522.72},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":23866.05},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7725.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7725.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":13466.79},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":44872.44},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34060.19},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8026.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7650.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16954.67},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7500.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7650.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15055.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7950.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15173.94},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21484.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8018.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":19980.82},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":15173.94},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7500.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8401.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7500.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction Without Mcc","code_information":[{"code":"068","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7087.66,"maximum":42169.75,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":16044.99},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13104.3},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25543.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7371.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7087.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":14734.56},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":27194.02},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":13648.01},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":22428.59},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7300.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7300.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":12655.68},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":42169.75},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32008.73},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7583.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7229.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15933.49},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7087.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7229.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14226.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7512.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14260.01},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20190.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7576.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":18777.36},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":14260.01},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7087.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7938.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7087.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis Without Cc/Mcc","code_information":[{"code":"076","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6795.24,"maximum":40257.38,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":15317.36},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12510.03},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24384.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7067.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6795.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":14066.36},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":25960.79},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":13029.08},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":21411.46},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6999.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6999.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":12081.75},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":40257.38},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30557.16},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7270.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6931.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15210.91},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6795.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6931.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13639.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7202.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13613.32},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19275.02},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7264.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":17925.82},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":13613.32},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6795.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7610.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6795.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","code_information":[{"code":"087","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7462.88,"maximum":44623.64,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":16978.66},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13866.85},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27029.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7761.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7462.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":15591.98},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":28776.46},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":14442.2},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":23733.72},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7686.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7686.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":13392.12},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":44623.64},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33871.34},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7985.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7612.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16860.67},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7462.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7612.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14979.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7910.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15089.81},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21365.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7977.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":19870.03},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":15089.81},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7462.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8358.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7462.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Cc","code_information":[{"code":"095","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19879.47,"maximum":125826.27,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":47875.11},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":39100.67},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":76215.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20674.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19879.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":43965.04},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":81141.63},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":40722.99},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":66922.5},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20475.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":20475.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":37762.07},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":125826.27},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":95507.78},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21271.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20277.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47542.39},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19879.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20277.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":39902.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21072.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":42549.06},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60244.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21251.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":56027.96},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":42549.06},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19879.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22265.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19879.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches Without Mcc","code_information":[{"code":"103","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6878.05,"maximum":40798.9,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":15523.4},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12678.31},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24712.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7153.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6878.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":14255.57},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":26310.0},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":13204.34},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":21699.48},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7084.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7084.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":12244.27},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":40798.9},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30968.19},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7359.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7015.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15415.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6878.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7015.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13805.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7290.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13796.44},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19534.3},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7352.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":18166.94},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":13796.44},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6878.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7703.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6878.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":5613.36,"10th_percentile":5613.36,"90th_percentile":5613.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological Eye Disorders","code_information":[{"code":"123","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6596.82,"maximum":38959.7,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":14823.61},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12106.78},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23598.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6860.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6596.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":13612.94},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":25123.96},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":12609.1},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":20721.27},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6794.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6794.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":11692.3},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":38959.7},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29572.16},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7058.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6728.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14720.59},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6596.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6728.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13241.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6992.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13174.5},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18653.7},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7052.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":17347.99},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":13174.5},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6596.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7388.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6596.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":25123.96,"10th_percentile":25123.96,"90th_percentile":25123.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6776.36,"10th_percentile":6776.36,"90th_percentile":6776.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6463.73,"10th_percentile":6463.73,"90th_percentile":6463.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Mcc","code_information":[{"code":"140","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32457.19,"maximum":208082.66,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":79172.5},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":64661.95},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":126039.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33755.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32457.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":72706.3},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":134186.34},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":67344.82},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":110671.74},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33430.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":33430.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":62448.26},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":208082.66},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":157944.06},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34729.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33106.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":78622.27},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32457.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33106.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":65148.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34404.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":70364.65},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":99628.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34696.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":92655.11},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":70364.65},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32457.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36352.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32457.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","code_information":[{"code":"148","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6585.63,"maximum":38886.52,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":14795.77},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12084.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23554.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6849.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6585.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":13587.37},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":25076.77},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":12585.41},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":20682.35},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6783.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6783.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":11670.34},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":38886.52},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29516.61},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7046.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6717.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14692.94},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6585.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6717.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13218.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6980.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13149.76},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18618.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7040.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":17315.4},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":13149.76},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6585.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7375.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6585.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","code_information":[{"code":"156","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5794.9,"maximum":33715.31,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":12828.2},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10477.08},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20422.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6026.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5794.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":11780.49},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":21742.01},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":10911.78},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":17931.97},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5968.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":5968.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":10118.4},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":33715.31},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25591.43},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6200.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5910.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12739.05},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5794.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5910.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11631.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6142.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11401.08},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16142.71},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6194.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":15012.77},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":11401.08},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5794.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6490.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5794.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Cc","code_information":[{"code":"167","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14092.27,"maximum":87978.87,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":33474.71},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27339.54},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53290.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14655.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14092.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":30740.76},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":56734.96},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":28473.88},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":46792.82},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14515.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14515.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":26403.58},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":87978.87},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":66779.9},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15078.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14374.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33242.07},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14092.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14374.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28286.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14937.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29750.69},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42123.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15064.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":39175.26},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":29750.69},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14092.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15783.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14092.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":34686.07,"10th_percentile":34686.07,"90th_percentile":34686.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Mcc","code_information":[{"code":"180","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13813.28,"maximum":86154.31,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":32780.49},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26772.56},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52185.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14365.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13813.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":30103.24},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":55558.36},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":27883.37},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":45822.4},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14227.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14227.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":25856.01},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":86154.31},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":65394.98},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14780.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14089.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32552.68},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13813.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14089.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27726.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14642.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29133.7},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41250.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14766.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":38362.82},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":29133.7},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13813.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15470.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13813.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12469.35,"10th_percentile":12469.35,"90th_percentile":12469.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"1 through 10","median_amount":34604.56,"10th_percentile":34604.56,"90th_percentile":34604.56},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13501.93,"10th_percentile":13501.93,"90th_percentile":13501.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13326.85,"10th_percentile":13326.85,"90th_percentile":13326.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion Without Cc/Mcc","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5989.6,"maximum":34988.6,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":13312.67},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10872.75},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21193.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6229.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5989.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":12225.39},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":22563.11},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":11323.87},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":18609.19},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6169.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6169.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":10500.53},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":34988.6},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26557.92},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6408.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6109.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13220.15},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5989.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6109.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12022.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6348.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11831.65},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16752.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6402.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":15579.74},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":11831.65},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5989.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6708.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5989.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Mcc","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14717.39,"maximum":92067.05,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":35030.21},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":28609.95},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":55766.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15306.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14717.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":32169.21},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":59371.31},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":29797.0},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":48967.18},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15158.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":15158.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":27630.5},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":92067.05},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":69883.02},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15747.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15011.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34786.76},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14717.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15011.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":29540.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15600.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":31133.14},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44081.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15732.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":40995.65},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":31133.14},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14717.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16483.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14717.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10016.29,"10th_percentile":10016.29,"90th_percentile":10016.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14013.87,"10th_percentile":14013.87,"90th_percentile":14013.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Signs And Symptoms","code_information":[{"code":"204","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6662.46,"maximum":39389.01,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":14986.96},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12240.18},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23858.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6928.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6662.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":13762.94},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":25400.8},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":12748.04},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":20949.61},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6862.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6862.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":11821.14},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":39389.01},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29898.02},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7128.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6795.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14882.8},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6662.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6795.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13372.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7062.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13319.68},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18859.25},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7122.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":17539.15},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":13319.68},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6662.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7461.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6662.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Heart Assist System Implant","code_information":[{"code":"215","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":74915.28,"maximum":485752.25,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":184821.83},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":150948.12},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294229.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":77911.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74915.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":169727.02},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":313247.22},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":157211.07},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":258354.28},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":77162.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":77162.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":145780.44},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":485752.25},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":368707.71},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80159.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":76413.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":183537.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":74915.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":76413.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":150369.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":79410.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":164260.63},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":232575.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80084.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":216295.91},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":164260.63},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":74915.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":83905.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74915.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":71553.22,"10th_percentile":71553.22,"90th_percentile":71553.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":71450.32,"10th_percentile":71450.32,"90th_percentile":71450.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures Without Mcc","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24133.71,"maximum":153648.36,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":58461.02},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":47746.42},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":93067.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25099.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24133.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":53686.38},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":99083.27},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":49727.46},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":81720.08},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24857.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":24857.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":46111.83},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":153648.36},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":116625.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25823.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24616.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58054.73},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24133.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24616.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":48441.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25581.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":51957.3},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":73566.02},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25798.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":68416.59},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":51957.3},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24133.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27029.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24133.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27617.32,"10th_percentile":27617.32,"90th_percentile":27617.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","code_information":[{"code":"240","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21903.27,"maximum":139061.64,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":52910.98},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":43213.58},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":84232.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22779.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21903.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":48589.62},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":89676.73},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":45006.54},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":73961.92},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22560.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":22560.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":41734.17},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":139061.64},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":105554.02},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23436.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22341.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52543.27},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21903.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22341.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":43964.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23217.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":47024.7},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":66581.98},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23414.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":61921.41},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":47024.7},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21903.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24531.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21903.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1400.0,"10th_percentile":1400.0,"90th_percentile":1400.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Mcc","code_information":[{"code":"252","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26661.04,"maximum":170176.72,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":64749.82},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":52882.63},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":103079.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27727.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26661.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":59461.56},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":109741.92},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":55076.77},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":90510.92},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27460.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":27460.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":51072.2},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":170176.72},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":129171.75},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28527.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27194.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64299.83},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26661.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27194.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":53514.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28260.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":57546.49},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":81479.71},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28500.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":75776.34},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":57546.49},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26661.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29860.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26661.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19544.97,"10th_percentile":19544.97,"90th_percentile":19544.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24377.84,"10th_percentile":24377.84,"90th_percentile":26068.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Mcc","code_information":[{"code":"260","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24904.29,"maximum":158687.85,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":60378.47},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":49312.45},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":96120.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25900.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24904.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":55447.23},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":102333.09},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":51358.46},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":84400.4},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25651.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":25651.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":47624.24},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":158687.85},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":120451.18},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26647.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25402.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59958.86},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24904.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25402.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":49987.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26398.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":53661.44},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":75978.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26622.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":70660.57},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":53661.44},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24904.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27892.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24904.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22620.02,"10th_percentile":22620.02,"90th_percentile":22620.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","code_information":[{"code":"268","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":51946.27,"maximum":335538.35,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":127667.58},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":104268.96},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":203241.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54024.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51946.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":117240.68},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":216378.73},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":108595.16},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":178460.87},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":53504.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":53504.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":100699.33},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":335538.35},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":254688.64},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":55582.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":52985.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":126780.33},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51946.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":52985.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":104266.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55063.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":113464.72},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":160653.99},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":55530.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":149408.62},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":113464.72},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51946.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58179.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51946.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","code_information":[{"code":"276","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45446.68,"maximum":293031.98,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":111494.51},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":91060.06},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":177495.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47264.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45446.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":102388.5},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":188967.64},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":94838.21},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":155853.25},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":46810.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":46810.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":87942.63},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":293031.98},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":222424.4},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48627.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":46355.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":110719.66},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45446.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":46355.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":91220.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":48173.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":99090.88},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":140302.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48582.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":130481.37},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":99090.88},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45446.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50900.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45446.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":24441.47,"10th_percentile":24441.47,"90th_percentile":24441.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36654.3,"10th_percentile":36654.3,"90th_percentile":36654.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":16434.95,"10th_percentile":16434.95,"90th_percentile":16434.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Cc","code_information":[{"code":"284","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5803.11,"maximum":33768.98,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":12848.62},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10493.75},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20454.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6035.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5803.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":11799.24},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":21776.61},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":10929.15},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":17960.51},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5977.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":5977.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":10134.5},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":33768.98},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25632.17},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6209.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5919.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12759.32},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5803.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5919.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11648.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6151.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11419.22},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16168.41},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6203.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":15036.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":11419.22},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5803.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6499.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5803.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Cc","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6972.78,"maximum":41418.47,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":15759.14},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12870.84},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25087.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7251.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6972.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":14472.05},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":26709.54},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":13404.86},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":22029.0},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7181.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7181.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":12430.21},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":41418.47},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31438.47},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7460.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7112.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15649.62},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6972.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7112.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13995.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7391.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14005.95},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19830.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7453.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":18442.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":14005.95},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6972.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7809.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6972.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5514.71,"10th_percentile":5514.71,"90th_percentile":5514.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis With Mcc","code_information":[{"code":"302","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9565.76,"maximum":58376.13,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":22211.29},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18140.46},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35359.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9948.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9565.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":20397.24},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":37645.04},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":18893.12},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":31048.18},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9852.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9852.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":17519.42},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":58376.13},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":44310.1},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10235.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9757.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22056.93},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9565.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9757.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19200.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10139.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19740.31},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27950.18},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10225.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":25993.74},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":19740.31},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9565.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10713.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9565.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9350.55,"10th_percentile":9350.55,"90th_percentile":9350.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4862.45,"maximum":27617.19,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":10507.95},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":8582.08},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16728.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5056.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4862.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":9649.74},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":17809.51},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":8938.15},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":14688.6},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5008.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":5008.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":8288.27},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":27617.19},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20962.68},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5202.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4959.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10434.92},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4862.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4959.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9759.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5154.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":9338.95},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13222.96},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5197.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":12297.39},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":9338.95},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4862.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5445.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4862.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7294.77,"10th_percentile":7294.77,"90th_percentile":7294.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":8151.82,"10th_percentile":8151.82,"90th_percentile":8151.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4385.31,"10th_percentile":4385.31,"90th_percentile":4385.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":15955.28,"10th_percentile":15955.28,"90th_percentile":15955.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":7631.94,"10th_percentile":7631.94,"90th_percentile":7631.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4686.51,"10th_percentile":4686.51,"90th_percentile":4686.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":24757.2,"10th_percentile":24757.2,"90th_percentile":24757.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"1 through 10","median_amount":55059.28,"10th_percentile":55059.28,"90th_percentile":55059.28},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4859.57,"10th_percentile":4859.57,"90th_percentile":4859.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4753.96,"10th_percentile":4753.96,"90th_percentile":4753.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4757.87,"10th_percentile":4757.87,"90th_percentile":4757.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy Without Intraluminal Device","code_information":[{"code":"318","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18708.31,"maximum":118167.03,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":44960.88},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":36720.55},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":71576.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19456.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18708.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":41288.82},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":76202.41},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":38244.12},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":62848.82},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19269.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":19269.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":35463.43},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":118167.03},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":89694.07},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20017.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19082.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44648.41},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18708.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19082.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":37551.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19830.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":39959.03},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56577.75},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19999.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":52617.45},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":39959.03},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18708.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20953.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18708.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Mcc","code_information":[{"code":"326","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37843.8,"maximum":243310.31,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":92576.12},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":75608.98},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":147377.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39357.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37843.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":85015.22},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":156903.6},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":78746.06},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":129408.07},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38979.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":38979.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":73020.52},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":243310.31},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":184683.42},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40492.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38600.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":91932.74},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37843.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38600.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":75960.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40114.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":82277.14},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116495.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40455.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":108341.29},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":82277.14},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37843.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42385.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37843.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36801.67,"10th_percentile":36801.67,"90th_percentile":36801.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":6156.63,"10th_percentile":6156.63,"90th_percentile":6156.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35062.17,"10th_percentile":35062.17,"90th_percentile":35062.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection Without Cc/Mcc","code_information":[{"code":"334","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12857.7,"maximum":79904.95,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":30402.7},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24830.56},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48399.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13372.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12857.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":27919.64},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":51528.33},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":25860.8},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":42498.59},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13243.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":13243.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":23980.49},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":79904.95},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":60651.44},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13757.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13114.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30191.41},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12857.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13114.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25807.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13629.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27020.44},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38258.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13744.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":35580.1},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":27020.44},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12857.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14400.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12857.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":86641.05,"10th_percentile":86641.05,"90th_percentile":86641.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Cc","code_information":[{"code":"348","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10402.73,"maximum":63849.81,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":24293.95},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19841.41},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38675.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10818.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10402.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":22309.8},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":41174.85},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":20664.64},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":33959.43},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10714.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":10714.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":19162.14},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":63849.81},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":48464.86},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11130.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10610.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24125.11},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10402.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10610.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20880.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11026.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21591.27},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30570.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11120.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":28431.06},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":21591.27},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10402.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11651.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10402.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Mcc","code_information":[{"code":"356","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33408.29,"maximum":214302.75,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":81539.15},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":66594.85},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":129807.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34744.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33408.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":74879.67},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":138197.49},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":69357.92},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":113979.98},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34410.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":34410.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":64314.98},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":214302.75},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":162665.38},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35746.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34076.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":80972.48},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33408.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34076.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":67057.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35412.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":72468.02},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":102607.02},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35713.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":95424.79},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":72468.02},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33408.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37417.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33408.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9053.68,"10th_percentile":9053.68,"90th_percentile":9053.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","code_information":[{"code":"371","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13866.25,"maximum":86500.68,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":32912.28},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26880.2},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52395.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14420.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13866.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":30224.26},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":55781.73},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":27995.48},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":46006.63},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14282.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14282.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":25959.96},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":86500.68},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":65657.89},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14836.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14143.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32683.55},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13866.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14143.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27832.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14698.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29250.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41416.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14823.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":38517.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":29250.83},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13866.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15530.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13866.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13553.69,"10th_percentile":13553.69,"90th_percentile":13553.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage Without Cc/Mcc","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5342.1,"maximum":30754.06,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":11701.48},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9556.86},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18628.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5555.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5342.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":10745.8},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":19832.38},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":9953.39},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":16356.99},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5502.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":5502.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":9229.69},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":30754.06},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23343.71},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5716.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5448.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11620.16},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5342.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5448.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10722.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5662.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10399.71},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14724.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5710.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":13694.18},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":10399.71},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5342.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5983.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5342.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease Without Cc/Mcc","code_information":[{"code":"387","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5721.8,"maximum":33237.22,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":12646.29},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10328.51},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20132.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5950.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5721.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":11613.44},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":21433.7},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":10757.05},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":17677.69},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5893.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":5893.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":9974.91},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":33237.22},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25228.54},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6122.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12558.4},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5721.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5836.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11484.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6065.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11239.41},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15913.81},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6116.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":14799.88},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":11239.41},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5721.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6408.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5721.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":16677.85,"10th_percentile":16677.85,"90th_percentile":16677.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses Without Cc/Mcc","code_information":[{"code":"395","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5480.85,"maximum":31661.47,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":12046.74},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9838.84},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19177.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5700.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5480.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":11062.85},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":20417.54},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":10247.06},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":16839.6},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5645.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":5645.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":9502.01},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":31661.47},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":24032.47},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5864.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5590.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11963.02},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5480.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5590.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11001.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5809.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10706.55},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15159.34},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5859.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":14098.23},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":10706.55},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5480.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6138.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5480.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5177.94,"10th_percentile":5177.94,"90th_percentile":5177.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":9630.65,"10th_percentile":9630.65,"90th_percentile":9630.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3790.34,"10th_percentile":3790.34,"90th_percentile":3790.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":10449.13,"10th_percentile":10449.13,"90th_percentile":10449.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","code_information":[{"code":"408","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27237.67,"maximum":173947.8,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":66184.67},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":54054.5},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105363.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28327.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27237.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":60779.22},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":112173.78},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":56297.26},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":92516.62},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28054.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":28054.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":52203.95},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":173947.8},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":132034.17},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29144.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27782.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65724.7},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27237.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27782.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":54671.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28871.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":58821.7},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":83285.28},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29117.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":77455.53},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":58821.7},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27237.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30506.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27237.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","code_information":[{"code":"416","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10809.28,"maximum":66508.59,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":25305.57},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20667.63},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40285.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11241.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10809.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":23238.81},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":42889.42},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":21525.14},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":35373.55},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11133.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11133.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":19960.08},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":66508.59},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":50483.0},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11565.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11025.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25129.71},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10809.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11025.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21696.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11457.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22490.36},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31843.96},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11555.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":29614.97},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":22490.36},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10809.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12106.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10809.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":16466.75,"10th_percentile":16466.75,"90th_percentile":16466.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8900.02,"10th_percentile":8900.02,"90th_percentile":8900.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","code_information":[{"code":"424","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16960.51,"maximum":106736.7,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":40611.8},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":33168.56},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64652.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17638.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16960.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":37294.94},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":68831.33},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":34544.75},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":56769.44},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17469.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":17469.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":32033.04},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":106736.7},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":81017.94},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18147.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17299.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40329.56},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16960.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17299.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34043.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17978.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":36093.79},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51104.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18130.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":47527.75},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":36093.79},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16960.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18995.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16960.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Cc","code_information":[{"code":"433","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8518.42,"maximum":51526.72,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":19605.18},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16011.99},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31210.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8859.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8518.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":18003.99},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":33228.05},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":16676.34},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":27405.22},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8773.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8773.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":15463.82},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":51526.72},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39111.09},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9114.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8688.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19468.93},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8518.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8688.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17098.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9029.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17424.13},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24670.72},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9106.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":22943.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":17424.13},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8518.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9540.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8518.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"1 through 10","median_amount":3379.06,"10th_percentile":3379.06,"90th_percentile":3379.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5983.09,"10th_percentile":5983.09,"90th_percentile":6759.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":5166.83,"10th_percentile":5166.83,"90th_percentile":5166.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","code_information":[{"code":"441","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14027.37,"maximum":87554.44,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":33313.22},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27207.65},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53033.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14588.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14027.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":30592.46},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":56461.26},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":28336.52},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":46567.08},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14448.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14448.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":26276.2},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":87554.44},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":66457.74},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15009.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14307.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33081.71},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14027.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14307.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28155.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14869.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29607.17},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41920.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14995.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":38986.27},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":29607.17},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14027.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15710.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14027.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13029.9,"10th_percentile":13029.9,"90th_percentile":13029.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","code_information":[{"code":"450","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40396.49,"maximum":260004.54,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":98928.04},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":80796.74},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":157489.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42012.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40396.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":90848.36},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":167669.22},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":84149.05},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":138287.13},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41608.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":41608.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":78030.67},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":260004.54},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":197355.09},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43224.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41204.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98240.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40396.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41204.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":81083.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":42820.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":87922.41},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":124488.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43183.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":115774.9},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":87922.41},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40396.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45244.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40396.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"464","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23874.11,"maximum":151950.64,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":57815.06},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":47218.85},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":92039.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24829.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23874.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":53093.18},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":97988.46},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":49178.0},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":80817.12},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24590.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":24590.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":45602.32},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":151950.64},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":115337.34},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25545.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24351.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57413.27},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23874.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24351.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":47920.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25306.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":51383.21},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":72753.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25521.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":67660.63},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":51383.21},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23874.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26739.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23874.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Cc","code_information":[{"code":"472","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22616.42,"maximum":143725.49,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":54685.51},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":44662.88},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":87057.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23521.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22616.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":50219.22},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":92684.31},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":46515.97},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":76442.46},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23294.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":23294.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":43133.85},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":143725.49},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":109094.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24199.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23068.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54305.46},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22616.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23068.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":45395.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23973.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":48601.81},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":68815.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24176.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":63998.13},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":48601.81},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22616.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25330.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22616.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Mcc","code_information":[{"code":"480","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22364.28,"maximum":142076.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":54058.11},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":44150.47},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":86058.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23258.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22364.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":49643.07},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":91620.96},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":45982.3},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":75565.45},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23035.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":23035.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":42638.98},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":142076.56},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":107842.47},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23929.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22811.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53682.43},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22364.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22811.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":44889.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23706.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":48044.21},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":68025.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23907.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":63263.89},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":48044.21},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22364.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25047.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22364.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21890.35,"10th_percentile":21890.35,"90th_percentile":21890.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"489","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8970.48,"maximum":54483.09,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":20730.04},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16930.69},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33001.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9329.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8970.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":19036.97},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":35134.53},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":17633.16},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":28977.61},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9239.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9239.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":16351.07},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":54483.09},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":41355.1},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9598.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9149.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20585.97},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8970.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9149.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18005.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9508.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18423.85},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26086.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9589.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":24260.25},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":18423.85},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8970.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10046.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8970.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","code_information":[{"code":"499","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15669.24,"maximum":98292.02,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":37398.72},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30544.37},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":59537.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16296.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15669.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":34344.28},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":63385.61},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":31811.68},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":52278.02},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16139.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":16139.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":29498.69},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":98292.02},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":74608.04},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16766.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15982.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37138.81},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15669.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15982.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":31451.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16609.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":33238.16},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47061.7},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16750.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":43767.5},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":33238.16},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15669.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17549.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15669.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","code_information":[{"code":"507","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14114.65,"maximum":88125.22,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":33530.4},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27385.02},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53379.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14679.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14114.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":30791.89},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":56829.34},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":28521.25},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":46870.66},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14538.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14538.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":26447.5},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":88125.22},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":66890.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15102.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14396.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33297.37},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14114.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14396.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28330.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14961.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29800.18},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42193.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15088.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":39240.43},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":29800.18},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14114.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15808.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14114.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","code_information":[{"code":"516","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16141.44,"maximum":101380.11,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":38573.69},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31504.0},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":61407.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16787.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16141.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":35423.29},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":65377.03},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":32811.12},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":53920.46},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16625.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":16625.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":30425.46},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":101380.11},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":76952.04},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17271.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16464.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38305.62},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16141.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16464.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32399.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17109.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34282.42},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48540.26},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17255.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":45142.57},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":34282.42},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16141.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18078.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16141.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15773.13,"10th_percentile":15773.13,"90th_percentile":15773.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur Without Mcc","code_information":[{"code":"534","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6652.76,"maximum":39325.59,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":14962.83},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12220.48},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23820.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6918.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6652.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":13740.78},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":25359.91},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":12727.51},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":20915.88},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6852.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6852.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":11802.11},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":39325.59},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29849.88},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7118.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6785.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14858.84},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6652.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6785.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13353.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7051.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13298.23},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18828.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7111.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":17510.91},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":13298.23},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6652.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7451.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6652.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","code_information":[{"code":"542","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13817.01,"maximum":86178.7,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":32789.77},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26780.14},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52200.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14369.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13817.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":30111.76},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":55574.09},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":27891.27},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":45835.38},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14231.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14231.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":25863.33},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":86178.7},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":65413.5},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14784.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14093.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32561.89},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13817.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14093.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27733.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14646.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29141.95},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41261.91},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14770.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":38373.68},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":29141.95},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13817.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15475.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13817.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis Without Cc/Mcc","code_information":[{"code":"550","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7160.02,"maximum":42642.97,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":16225.04},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13251.36},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25829.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7446.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7160.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":14899.91},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":27499.19},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":13801.16},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":22680.27},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7374.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7374.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":12797.7},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":42642.97},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32367.92},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7661.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7303.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16112.29},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7160.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7303.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14371.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7589.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14420.03},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20417.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7654.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":18988.07},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":14420.03},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7160.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8019.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7160.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis Without Mcc","code_information":[{"code":"558","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7302.5,"maximum":43574.76,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":16579.58},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13540.91},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26394.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7594.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7302.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":15225.49},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":28100.07},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":14102.73},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":23175.86},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7521.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7521.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":13077.34},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":43574.76},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33075.2},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7813.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7448.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16464.36},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7302.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7448.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14657.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7740.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14735.12},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20863.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7806.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":19402.98},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":14735.12},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7302.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8178.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7302.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4515.0,"10th_percentile":4515.0,"90th_percentile":4515.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":6612.0,"10th_percentile":6612.0,"90th_percentile":6612.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":175.0,"10th_percentile":175.0,"90th_percentile":175.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"1 through 10","median_amount":5894.05,"10th_percentile":5894.05,"90th_percentile":5894.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7678.86,"10th_percentile":7678.86,"90th_percentile":7678.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant Without Mcc","code_information":[{"code":"006","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35229.94,"maximum":226216.05,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":86071.99},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":70296.92},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":137023.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36639.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35229.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":79042.3},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":145880.02},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":73213.59},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":120316.24},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36286.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":36286.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":67890.32},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":226216.05},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":171708.11},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37696.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35934.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":85473.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35229.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35934.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":70713.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37343.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":76496.59},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":108311.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37660.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":100729.55},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":76496.59},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35229.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39457.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35229.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant With Cc/Mcc","code_information":[{"code":"016","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44873.03,"maximum":289280.41,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":110067.09},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":89894.25},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":175222.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46667.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44873.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":101077.67},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":186548.36},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":93624.03},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":153857.93},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":46219.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":46219.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":86816.74},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":289280.41},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":219576.79},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48014.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":45770.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":109302.16},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44873.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":45770.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":90069.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":47565.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":97822.26},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138505.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47969.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":128810.87},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":97822.26},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44873.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50257.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44873.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","code_information":[{"code":"024","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29820.95,"maximum":190842.04,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":72612.69},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":59304.4},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":115596.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31013.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29820.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":66682.25},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":123068.37},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":61764.99},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":101502.07},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30715.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":30715.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":57274.13},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":190842.04},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":144857.66},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31908.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30417.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":72108.05},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29820.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30417.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":59856.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31610.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":64534.61},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":91374.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31878.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":84978.2},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":64534.61},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29820.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33399.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29820.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Cc","code_information":[{"code":"032","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16536.06,"maximum":103960.84,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":39555.62},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":32305.96},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":62971.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17197.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16536.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":36325.03},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":67041.26},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":33646.36},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":55293.06},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17032.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":17032.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":31199.97},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":103960.84},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":78910.93},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17693.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16866.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39280.72},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16536.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16866.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33191.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17528.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":35155.11},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49775.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17677.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":46291.71},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":35155.11},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16536.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18520.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16536.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","code_information":[{"code":"040","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29442.74,"maximum":188368.64,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":71671.59},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":58535.79},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":114098.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30620.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29442.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":65818.02},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":121473.35},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":60964.49},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":100186.56},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30326.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":30326.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":56531.83},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":188368.64},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":142980.24},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31503.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30031.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":71173.5},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29442.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30031.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":59097.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31209.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":63698.22},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":90189.91},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31474.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":83876.85},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":63698.22},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29442.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32975.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29442.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders Without Mcc","code_information":[{"code":"057","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10304.26,"maximum":63205.85,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":24048.93},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19641.3},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38284.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10716.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10304.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":22084.8},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":40759.58},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":20456.23},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":33616.93},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10613.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":10613.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":18968.88},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":63205.85},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":47976.07},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11025.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10510.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23881.79},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10304.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10510.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20682.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10922.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21373.51},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30262.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11015.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":28144.32},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":21373.51},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10304.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11540.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10304.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7778.48,"10th_percentile":7778.48,"90th_percentile":7778.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7731.33,"10th_percentile":7731.33,"90th_percentile":9406.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8176.02,"maximum":49287.49,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":18753.19},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15316.15},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29854.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8503.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8176.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":17221.57},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":31784.04},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":15951.63},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":26214.25},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8421.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8421.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":14791.8},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":49287.49},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37411.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8748.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8339.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18622.86},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8176.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8339.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16410.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8666.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16666.92},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23598.59},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8740.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":21946.75},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":16666.92},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8176.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9157.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8176.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":12940.0,"10th_percentile":12940.0,"90th_percentile":12940.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":14651.05,"10th_percentile":14651.05,"90th_percentile":14651.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8155.54,"10th_percentile":8155.54,"90th_percentile":8155.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8012.43,"10th_percentile":5897.97,"90th_percentile":8541.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders With Mcc","code_information":[{"code":"073","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12607.06,"maximum":78265.78,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":29779.02},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24321.19},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47407.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13111.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12607.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":27346.9},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":50471.28},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":25330.29},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":41626.77},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12985.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12985.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":23488.56},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":78265.78},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":59407.23},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13489.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12859.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29572.06},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12607.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12859.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25304.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13363.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26466.14},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37473.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13476.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":34850.21},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":26466.14},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12607.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14119.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12607.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12574.54,"10th_percentile":12574.54,"90th_percentile":12574.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11833.05,"10th_percentile":11833.05,"90th_percentile":11833.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","code_information":[{"code":"084","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7769.47,"maximum":46628.7,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":17741.56},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14489.93},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28243.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8080.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7769.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":16292.57},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":30069.47},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":15091.13},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":24800.14},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8002.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8002.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":13993.87},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":46628.7},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35393.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8313.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7924.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17618.26},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7769.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7924.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15594.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8235.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15767.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22325.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8305.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":20762.84},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":15767.83},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7769.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8701.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7769.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Cc","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8270.76,"maximum":49907.06,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":18988.93},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15508.68},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30229.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8601.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8270.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":17438.06},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":32183.58},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":16152.15},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":26543.78},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8518.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8518.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":14977.74},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":49907.06},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37881.69},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8849.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8436.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18856.96},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8270.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8436.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16601.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8767.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16876.43},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23895.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8841.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":22222.63},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":16876.43},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8270.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9263.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8270.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2489.65,"10th_percentile":2489.65,"90th_percentile":2489.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6757.67,"10th_percentile":6757.67,"90th_percentile":6757.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures With Mcc","code_information":[{"code":"100","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15087.39,"maximum":94486.79,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":35950.88},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29361.89},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57232.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15690.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15087.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":33014.69},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":60931.73},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":30580.14},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":50254.15},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15540.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":15540.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":28356.69},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":94486.79},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":71719.7},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16143.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15389.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35701.03},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15087.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15389.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30283.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15992.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":31951.39},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45239.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16128.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":42073.11},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":31951.39},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15087.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16897.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15087.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":11047.28,"10th_percentile":11047.28,"90th_percentile":11047.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11424.12,"10th_percentile":11424.12,"90th_percentile":11424.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13825.06,"10th_percentile":13825.06,"90th_percentile":13825.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11736.01,"10th_percentile":11736.01,"90th_percentile":11736.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures Without Cc/Mcc","code_information":[{"code":"117","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8732.51,"maximum":52926.85,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":20137.91},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16447.08},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32058.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9081.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8732.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":18493.21},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":34130.95},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":17129.49},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":28149.9},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8994.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8994.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":15884.02},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":52926.85},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40173.85},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9343.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8907.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19997.96},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8732.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8907.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17527.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9256.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17897.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25341.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9335.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":23567.28},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":17897.6},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8732.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9780.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8732.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures With Cc/Mcc","code_information":[{"code":"137","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11778.29,"maximum":72845.76,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":27716.78},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22636.91},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44124.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12249.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11778.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":25453.09},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":46976.07},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":23576.13},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":38744.06},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12131.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12131.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":21861.94},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":72845.76},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":55293.2},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12602.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12013.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27524.16},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11778.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12013.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23641.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12484.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24633.32},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34878.17},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12590.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":32436.78},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":24633.32},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11778.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13191.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11778.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","code_information":[{"code":"145","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9608.28,"maximum":58654.21,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":22317.09},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18226.87},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35527.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9992.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9608.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":20494.41},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":37824.36},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":18983.11},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":31196.08},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9896.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9896.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":17602.87},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":58654.21},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":44521.17},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10280.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9800.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22162.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9608.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9800.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19285.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10184.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19834.34},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28083.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10271.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":26117.56},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":19834.34},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9608.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10761.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9608.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri Without Mcc","code_information":[{"code":"153","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6146.25,"maximum":36013.09,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":13702.47},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11191.11},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21813.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6392.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6146.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":12583.36},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":23223.77},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":11655.44},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":19154.08},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6330.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6330.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":10807.99},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":36013.09},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27335.55},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6576.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6269.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13607.24},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6146.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6269.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12336.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6515.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12178.09},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17242.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6570.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":16035.92},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":12178.09},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6146.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6883.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6146.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6315.23,"10th_percentile":6315.23,"90th_percentile":6315.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":9214.91,"10th_percentile":9214.91,"90th_percentile":9214.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6024.48,"10th_percentile":6024.48,"90th_percentile":6024.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":11368.51,"10th_percentile":11368.51,"90th_percentile":11368.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5768.56,"10th_percentile":5768.56,"90th_percentile":5768.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Cc","code_information":[{"code":"164","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19467.7,"maximum":123133.34,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":46850.49},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":38263.84},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":74584.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20246.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19467.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":43024.1},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":79405.04},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":39851.44},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":65490.23},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20051.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":20051.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":36953.88},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":123133.34},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":93463.72},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20830.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19857.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46524.89},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19467.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19857.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":39075.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20635.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":41638.43},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58955.59},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20810.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":54828.85},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":41638.43},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19467.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21803.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19467.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19062.21,"10th_percentile":19062.21,"90th_percentile":19062.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18557.91,"10th_percentile":18557.91,"90th_percentile":18557.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Mcc","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12296.74,"maximum":76236.32,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":29006.84},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23690.53},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46177.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12788.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12296.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":26637.78},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":49162.54},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":24673.47},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":40547.38},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12665.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12665.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":22879.49},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":76236.32},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":57866.78},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13157.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12542.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28805.25},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12296.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12542.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24682.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13034.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25779.86},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36501.55},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13145.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":33946.53},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":25779.86},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12296.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13772.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12296.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20321.84,"10th_percentile":20321.84,"90th_percentile":20321.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":23148.63,"10th_percentile":23148.63,"90th_percentile":26164.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11127.55,"10th_percentile":10373.35,"90th_percentile":12019.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":48912.54,"10th_percentile":48912.54,"90th_percentile":48912.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12629.68,"10th_percentile":12629.68,"90th_percentile":12633.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12260.14,"10th_percentile":12260.14,"90th_percentile":12260.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10613.76,"10th_percentile":6131.14,"90th_percentile":12075.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4199.21,"10th_percentile":4199.21,"90th_percentile":4199.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":35331.08,"10th_percentile":35331.08,"90th_percentile":35331.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12019.75,"10th_percentile":5762.76,"90th_percentile":12834.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma Without Cc/Mcc","code_information":[{"code":"185","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6506.56,"maximum":38369.4,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":14599.01},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11923.34},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23241.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6766.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6506.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":13406.68},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":24743.29},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":12418.05},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":20407.32},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6701.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6701.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":11515.15},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":38369.4},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29124.1},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6962.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6636.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14497.55},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6506.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6636.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13059.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6896.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12974.89},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18371.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6955.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":17085.14},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":12974.89},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6506.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7287.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6506.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10444.5,"maximum":64123.0,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":24397.89},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19926.3},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38840.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10862.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10444.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":22405.26},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":41351.02},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":20753.06},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":34104.74},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10757.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":10757.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":19244.13},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":64123.0},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":48672.23},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11175.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10653.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24228.34},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10444.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10653.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20964.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11071.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21683.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30701.76},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11165.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":28552.71},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":21683.66},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10444.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11697.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10444.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18173.68,"10th_percentile":18173.68,"90th_percentile":18173.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":6523.24,"10th_percentile":5571.24,"90th_percentile":9004.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":18919.82,"10th_percentile":18919.82,"90th_percentile":18919.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":13055.35,"10th_percentile":13055.35,"90th_percentile":13055.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9177.87,"10th_percentile":9177.87,"90th_percentile":10730.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10417.87,"10th_percentile":10417.87,"90th_percentile":10730.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":17658.22,"10th_percentile":17658.22,"90th_percentile":64123.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9649.31,"10th_percentile":9649.31,"90th_percentile":9649.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2576.13,"10th_percentile":2576.13,"90th_percentile":2576.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"20","median_amount":8641.51,"10th_percentile":5600.14,"90th_percentile":10209.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3993.52,"10th_percentile":3993.52,"90th_percentile":3993.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4144.22,"10th_percentile":4144.22,"90th_percentile":4144.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":25009.91,"10th_percentile":25009.91,"90th_percentile":25009.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"20","median_amount":9624.11,"10th_percentile":5190.05,"90th_percentile":10255.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax Without Cc/Mcc","code_information":[{"code":"201","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5973.94,"maximum":34886.15,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":13273.69},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10840.92},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21131.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6212.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5973.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":12189.59},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":22497.05},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":11290.71},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":18554.7},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6153.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6153.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":10469.78},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":34886.15},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26480.15},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6392.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6093.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13181.44},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5973.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6093.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11990.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6332.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11797.0},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16703.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6386.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":15534.12},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":11797.0},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5973.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6690.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5973.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex Aortic Arch Procedures","code_information":[{"code":"209","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":85073.83,"maximum":552187.66,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":210099.57},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":171593.01},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":334470.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":88476.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85073.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":192940.26},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":356089.45},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":178712.53},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":293688.9},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":87626.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":87626.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":165718.55},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":552187.66},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":419135.16},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":91029.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":86775.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":208639.44},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":85073.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":86775.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":170760.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":90178.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":186726.24},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264384.53},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":90943.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":245878.29},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":186726.24},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":85073.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":95282.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85073.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","code_information":[{"code":"220","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40420.36,"maximum":260160.65,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":98987.43},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":80845.25},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":157584.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42037.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40420.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":90902.91},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":167769.89},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":84199.58},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":138370.16},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41632.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":41632.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":78077.52},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":260160.65},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":197473.58},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43249.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41228.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98299.5},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40420.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41228.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":81131.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":42845.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":87975.2},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":124563.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43209.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":115844.41},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":87975.2},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40420.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45270.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40420.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":184855.99,"10th_percentile":184855.99,"90th_percentile":184855.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41510.32,"10th_percentile":41510.32,"90th_percentile":41510.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35603.91,"10th_percentile":35603.91,"90th_percentile":35603.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization With Mcc","code_information":[{"code":"235","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44417.25,"maximum":286299.65,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":108932.95},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":88967.98},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":173417.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46193.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44417.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":100036.16},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":184626.16},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":92659.33},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":152272.56},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":45749.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":45749.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":85922.17},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":286299.65},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":217314.26},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47526.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":45305.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":108175.9},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44417.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":45305.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":89154.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":47082.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":96814.29},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":137078.76},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47482.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":127483.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":96814.29},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44417.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49747.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44417.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":90507.47,"10th_percentile":90507.47,"90th_percentile":90507.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30430.59,"10th_percentile":30430.59,"90th_percentile":30430.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Generator Procedures","code_information":[{"code":"245","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34673.45,"maximum":222576.68,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":84687.27},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":69165.98},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":134818.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36060.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34673.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":77770.67},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":143533.1},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":72035.73},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":118380.59},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35713.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":35713.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":66798.1},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":222576.68},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":168945.67},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37100.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35366.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":84098.72},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34673.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35366.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":69596.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36753.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":75265.91},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":106568.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37065.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":99109.02},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":75265.91},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34673.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38834.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34673.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33889.38,"10th_percentile":33889.38,"90th_percentile":33889.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","code_information":[{"code":"257","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8786.97,"maximum":53282.98,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":20273.42},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16557.75},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32274.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9138.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8786.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":18617.64},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":34360.61},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":17244.75},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":28339.31},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9050.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9050.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":15990.9},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":53282.98},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40444.17},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9402.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8962.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20132.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8786.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8962.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17637.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9314.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18018.02},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25511.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9393.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":23725.86},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":18018.02},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8786.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9841.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8786.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Lead Procedures","code_information":[{"code":"265","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27630.05,"maximum":176513.89,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":67161.03},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":54851.91},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":106917.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28735.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27630.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":61675.84},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":113828.57},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":57127.76},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":93881.44},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28458.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":28458.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":52974.07},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":176513.89},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":133981.95},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29564.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28182.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":66694.28},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27630.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28182.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55459.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29287.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":59689.45},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":84513.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29536.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":78598.16},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":59689.45},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27630.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30945.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27630.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures With Mcc","code_information":[{"code":"273","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31414.33,"maximum":201262.52,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":76577.53},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":62542.58},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":121908.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32670.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31414.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":70323.27},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":129788.23},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":65137.52},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":107044.35},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32356.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":32356.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":60401.45},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":201262.52},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":152767.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33613.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32042.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76045.34},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31414.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32042.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":63054.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33299.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":68058.37},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":96363.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33581.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":89618.24},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":68058.37},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31414.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35184.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31414.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30715.7,"10th_percentile":30709.9,"90th_percentile":30743.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35300.78,"10th_percentile":35300.78,"90th_percentile":35300.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34069.53,"10th_percentile":34069.53,"90th_percentile":34069.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":14898.66,"10th_percentile":14898.66,"90th_percentile":14898.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29029.76,"10th_percentile":29029.76,"90th_percentile":30712.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30695.76,"10th_percentile":28278.6,"90th_percentile":30749.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Cc","code_information":[{"code":"281","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7495.7,"maximum":44838.29,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":17060.33},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13933.56},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27159.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7795.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7495.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":15666.98},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":28914.89},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":14511.67},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":23847.89},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7720.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7720.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":13456.54},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":44838.29},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34034.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8020.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7645.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16941.77},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7495.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7645.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15045.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7945.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15162.39},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21468.34},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8012.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":19965.61},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":15162.39},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7495.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8395.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7495.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":26892.64,"10th_percentile":26892.64,"90th_percentile":26892.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5912.58,"10th_percentile":5912.58,"90th_percentile":5912.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":11528.23,"10th_percentile":11528.23,"90th_percentile":11528.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7477.07,"10th_percentile":7477.07,"90th_percentile":7477.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":14330.4,"10th_percentile":14330.4,"90th_percentile":14330.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6372.03,"10th_percentile":6372.03,"90th_percentile":6372.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5636.15,"10th_percentile":5636.15,"90th_percentile":5774.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":17922.83,"10th_percentile":17922.83,"90th_percentile":17922.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6615.78,"10th_percentile":5644.97,"90th_percentile":7831.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7477.07,"10th_percentile":7477.07,"90th_percentile":7477.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Cc","code_information":[{"code":"289","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13372.42,"maximum":83271.12,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":31683.48},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25876.6},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50438.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13907.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13372.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":29095.82},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":53699.07},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":26950.24},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":44288.93},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13773.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":13773.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":24990.72},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":83271.12},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":63206.51},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14308.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13639.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31463.29},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13372.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13639.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26841.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14174.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28158.73},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39869.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14295.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":37078.99},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":28158.73},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13372.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14977.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13372.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":40069.75,"10th_percentile":40069.75,"90th_percentile":40069.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Mcc","code_information":[{"code":"299","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12818.91,"maximum":79651.27,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":30306.18},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24751.73},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48246.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13331.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12818.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":27831.0},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":51364.74},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":25778.7},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":42363.67},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13203.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":13203.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":23904.36},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":79651.27},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":60458.88},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13716.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13075.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30095.56},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12818.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13075.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25730.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13588.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26934.65},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38136.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13703.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":35467.14},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":26934.65},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12818.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14357.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12818.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12541.71,"10th_percentile":12541.71,"90th_percentile":12541.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7728.67,"10th_percentile":7728.67,"90th_percentile":7728.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders Without Mcc","code_information":[{"code":"307","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7451.69,"maximum":44550.46,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":16950.82},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13844.11},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26985.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7749.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7451.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":15566.41},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":28729.27},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":14418.51},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":23694.8},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7675.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7675.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":13370.16},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":44550.46},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33815.8},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7973.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7600.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16833.02},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7451.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7600.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14957.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7898.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15065.06},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21330.53},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7965.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":19837.44},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":15065.06},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7451.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8345.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7451.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":11602.42,"10th_percentile":11602.42,"90th_percentile":11602.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7284.52,"10th_percentile":7284.52,"90th_percentile":7284.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Cc","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7825.42,"maximum":46994.59,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":17880.77},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14603.63},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28465.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8138.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7825.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":16420.41},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":30305.42},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":15209.54},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":24994.75},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8060.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8060.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":14103.68},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":46994.59},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35671.0},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8373.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7981.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17756.51},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7825.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7981.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15707.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8294.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15891.56},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22500.76},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8365.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":20925.77},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":15891.56},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7825.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8764.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7825.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":14780.3,"10th_percentile":14780.3,"90th_percentile":14780.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":23946.67,"10th_percentile":23946.67,"90th_percentile":23946.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8038.03,"10th_percentile":8038.03,"90th_percentile":8038.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7805.9,"10th_percentile":7805.9,"90th_percentile":7805.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7664.78,"10th_percentile":7664.78,"90th_percentile":7664.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5724.08,"10th_percentile":5724.08,"90th_percentile":5724.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","code_information":[{"code":"566","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6229.06,"maximum":36554.6,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":13908.51},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11359.39},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22141.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6478.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6229.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":12772.57},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":23572.98},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":11830.7},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":19442.09},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6415.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6415.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":10970.5},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":36554.6},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27746.58},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6665.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6353.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13811.85},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6229.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6353.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12502.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6602.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12361.2},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17502.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6658.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":16277.04},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":12361.2},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6229.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6976.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6229.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"577","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20412.84,"maximum":129314.4,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":49202.29},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":40184.61},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":78328.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21229.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20412.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":45183.83},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":83391.02},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":41851.9},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":68777.71},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21025.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":21025.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":38808.9},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":129314.4},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":98155.42},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21841.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20821.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48860.35},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20412.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20821.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":40972.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21637.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":43728.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":61915.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21821.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":57581.16},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":43728.6},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20412.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22862.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20412.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","code_information":[{"code":"585","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15029.95,"maximum":94111.14,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":35807.95},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29245.16},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57004.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15631.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15029.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":32883.44},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":60689.49},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":30458.56},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":50054.36},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15480.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":15480.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":28243.95},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":94111.14},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":71434.57},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16082.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15330.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35559.1},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15029.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15330.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30168.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15931.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":31824.36},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45059.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16067.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":41905.84},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":31824.36},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15029.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16833.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15029.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12922.13,"10th_percentile":12922.13,"90th_percentile":12922.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"599","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6379.0,"maximum":37535.18,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":14281.6},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11664.1},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22735.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6634.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6379.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":13115.19},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":24205.32},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":12148.06},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":19963.62},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6570.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6570.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":11264.79},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":37535.18},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28490.88},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6825.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6506.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14182.35},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6379.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6506.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12803.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6761.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12692.79},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17971.65},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6819.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":16713.68},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":12692.79},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6379.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7144.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6379.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders Without Mcc","code_information":[{"code":"607","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7400.97,"maximum":44218.72,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":16824.6},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13741.02},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26784.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7697.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7400.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":15450.49},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":28515.34},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":14311.15},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":23518.36},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7623.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7623.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":13270.6},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":44218.72},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33563.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7919.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7548.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16707.67},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7400.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7548.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14855.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7845.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14952.88},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21171.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7911.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":19689.73},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":14952.88},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7400.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8289.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7400.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7234.96,"10th_percentile":7234.96,"90th_percentile":7234.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity Without Cc/Mcc","code_information":[{"code":"621","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11891.68,"maximum":73587.29,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":27998.92},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22867.34},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44573.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12367.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11891.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":25712.19},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":47454.26},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":23816.13},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":39138.45},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12248.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12248.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":22084.48},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":73587.29},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":55856.05},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12724.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12129.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27804.34},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11891.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12129.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23868.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12605.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24884.07},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35233.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12712.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":32766.97},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":24884.07},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11891.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13318.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11891.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","code_information":[{"code":"323","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32920.43,"maximum":211112.21,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":80325.2},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":65603.38},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":127874.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34237.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32920.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":73764.86},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":136140.0},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":68325.32},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":112283.05},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33908.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":33908.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":63357.46},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":211112.21},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":160243.62},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35224.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33578.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":79766.96},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32920.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33578.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":66077.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34895.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":71389.12},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101079.41},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35191.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":94004.11},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":71389.12},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32920.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36870.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32920.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":76654.48,"10th_percentile":76654.48,"90th_percentile":76654.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32216.09,"10th_percentile":32216.09,"90th_percentile":32216.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31961.38,"10th_percentile":31961.38,"90th_percentile":31961.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"331","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13193.39,"maximum":82100.28,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":31237.99},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25512.76},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49729.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13721.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13193.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":28686.71},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":52944.03},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":26571.31},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":43666.21},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13589.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":13589.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":24639.34},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":82100.28},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":62317.79},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14116.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13457.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31020.9},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13193.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13457.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26481.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13984.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27762.8},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39309.18},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14103.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":36557.64},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":27762.8},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13193.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14776.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13193.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":28116.17,"10th_percentile":28116.17,"90th_percentile":28116.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12630.09,"10th_percentile":12374.29,"90th_percentile":12930.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":44156.36,"10th_percentile":44156.36,"90th_percentile":44156.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13550.48,"10th_percentile":13550.48,"90th_percentile":13550.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"1 through 10","median_amount":232037.02,"10th_percentile":232037.02,"90th_percentile":232037.02},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12892.69,"10th_percentile":12068.19,"90th_percentile":12930.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12508.3,"10th_percentile":12508.3,"90th_percentile":12508.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Cc","code_information":[{"code":"345","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11864.08,"maximum":73406.79,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":27930.24},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22811.25},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44463.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12338.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11864.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":25649.12},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":47337.86},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":23757.71},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":39042.45},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12220.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12220.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":22030.31},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":73406.79},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":55719.04},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12694.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12101.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27736.14},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11864.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12101.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23813.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12575.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24823.04},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35146.78},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12682.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":32686.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":24823.04},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11864.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13287.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11864.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4405.29,"10th_percentile":4405.29,"90th_percentile":4405.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Mcc","code_information":[{"code":"353","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22287.45,"maximum":141574.07,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":53866.92},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":43994.32},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":85754.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23178.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22287.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":49467.49},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":91296.92},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":45819.68},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":75298.19},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22956.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":22956.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":42488.18},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":141574.07},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":107461.06},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23847.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22733.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53492.57},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22287.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22733.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":44735.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23624.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":47874.29},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":67784.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23825.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":63040.15},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":47874.29},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22287.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24961.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22287.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":17198.84,"10th_percentile":17198.84,"90th_percentile":17198.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Mcc","code_information":[{"code":"368","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12514.56,"maximum":77660.84,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":29548.85},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24133.2},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47040.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13015.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12514.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":27135.53},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":50081.17},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":25134.51},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":41305.03},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12890.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12890.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":23307.01},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":77660.84},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":58948.06},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13390.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12764.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29343.49},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12514.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12764.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25119.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13265.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26261.57},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37183.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13378.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":34580.84},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":26261.57},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12514.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14016.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12514.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6189.6,"10th_percentile":6189.6,"90th_percentile":6189.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy Without Cc/Mcc","code_information":[{"code":"376","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7534.5,"maximum":45091.98,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":17156.86},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14012.39},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27313.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7835.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7534.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":15755.62},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":29078.48},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":14593.77},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":23982.81},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7760.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7760.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":13532.68},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":45091.98},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34226.83},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8061.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7685.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17037.62},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7534.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7685.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15123.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7986.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15248.18},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21589.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8054.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":20078.57},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":15248.18},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7534.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8438.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7534.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"1 through 10","median_amount":15299.94,"10th_percentile":15299.94,"90th_percentile":15299.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer Without Mcc","code_information":[{"code":"384","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7016.05,"maximum":41701.42,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":15866.8},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12958.77},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25259.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7296.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7016.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":14570.92},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":26892.01},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":13496.44},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":22179.5},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7226.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7226.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":12515.13},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":41701.42},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31653.24},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7507.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7156.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15756.53},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7016.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7156.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14082.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7437.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14101.64},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19966.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7500.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":18568.82},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":14101.64},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7016.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7857.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7016.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":19326.17,"10th_percentile":19326.17,"90th_percentile":19326.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6455.08,"maximum":38032.79,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":14470.94},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11818.74},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23037.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6713.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6455.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":13289.06},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":24526.22},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":12309.1},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":20228.28},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6648.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6648.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":11414.12},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":38032.79},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28868.59},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6906.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6584.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14370.37},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6455.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6584.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12956.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6842.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12861.06},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18209.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6900.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":16935.25},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":12861.06},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6455.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7229.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6455.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":13247.74,"10th_percentile":13247.74,"90th_percentile":13247.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":5936.52,"10th_percentile":2367.74,"90th_percentile":6333.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":23399.2,"10th_percentile":23399.2,"90th_percentile":24526.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":5141.0,"10th_percentile":5141.0,"90th_percentile":5141.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6010.8,"10th_percentile":6010.8,"90th_percentile":6010.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6499.79,"10th_percentile":6499.79,"90th_percentile":6630.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":11414.12,"10th_percentile":11414.12,"90th_percentile":11414.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":7024.74,"10th_percentile":7024.74,"90th_percentile":38032.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2508.4,"10th_percentile":2508.4,"90th_percentile":2508.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":5181.12,"10th_percentile":4644.5,"90th_percentile":6310.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2103.79,"10th_percentile":2103.79,"90th_percentile":2103.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2970.21,"10th_percentile":2970.21,"90th_percentile":2970.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":17625.98,"10th_percentile":17625.98,"90th_percentile":17625.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4855.2,"10th_percentile":2823.18,"90th_percentile":6744.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"1 through 10","median_amount":14507.48,"10th_percentile":14507.48,"90th_percentile":14507.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Mcc","code_information":[{"code":"405","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41447.56,"maximum":266878.34,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":101543.42},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":82932.78},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":161653.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43105.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41447.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":93250.14},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":172101.93},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":86373.72},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":141943.06},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":42690.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":42690.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":80093.59},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":266878.34},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":202572.62},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44348.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":42276.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":100837.73},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41447.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":42276.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":83193.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43934.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":90246.84},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":127779.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44307.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":118835.67},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":90246.84},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41447.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46421.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41447.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. Without Cc/Mcc","code_information":[{"code":"413","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13026.29,"maximum":81007.49,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":30822.2},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25173.18},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49067.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13547.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13026.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":28304.88},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":52239.33},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":26217.63},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":43084.99},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13417.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":13417.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":24311.38},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":81007.49},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":61488.32},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13938.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13286.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30608.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13026.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13286.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26146.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13807.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27393.27},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38785.96},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13925.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":36071.04},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":27393.27},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13026.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14589.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13026.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Cc","code_information":[{"code":"421","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13600.68,"maximum":84763.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":32251.48},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26340.5},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51343.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14144.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13600.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":29617.43},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":54661.75},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":27433.39},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":45082.91},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14008.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14008.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":25438.74},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":84763.94},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":64339.63},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14552.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13872.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32027.34},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13600.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13872.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27299.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14416.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28663.54},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40584.53},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14539.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":37743.71},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":28663.54},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13600.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15232.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13600.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","code_information":[{"code":"429","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":67848.01,"maximum":439533.34,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":167236.2},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":136585.54},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266233.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":70561.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67848.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":153577.64},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":283442.02},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":142252.57},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":233772.09},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":69883.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":69883.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":131909.55},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":439533.34},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":333625.49},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":72597.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":69204.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":166073.96},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":67848.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":69204.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":136184.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":71918.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":148631.37},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":210446.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":72529.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":195715.54},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":148631.37},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":67848.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":75989.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67848.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Mcc","code_information":[{"code":"438","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12800.26,"maximum":79529.31,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":30259.77},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24713.83},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48172.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13312.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12800.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":27788.39},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":51286.09},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":25739.23},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":42298.8},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13184.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":13184.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":23867.76},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":79529.31},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":60366.31},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13696.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13056.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30049.48},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12800.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13056.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25692.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13568.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26893.41},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38078.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13683.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":35412.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":26893.41},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12800.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14336.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12800.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":27701.99,"10th_percentile":27701.99,"90th_percentile":27701.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10586.19,"10th_percentile":10586.19,"90th_percentile":10586.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract Without Cc/Mcc","code_information":[{"code":"446","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6810.91,"maximum":40359.83,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":15356.34},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12541.87},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24446.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7083.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6810.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":14102.16},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":26026.86},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":13062.24},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":21465.95},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7015.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7015.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":12112.5},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":40359.83},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30634.92},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7287.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6947.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15249.62},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6810.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6947.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13670.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7219.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13647.97},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19324.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7280.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":17971.44},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":13647.97},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6810.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7628.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6810.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":11390.08,"10th_percentile":11390.08,"90th_percentile":11390.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4815.91,"10th_percentile":4815.91,"90th_percentile":4815.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","code_information":[{"code":"461","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41839.19,"maximum":269439.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":102517.93},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":83728.68},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":163204.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43512.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41839.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":94145.06},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":173753.58},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":87202.65},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":143305.28},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43094.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":43094.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":80862.24},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":269439.56},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":204516.69},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44767.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":42675.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":101805.46},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41839.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":42675.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":83979.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44349.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":91112.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":129006.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44726.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":119976.13},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":91112.93},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41839.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46859.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41839.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","code_information":[{"code":"469","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23266.15,"maximum":147974.66,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":56302.26},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":45983.31},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":89631.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24196.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23266.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":51703.93},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":95424.47},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":47891.19},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":78702.44},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23964.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":23964.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":44409.08},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":147974.66},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":112319.4},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24894.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23731.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":55910.98},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23266.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23731.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":46699.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24662.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":50038.7},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":70849.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24871.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":65890.2},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":50038.7},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23266.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26058.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23266.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"477","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26409.65,"maximum":168532.66,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":64124.29},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":52371.74},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":102083.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27466.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26409.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":58887.11},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":108681.72},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":54544.68},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":89636.51},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27201.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":27201.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":50578.8},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":168532.66},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":127923.84},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28258.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26937.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":63678.64},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26409.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26937.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":53009.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27994.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":56990.54},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80692.55},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28231.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":75044.28},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":56990.54},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26409.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29578.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26409.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Cc","code_information":[{"code":"486","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16238.42,"maximum":102014.31,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":38815.0},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31701.08},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":61792.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16887.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16238.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":35644.89},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":65786.01},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":33016.38},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":54257.77},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16725.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":16725.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":30615.8},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":102014.31},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":77433.43},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17375.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16563.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38545.25},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16238.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16563.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32593.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17212.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34496.88},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48843.91},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17358.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":45424.97},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":34496.88},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16238.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18187.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16238.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16681.92,"10th_percentile":16681.92,"90th_percentile":16681.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","code_information":[{"code":"496","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14096.0,"maximum":88003.26,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":33483.99},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27347.12},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53305.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14659.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14096.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":30749.28},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":56750.69},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":28481.78},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":46805.79},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14518.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14518.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":26410.9},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":88003.26},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":66798.42},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15082.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14377.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33251.29},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14096.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14377.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28293.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14941.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29758.94},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42135.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15068.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":39186.12},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":29758.94},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14096.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15787.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14096.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13209.85,"10th_percentile":13209.85,"90th_percentile":13209.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Cc","code_information":[{"code":"504","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14583.12,"maximum":91188.92,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":34696.09},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":28337.07},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":55234.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15166.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14583.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":31862.38},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":58805.03},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":29512.8},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":48500.13},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15020.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":15020.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":27366.96},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":91188.92},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":69216.48},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15603.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14874.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34454.96},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14583.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14874.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":29271.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15458.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30836.19},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43660.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15589.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":40604.63},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":30836.19},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14583.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16333.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14583.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2617.74,"10th_percentile":2617.74,"90th_percentile":2617.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":2799.34,"10th_percentile":2799.34,"90th_percentile":2799.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"1 through 10","median_amount":110677.87,"10th_percentile":110677.87,"90th_percentile":110677.87},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","code_information":[{"code":"513","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12383.27,"maximum":76802.23,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":29222.16},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23866.39},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46520.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12878.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12383.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":26835.52},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":49527.48},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":24856.62},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":40848.36},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12754.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12754.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":23049.33},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":76802.23},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":58296.33},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13250.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12630.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29019.07},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12383.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12630.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24855.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13126.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25971.23},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36772.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13237.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":34198.52},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":25971.23},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12383.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13869.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12383.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","code_information":[{"code":"521","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22050.23,"maximum":140022.71,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":53276.65},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":43512.23},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":84814.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22932.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22050.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":48925.43},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":90296.49},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":45317.59},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":74473.08},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22711.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":22711.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":42022.6},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":140022.71},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":106283.51},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23593.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22491.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52906.4},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22050.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22491.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":44259.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23373.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":47349.69},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":67042.13},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23571.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":62349.35},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":47349.69},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22050.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24696.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22050.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20351.72,"10th_percentile":20351.72,"90th_percentile":21577.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Mcc","code_information":[{"code":"539","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15332.81,"maximum":96091.81,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":36561.57},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29860.65},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58204.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15946.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15332.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":33575.51},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":61966.76},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":31099.59},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":51107.81},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15792.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":15792.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":28838.38},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":96091.81},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":72937.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16406.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15639.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36307.48},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15332.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15639.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30776.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16252.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32494.14},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46008.25},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16390.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":42787.79},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":32494.14},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15332.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17172.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15332.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"547","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6877.3,"maximum":40794.02,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":15521.54},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12676.79},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24709.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7152.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6877.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":14253.87},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":26306.85},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":13202.76},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":21696.88},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7083.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7083.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":12242.8},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":40794.02},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30964.49},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7358.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7014.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15413.67},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6877.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7014.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13804.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7289.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13794.79},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19531.96},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7351.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":18164.77},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":13794.79},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6877.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7702.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6877.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":12002.76,"10th_percentile":12002.76,"90th_percentile":12002.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"555","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10499.71,"maximum":64484.01,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":24535.25},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20038.49},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39059.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10919.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10499.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":22531.4},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":41583.83},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":20869.9},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":34296.74},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10814.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":10814.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":19352.47},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":64484.01},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":48946.25},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11234.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10709.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24364.74},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10499.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10709.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21075.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11129.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21805.73},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30874.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11224.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":28713.46},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":21805.73},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10499.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11759.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10499.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","code_information":[{"code":"563","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7319.66,"maximum":43686.97,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":16622.27},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13575.78},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26462.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7612.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7319.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":15264.69},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":28172.43},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":14139.05},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":23235.54},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7539.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7539.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":13111.02},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":43686.97},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33160.37},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7832.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7466.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16506.75},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7319.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7466.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14692.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7758.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14773.06},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20917.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7824.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":19452.95},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":14773.06},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7319.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8198.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7319.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5450.27,"10th_percentile":5450.27,"90th_percentile":5450.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7301.5,"10th_percentile":7301.5,"90th_percentile":7520.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7180.97,"10th_percentile":7180.97,"90th_percentile":7180.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7155.47,"10th_percentile":7155.47,"90th_percentile":7155.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"574","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26534.97,"maximum":169352.25,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":64436.13},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":52626.42},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":102579.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27596.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26534.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":59173.48},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":109210.24},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":54809.93},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":90072.42},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27331.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":27331.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":50824.77},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":169352.25},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":128545.94},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28392.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27065.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":63988.32},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26534.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27065.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":53260.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28127.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":57267.69},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":81084.96},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28365.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":75409.22},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":57267.69},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26534.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29719.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26534.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy With Cc/Mcc","code_information":[{"code":"582","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15011.3,"maximum":93989.18,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":35761.55},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29207.26},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56931.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15611.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15011.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":32840.82},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":60610.84},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":30419.09},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":49989.49},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15461.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":15461.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":28207.35},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":93989.18},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":71342.0},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16062.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15311.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35513.02},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15011.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15311.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30130.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15911.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":31783.12},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45001.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16047.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":41851.53},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":31783.12},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15011.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16812.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15011.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders Without Mcc","code_information":[{"code":"596","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8714.61,"maximum":52809.76,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":20093.37},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16410.7},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31987.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9063.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8714.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":18452.3},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":34055.45},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":17091.59},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":28087.63},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8976.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8976.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":15848.88},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":52809.76},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40084.98},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9324.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8888.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19953.72},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8714.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8888.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17491.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9237.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17858.0},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25285.04},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9315.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":23515.15},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":17858.0},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8714.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9760.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8714.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7090.43,"10th_percentile":7090.43,"90th_percentile":7090.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","code_information":[{"code":"604","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11620.89,"maximum":71816.4,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":27325.12},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22317.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43500.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12085.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11620.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":25093.42},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":46312.27},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":23242.99},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":38196.58},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11969.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11969.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":21553.02},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":71816.4},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":54511.86},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12434.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11853.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27135.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11620.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11853.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23325.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12318.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24285.23},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34385.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12422.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":31978.43},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":24285.23},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11620.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13015.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11620.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11359.23,"10th_percentile":11359.23,"90th_percentile":11359.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"618","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11219.56,"maximum":69191.77,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":26326.48},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21501.43},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41910.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11668.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11219.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":24176.34},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":44619.72},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":22393.54},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":36800.63},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11556.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11556.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":20765.33},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":69191.77},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":52519.65},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12004.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11443.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26143.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11219.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11443.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22519.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11892.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23397.7},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33128.65},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11993.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":30809.73},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":23397.7},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11219.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12565.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11219.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","code_information":[{"code":"626","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11824.54,"maximum":73148.23,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":27831.86},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22730.9},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44307.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12297.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11824.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":25558.77},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":47171.12},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":23674.03},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":38904.93},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12179.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12179.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":21952.72},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":73148.23},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":55522.78},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12652.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12061.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27638.44},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11824.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12061.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23734.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12534.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24735.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35022.99},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12640.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":32571.47},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":24735.6},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11824.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13243.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11824.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System Without Mcc","code_information":[{"code":"002","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":85170.81,"maximum":552821.86,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":210340.87},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":171790.09},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":334854.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":88577.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85170.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":193161.86},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":356498.43},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":178917.79},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":294026.21},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":87725.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":87725.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":165908.88},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":552821.86},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":419616.55},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":91132.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":86874.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":208879.07},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":85170.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":86874.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":170954.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":90281.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":186940.7},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264688.18},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":91047.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":246160.69},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":186940.7},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":85170.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":95391.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85170.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","code_information":[{"code":"011","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41325.22,"maximum":266078.27,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":101239.0},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":82684.16},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":161168.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42978.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41325.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":92970.59},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":171585.99},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":86114.78},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":141517.53},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":42564.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":42564.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":79853.48},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":266078.27},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":201965.32},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44217.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":42151.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":100535.43},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41325.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":42151.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":82947.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43804.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":89976.29},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":127396.87},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44176.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":118479.41},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":89976.29},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41325.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46284.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41325.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","code_information":[{"code":"020","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":59338.04,"maximum":383879.41,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":146060.67},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":119291.01},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":232523.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":61711.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59338.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":134131.56},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":247552.45},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":124240.48},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":204171.75},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":61118.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":61118.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":115207.1},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":383879.41},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":291381.66},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":63491.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":60524.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145045.59},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":59338.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":60524.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":119103.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62898.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":129811.59},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":183799.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":63432.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":170933.94},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":129811.59},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":59338.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":66458.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59338.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Mcc","code_information":[{"code":"028","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45459.36,"maximum":293114.92,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":111526.06},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":91085.83},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":177545.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47277.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45459.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":102417.48},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":189021.12},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":94865.05},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":155897.36},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":46823.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":46823.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":87967.52},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":293114.92},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":222487.35},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48641.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":46368.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":110750.99},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45459.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":46368.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":91246.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":48186.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":99118.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":140341.87},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48596.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":130518.3},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":99118.93},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45459.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50914.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45459.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures Without Cc/Mcc","code_information":[{"code":"036","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15132.15,"maximum":94779.5,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":36062.25},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29452.85},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57409.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15737.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15132.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":33116.97},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":61120.49},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":30674.87},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":50409.83},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15586.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":15586.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":28444.53},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":94779.5},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":71941.88},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16191.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15434.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35811.63},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15132.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15434.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30373.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16040.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32050.37},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45379.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16176.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":42203.44},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":32050.37},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15132.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16948.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15132.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14794.52,"10th_percentile":14794.52,"90th_percentile":14794.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries Without Cc/Mcc","code_information":[{"code":"053","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7944.03,"maximum":47770.27,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":18175.91},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14844.67},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28935.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8261.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7944.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":16691.44},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":30805.63},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":15460.59},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":25407.3},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8182.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8182.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":14336.47},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":47770.27},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36259.78},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8500.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8102.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18049.59},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7944.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8102.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15945.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8420.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16153.86},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22872.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8492.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":21271.16},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":16153.86},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7944.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8897.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7944.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","code_information":[{"code":"061","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21206.54,"maximum":134505.12,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":51177.29},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":41797.64},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":81472.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22054.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21206.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":46997.53},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":86738.37},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":43531.85},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":71538.47},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21842.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":21842.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":40366.7},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":134505.12},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":102095.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22691.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21630.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50821.62},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21206.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21630.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":42565.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22478.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":45483.88},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64400.34},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22669.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":59892.48},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":45483.88},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21206.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23751.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21206.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient Ischemia Without Thrombolytic","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6598.31,"maximum":38969.46,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":14827.33},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12109.81},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23604.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6862.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6598.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":13616.34},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":25130.25},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":12612.25},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":20726.46},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6796.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6796.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":11695.23},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":38969.46},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29579.56},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7060.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6730.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14724.28},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6598.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6730.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13244.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6994.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13177.8},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18658.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7053.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":17352.33},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":13177.8},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6598.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7390.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6598.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5597.88,"10th_percentile":5597.88,"90th_percentile":5597.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":7290.47,"10th_percentile":7290.47,"90th_percentile":7290.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":10042.9,"10th_percentile":10042.9,"90th_percentile":10042.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"1 through 10","median_amount":7759.0,"10th_percentile":7759.0,"90th_percentile":7759.0},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6648.83,"10th_percentile":6648.83,"90th_percentile":6648.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma With Mcc","code_information":[{"code":"080","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14141.51,"maximum":88300.85,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":33597.22},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27439.6},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53485.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14707.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14141.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":30853.26},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":56942.6},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":28578.09},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":46964.07},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14565.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14565.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":26500.21},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":88300.85},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":67024.3},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15131.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14424.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33363.73},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14141.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14424.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28384.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14990.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29859.57},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42277.98},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15117.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":39318.63},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":29859.57},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14141.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15838.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14141.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Mcc","code_information":[{"code":"088","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10723.5,"maximum":65947.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":25092.11},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20493.29},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39945.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11152.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10723.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":23042.78},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":42527.63},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":21343.57},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":35075.15},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11045.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11045.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":19791.7},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":65947.56},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":50057.15},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11474.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10937.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24917.73},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10723.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10937.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21524.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11366.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22300.64},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31575.34},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11463.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":29365.15},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":22300.64},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10723.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12010.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10723.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","code_information":[{"code":"096","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19879.47,"maximum":125826.27,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":47875.11},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":39100.67},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":76215.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20674.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19879.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":43965.04},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":81141.63},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":40722.99},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":66922.5},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20475.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":20475.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":37762.07},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":125826.27},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":95507.78},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21271.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20277.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47542.39},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19879.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20277.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":39902.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21072.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":42549.06},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60244.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21251.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":56027.96},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":42549.06},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19879.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22265.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19879.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures With Cc/Mcc","code_information":[{"code":"113","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18177.92,"maximum":114698.41,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":43641.12},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":35642.68},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69475.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18905.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18177.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":40076.85},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":73965.61},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":37121.52},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":61003.99},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18723.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":18723.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":34422.46},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":114698.41},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":87061.23},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19450.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18541.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43337.83},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18177.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18541.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36486.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19268.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":38786.1},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54916.99},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19432.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":51072.95},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":38786.1},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18177.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20359.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18177.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","code_information":[{"code":"124","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10509.4,"maximum":64547.43,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":24559.38},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20058.2},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39097.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10929.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10509.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":22553.56},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":41624.73},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":20890.43},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":34330.48},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10824.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":10824.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":19371.51},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":64547.43},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":48994.39},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11245.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10719.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24388.7},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10509.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10719.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21094.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11139.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21827.18},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30904.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11234.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":28741.7},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":21827.18},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10509.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11770.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10509.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Cc","code_information":[{"code":"141","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16909.78,"maximum":106404.96,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":40485.58},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":33065.48},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64451.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17586.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16909.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":37179.03},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":68617.41},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":34437.39},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":56593.0},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17417.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":17417.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":31933.49},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":106404.96},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":80766.13},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18093.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17247.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40204.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16909.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17247.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33941.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17924.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":35981.61},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50946.13},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18076.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":47380.04},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":35981.61},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16909.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18938.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16909.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dysequilibrium","code_information":[{"code":"149","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6246.21,"maximum":36666.81,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":13951.2},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11394.26},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22209.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6496.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6246.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":12811.77},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":23645.34},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":11867.01},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":19501.77},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6433.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6433.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":11004.18},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":36666.81},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27831.75},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6683.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6371.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13854.24},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6246.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6371.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12537.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6620.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12399.15},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17555.87},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6677.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":16327.01},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":12399.15},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6246.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6995.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6246.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6106.36,"10th_percentile":6106.36,"90th_percentile":6106.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6230.98,"10th_percentile":6230.98,"90th_percentile":6230.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Mcc","code_information":[{"code":"157","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13446.27,"maximum":83754.09,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":31867.24},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26026.69},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50731.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13984.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13446.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":29264.57},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":54010.53},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":27106.56},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":44545.81},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13849.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":13849.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":25135.67},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":83754.09},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":63573.1},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14387.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13715.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31645.77},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13446.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13715.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26989.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14253.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28322.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40101.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14374.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":37294.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":28322.05},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13446.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15059.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13446.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"168","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10832.41,"maximum":66659.82,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":25363.12},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20714.62},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40377.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11265.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10832.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":23291.65},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":42986.94},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":21574.09},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":35453.98},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11157.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11157.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":20005.46},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":66659.82},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":50597.79},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11590.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11049.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25186.85},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10832.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11049.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21742.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11482.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22541.5},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31916.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11579.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":29682.31},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":22541.5},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10832.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12132.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10832.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Cc","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8628.83,"maximum":52248.74,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":19879.9},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16236.36},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31648.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8973.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8628.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":18256.27},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":33693.66},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":16910.02},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":27789.24},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8887.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8887.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":15680.51},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":52248.74},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39659.13},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9232.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8801.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19741.74},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8628.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8801.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17319.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9146.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17668.29},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25016.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9224.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":23265.33},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":17668.29},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8628.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9664.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8628.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4034.72,"10th_percentile":4034.72,"90th_percentile":4034.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Edema And Respiratory Failure","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9855.19,"maximum":60268.99,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":22931.49},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18728.66},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36506.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10249.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9855.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":21058.63},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":38865.68},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":19505.73},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":32054.92},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10150.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":10150.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":18087.49},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":60268.99},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":45746.86},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10545.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10052.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22772.13},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9855.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10052.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19781.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10446.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20380.39},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28856.47},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10535.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":26836.59},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":20380.39},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9855.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11037.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9855.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6273.41,"10th_percentile":6273.41,"90th_percentile":6273.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8433.04,"10th_percentile":8433.04,"90th_percentile":8433.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9649.54,"10th_percentile":4099.6,"90th_percentile":9689.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4700.11,"10th_percentile":4700.11,"90th_percentile":4700.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":9406.51,"10th_percentile":9406.51,"90th_percentile":9406.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8898.54,"10th_percentile":7477.54,"90th_percentile":9640.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Cc","code_information":[{"code":"197","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7719.49,"maximum":46301.84,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":17617.19},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14388.36},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28045.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8028.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7719.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":16178.36},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":29858.69},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":14985.34},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":24626.3},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7951.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7951.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":13895.77},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":46301.84},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35145.17},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8259.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7873.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17494.76},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7719.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7873.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15494.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8182.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15657.3},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22169.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8252.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":20617.3},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":15657.3},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7719.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8645.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7719.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses With Mcc","code_information":[{"code":"205","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14298.16,"maximum":89325.34,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":33987.02},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27757.96},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54106.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14870.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14298.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":31211.23},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":57603.26},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":28909.66},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":47508.96},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14727.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14727.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":26807.67},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":89325.34},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":67801.93},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15299.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14584.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33750.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14298.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14584.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28699.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15156.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30206.01},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42768.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15284.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":39774.81},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":30206.01},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14298.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16013.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14298.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8944.15,"10th_percentile":8944.15,"90th_percentile":8944.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","code_information":[{"code":"216","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":73615.81,"maximum":477253.9,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":181588.33},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":148307.25},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":289081.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":76560.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73615.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":166757.61},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":307766.89},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":154460.63},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":253834.31},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":75824.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":75824.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":143229.97},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":477253.9},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":362257.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":78768.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":75088.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":180326.35},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":73615.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":75088.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":147761.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":78032.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":161386.85},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":228506.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":78695.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":212511.76},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":161386.85},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":73615.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":82449.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73615.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca With Mcc","code_information":[{"code":"231","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":63523.65,"maximum":411252.67,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":156475.8},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":127797.28},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":249103.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":66064.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63523.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":143696.08},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":265204.65},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":133099.69},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":218730.62},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65429.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":65429.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":123422.17},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":411252.67},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":312159.2},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":67970.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":64794.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":155388.35},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":63523.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":64794.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":127504.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":67335.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":139068.06},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":196905.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":67906.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":183122.72},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":139068.06},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":63523.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":71146.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63523.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","code_information":[{"code":"241","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10966.68,"maximum":67537.95,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":25697.23},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20987.5},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40909.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11405.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10966.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":23598.48},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":43553.22},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":21858.29},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":35921.03},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11295.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11295.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":20269.0},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":67537.95},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":51264.33},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11734.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11186.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25518.65},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10966.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11186.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22012.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11624.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22838.45},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32336.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11723.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":30073.32},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":22838.45},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10966.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12282.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10966.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Cc","code_information":[{"code":"253","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20001.81,"maximum":126626.35,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":48179.53},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":39349.3},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":76699.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20801.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20001.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":44244.6},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":81657.58},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":40981.93},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":67348.03},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20601.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":20601.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":38002.18},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":126626.35},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":96115.07},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21401.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20401.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47844.69},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20001.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20401.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":40147.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21201.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":42819.61},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60628.02},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21381.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":56384.22},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":42819.61},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20001.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22402.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20001.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19551.43,"10th_percentile":19551.43,"90th_percentile":19551.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":121317.42,"10th_percentile":121317.42,"90th_percentile":121317.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19935.88,"10th_percentile":19935.88,"90th_percentile":19935.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13627.79,"10th_percentile":13627.79,"90th_percentile":19550.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40676.25,"10th_percentile":40676.25,"90th_percentile":40676.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19465.94,"10th_percentile":19465.94,"90th_percentile":20893.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Cc","code_information":[{"code":"261","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14742.01,"maximum":92228.04,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":35091.46},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":28659.98},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":55864.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15331.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14742.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":32225.46},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":59475.13},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":29849.1},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":49052.8},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15184.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":15184.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":27678.81},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":92228.04},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":70005.22},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15773.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15036.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34847.59},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14742.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15036.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":29590.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15626.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":31187.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44158.3},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15759.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":41067.33},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":31187.58},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14742.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16511.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14742.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":32125.27,"10th_percentile":32125.27,"90th_percentile":32125.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","code_information":[{"code":"269","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32143.14,"maximum":206028.81,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":78391.04},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":64023.71},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":124795.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33428.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32143.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":71988.67},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":132861.87},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":66680.1},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":109579.37},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33107.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":33107.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":61831.87},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":206028.81},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":156385.1},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34393.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32786.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":77846.25},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32143.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32786.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64517.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34071.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":69670.13},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":98645.51},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34361.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":91740.57},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":69670.13},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32143.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36000.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32143.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31422.2,"10th_percentile":31422.2,"90th_percentile":31422.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":175072.46,"10th_percentile":175072.46,"90th_percentile":175072.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32057.55,"10th_percentile":32057.55,"90th_percentile":32057.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31418.9,"10th_percentile":31418.9,"90th_percentile":31418.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31421.4,"10th_percentile":31421.4,"90th_percentile":31421.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Mcc","code_information":[{"code":"277","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35091.94,"maximum":225313.52,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":85728.6},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":70016.46},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":136476.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36495.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35091.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":78726.95},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":145298.01},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":72921.5},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":119836.22},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36144.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":36144.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":67619.46},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":225313.52},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":171023.06},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37548.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35793.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":85132.81},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35091.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35793.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":70436.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37197.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":76191.39},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":107878.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37513.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":100327.68},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":76191.39},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35091.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39302.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35091.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired Without Cc/Mcc","code_information":[{"code":"285","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5107.12,"maximum":29217.34,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":11116.78},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9079.32},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17697.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5311.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5107.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":10208.85},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":18841.39},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":9456.03},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":15539.66},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5260.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":5260.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":8768.49},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":29217.34},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":22177.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5464.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5209.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11039.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5107.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5209.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10251.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5413.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":9880.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13989.11},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5459.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":13009.9},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":9880.05},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5107.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5719.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5107.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock Without Cc/Mcc","code_information":[{"code":"293","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4861.7,"maximum":27612.31,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":10506.09},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":8580.56},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16725.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5056.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4861.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":9648.04},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":17806.36},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":8936.57},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":14686.0},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5007.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":5007.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":8286.81},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":27612.31},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20958.98},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5202.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4958.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10433.08},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4861.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4958.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9758.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5153.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":9337.3},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13220.63},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5197.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":12295.22},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":9337.3},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4861.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5445.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4861.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis Without Mcc","code_information":[{"code":"303","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.38,"maximum":32842.06,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":12495.94},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10205.71},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19893.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5887.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5661.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":11475.37},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":21178.87},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":10629.15},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":17467.52},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5831.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":5831.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":9856.32},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":32842.06},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":24928.6},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6057.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5774.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12409.1},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5661.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5774.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11363.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6001.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11105.78},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15724.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6052.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":14623.92},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":11105.78},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5661.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6340.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5661.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Angina Pectoris","code_information":[{"code":"311","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5875.47,"maximum":34242.19,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":13028.67},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10640.8},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20741.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6110.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5875.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":11964.59},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":22081.77},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":11082.3},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":18212.2},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6051.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6051.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":10276.52},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":34242.19},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25991.36},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6286.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5992.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12938.12},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5875.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5992.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11793.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6228.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11579.24},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16394.98},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6280.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":15247.37},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":11579.24},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5875.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6580.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5875.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","code_information":[{"code":"629","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16892.63,"maximum":106292.76,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":40442.89},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":33030.61},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64383.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17568.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16892.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":37139.82},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":68545.05},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":34401.07},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":56533.32},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17399.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":17399.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":31899.81},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":106292.76},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":80680.96},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18075.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17230.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40161.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16892.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17230.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33906.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17906.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":35943.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50892.41},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18058.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":47330.07},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":35943.66},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16892.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18919.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16892.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Mcc","code_information":[{"code":"643","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12918.87,"maximum":80304.99,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":30554.91},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24954.88},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48642.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13435.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12918.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":28059.42},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":51786.31},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":25990.27},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":42711.36},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13306.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":13306.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":24100.55},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":80304.99},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":60955.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13823.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13177.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30342.56},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12918.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13177.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25930.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13694.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27155.71},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38449.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13810.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":35758.23},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":27155.71},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12918.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14469.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12918.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11399.48,"10th_percentile":11399.48,"90th_percentile":11399.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures Without Cc/Mcc","code_information":[{"code":"655","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16428.64,"maximum":103258.33,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":39288.33},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":32087.66},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":62545.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17085.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16428.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":36079.56},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":66588.24},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":33419.0},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":54919.42},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16921.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":16921.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":30989.14},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":103258.33},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":78377.7},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17578.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16757.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39015.29},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16428.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16757.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32975.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17414.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34917.55},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49439.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17562.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":45978.9},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":34917.55},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16428.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18400.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16428.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Cc","code_information":[{"code":"663","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11979.7,"maximum":74162.96,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":28217.95},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23046.23},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44921.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12458.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11979.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":25913.33},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":47825.49},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":24002.44},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":39444.63},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12339.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12339.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":22257.25},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":74162.96},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":56293.01},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12818.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12219.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28021.85},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11979.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12219.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24045.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12698.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25078.74},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35508.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12806.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":33023.3},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":25078.74},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11979.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13417.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11979.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7867.26,"10th_percentile":7867.26,"90th_percentile":7867.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures With Cc/Mcc","code_information":[{"code":"671","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14029.61,"maximum":87569.08,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":33318.79},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27212.2},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53042.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14590.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14029.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":30597.57},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":56470.7},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":28341.26},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":46574.87},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14450.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14450.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":26280.6},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":87569.08},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":66468.85},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15011.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14310.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33087.24},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14029.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14310.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28160.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14871.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29612.12},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41927.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14997.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":38992.79},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":29612.12},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14029.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15713.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14029.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Mcc","code_information":[{"code":"686","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14094.51,"maximum":87993.5,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":33480.28},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27344.09},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53299.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14658.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14094.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":30745.87},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":56744.4},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":28478.62},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":46800.6},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14517.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14517.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":26407.97},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":87993.5},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":66791.01},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15081.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14376.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33247.6},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14094.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14376.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28290.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14940.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29755.64},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42130.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15067.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":39181.78},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":29755.64},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14094.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15785.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14094.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms Without Mcc","code_information":[{"code":"696","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5779.24,"maximum":33612.87,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":12789.22},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10445.24},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20359.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6010.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5779.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":11744.69},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":21675.94},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":10878.62},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":17877.48},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5952.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":5952.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":10087.65},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":33612.87},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25513.67},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6183.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5894.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12700.34},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5779.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5894.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11600.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6125.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11366.43},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16093.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6178.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":14967.15},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":11366.43},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5779.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6472.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5779.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5102.97,"10th_percentile":5102.97,"90th_percentile":5102.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures Without Cc/Mcc","code_information":[{"code":"710","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11092.0,"maximum":68357.54,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":26009.07},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21242.19},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41405.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11535.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11092.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":23884.86},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":44081.75},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":22123.55},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":36356.94},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11424.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11424.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":20514.97},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":68357.54},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":51886.44},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11868.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11313.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25828.32},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11092.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11313.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22263.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11757.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23115.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32729.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11857.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":30438.27},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":23115.6},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11092.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12423.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11092.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","code_information":[{"code":"718","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10658.6,"maximum":65523.13,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":24930.62},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20361.4},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39688.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11084.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10658.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":22894.48},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":42253.93},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":21206.21},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":34849.42},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10978.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":10978.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":19664.33},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":65523.13},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":49734.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11404.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10871.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24757.36},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10658.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10871.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21393.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11298.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22157.12},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31372.13},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11394.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":29176.16},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":22157.12},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10658.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11937.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10658.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses With Cc/Mcc","code_information":[{"code":"729","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8537.07,"maximum":51648.68,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":19651.59},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16049.89},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31284.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8878.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8537.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":18046.6},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":33306.7},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":16715.81},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":27470.09},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8793.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8793.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":15500.43},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":51648.68},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39203.66},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9134.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8707.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19515.02},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8537.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8707.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17135.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9049.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17465.37},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24729.11},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9126.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":22998.14},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":17465.37},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8537.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9561.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8537.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","code_information":[{"code":"740","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14138.52,"maximum":88281.34,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":33589.8},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27433.54},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53473.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14704.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14138.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":30846.44},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":56930.02},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":28571.77},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":46953.69},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14562.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14562.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":26494.35},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":88281.34},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":67009.49},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15128.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14421.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33356.36},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14138.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14421.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28378.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14986.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29852.97},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42268.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15114.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":39309.94},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":29852.97},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14138.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15835.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14138.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Female Reproductive System Reconstructive Procedures","code_information":[{"code":"748","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10988.31,"maximum":67679.43,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":25751.06},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21031.47},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40994.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11427.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10988.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":23647.92},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":43644.46},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":21904.08},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":35996.27},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11317.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11317.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":20311.46},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":67679.43},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":51371.72},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11757.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11208.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25572.1},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10988.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11208.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22055.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11647.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22886.29},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32404.55},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11746.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":30136.32},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":22886.29},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10988.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12306.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10988.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"759","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5589.76,"maximum":32373.73,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":12317.74},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10060.18},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19609.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5813.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5589.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":11311.73},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":20876.86},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":10477.58},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":17218.43},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5757.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":5757.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":9715.77},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":32373.73},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":24573.11},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5981.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5701.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12232.14},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5701.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11219.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5925.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10947.41},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15500.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5975.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":14415.38},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":10947.41},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6260.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5589.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Mcc","code_information":[{"code":"783","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18953.73,"maximum":119772.05,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":45571.57},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":37219.32},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":72548.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19711.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18953.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":41849.63},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":77237.45},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":38763.57},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":63702.48},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19522.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":19522.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":35945.12},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":119772.05},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":90912.35},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20280.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19332.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45254.86},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18953.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19332.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":38043.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20090.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":40501.78},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57346.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20261.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":53332.14},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":40501.78},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18953.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21228.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18953.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity With Major Problems","code_information":[{"code":"791","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30918.26,"maximum":198018.32,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":75343.16},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":61534.44},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":119943.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32154.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30918.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":69189.71},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":127696.14},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":64087.55},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":105318.87},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31845.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":31845.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":59427.82},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":198018.32},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":150304.77},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33082.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31536.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":74819.55},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30918.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31536.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":62059.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32773.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":66961.32},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94810.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33051.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":88173.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":66961.32},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30918.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34628.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30918.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":8854.68,"10th_percentile":8854.68,"90th_percentile":8854.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"1 through 10","median_amount":4400.82,"10th_percentile":4400.82,"90th_percentile":4400.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3227.69,"10th_percentile":3227.69,"90th_percentile":3227.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Mcc","code_information":[{"code":"799","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34423.55,"maximum":220942.39,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":84065.44},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":68658.12},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":133829.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35800.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34423.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":77199.63},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":142479.19},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":71506.8},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":117511.37},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35456.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":35456.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":66307.62},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":220942.39},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":167705.17},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36833.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35112.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":83481.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34423.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35112.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":69094.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36488.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":74713.26},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105786.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36798.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":98381.29},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":74713.26},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34423.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38554.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34423.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","code_information":[{"code":"807","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5668.84,"maximum":32890.85,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":12514.5},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10220.87},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19922.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5895.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5668.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":11492.41},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":21210.33},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":10644.94},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":17493.47},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5838.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":5838.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":9870.96},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":32890.85},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":24965.63},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6065.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5782.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12427.53},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5668.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5782.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11378.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6008.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11122.28},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15747.96},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6059.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":14645.65},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":11122.28},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5668.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6349.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5668.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"1 through 10","median_amount":80.0,"10th_percentile":80.0,"90th_percentile":80.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9200.24,"10th_percentile":8356.4,"90th_percentile":9237.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":10956.68,"10th_percentile":8904.4,"90th_percentile":14834.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":16267.61,"10th_percentile":12426.25,"90th_percentile":20630.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":7599.0,"10th_percentile":7599.0,"90th_percentile":10644.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":17493.47,"10th_percentile":17493.47,"90th_percentile":17493.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":9457.0,"10th_percentile":9457.0,"90th_percentile":9457.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":30783.26,"10th_percentile":29486.14,"90th_percentile":32040.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"1 through 10","median_amount":13047.45,"10th_percentile":9463.97,"90th_percentile":28006.83},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"1 through 10","median_amount":1970.22,"10th_percentile":1970.22,"90th_percentile":2282.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1896.57,"10th_percentile":1896.57,"90th_percentile":1896.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7061.06,"10th_percentile":7061.06,"90th_percentile":9177.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1951.81,"10th_percentile":1951.81,"90th_percentile":2260.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"38","median_amount":2025.46,"10th_percentile":2025.46,"90th_percentile":2346.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"1 through 10","median_amount":6913.9,"10th_percentile":6913.9,"90th_percentile":6913.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":7509.0,"10th_percentile":5716.77,"90th_percentile":10044.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1841.33,"10th_percentile":1841.33,"90th_percentile":1841.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Cc","code_information":[{"code":"815","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8203.63,"maximum":49467.99,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":18821.87},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15372.24},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29963.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8531.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8203.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":17284.64},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":31900.44},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":16010.05},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":26310.26},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8449.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8449.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":14845.97},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":49467.99},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37548.42},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8777.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8367.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18691.06},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8203.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8367.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16466.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8695.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16727.96},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23685.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8769.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":22027.12},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":16727.96},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8203.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9188.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8203.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5275.41,"10th_percentile":5275.41,"90th_percentile":5275.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","code_information":[{"code":"823","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34840.55,"maximum":223669.47,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":85103.06},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":69505.57},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135480.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36234.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34840.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":78152.5},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":144237.81},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":72389.41},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":118961.81},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35885.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":35885.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":67126.06},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":223669.47},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":169775.14},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37279.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35537.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":84511.62},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34840.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35537.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":69931.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36930.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":75635.45},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":107091.76},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37244.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":99595.61},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":75635.45},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34840.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39021.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34840.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","code_information":[{"code":"831","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9609.77,"maximum":58663.96,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":22320.81},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18229.9},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35533.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9994.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9609.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":20497.82},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":37830.65},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":18986.27},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":31201.27},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9898.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9898.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":17605.8},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":58663.96},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":44528.58},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10282.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9801.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22165.68},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9609.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9801.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19288.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10186.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19837.64},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28088.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10272.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":26121.91},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":19837.64},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9609.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10762.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9609.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":2091.66,"10th_percentile":2091.66,"90th_percentile":2091.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":6854.6,"10th_percentile":6854.6,"90th_percentile":6854.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":16720.41,"10th_percentile":16720.41,"90th_percentile":16720.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"839","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11410.53,"maximum":70440.66,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":26801.67},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21889.52},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42667.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11410.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":24612.72},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":45425.09},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":22797.74},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":37464.87},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11752.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11752.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":21140.14},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":70440.66},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":53467.62},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12209.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11638.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26615.41},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11410.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11638.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22903.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12095.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23820.02},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33726.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12197.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":31365.84},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":23820.02},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11410.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12779.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11410.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","code_information":[{"code":"847","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10398.25,"maximum":63820.54,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":24282.81},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19832.31},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38657.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10814.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10398.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":22299.58},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":41155.97},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":20655.17},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":33943.87},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10710.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":10710.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":19153.36},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":63820.54},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":48442.65},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11126.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10606.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24114.05},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10398.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10606.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20871.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11022.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21581.38},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30556.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11115.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":28418.03},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":21581.38},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10398.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11646.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10398.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","code_information":[{"code":"857","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16614.38,"maximum":104473.08,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":39750.52},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":32465.14},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":63281.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17278.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16614.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":36504.01},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":67371.59},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":33812.14},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":55565.5},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17112.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":17112.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":31353.7},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":104473.08},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":79299.75},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17777.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16946.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39474.27},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16614.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16946.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33348.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17611.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":35328.33},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50021.16},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17760.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":46519.8},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":35328.33},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16614.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18608.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16614.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15826.24,"10th_percentile":15826.24,"90th_percentile":15826.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9298.27,"10th_percentile":9298.27,"90th_percentile":9298.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Cc","code_information":[{"code":"868","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8331.19,"maximum":50302.21,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":19139.28},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15631.48},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30469.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8664.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8331.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":17576.13},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":32438.41},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":16280.04},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":26753.95},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8581.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8581.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":15096.34},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":50302.21},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":38181.63},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8914.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8497.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19006.27},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8331.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8497.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16722.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8831.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17010.06},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24084.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8906.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":22398.59},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":17010.06},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8331.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9330.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8331.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neuroses Except Depressive","code_information":[{"code":"882","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8649.71,"maximum":52385.33,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":19931.88},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16278.81},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31730.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8995.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8649.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":18303.99},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":33781.75},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":16954.23},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":27861.89},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8909.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8909.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":15721.51},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":52385.33},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39762.81},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9255.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8822.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19793.36},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8649.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8822.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17361.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9168.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17714.48},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25081.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9246.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":23326.16},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":17714.48},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8649.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9687.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8649.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","code_information":[{"code":"896","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13657.38,"maximum":85134.7,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":32392.55},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26455.72},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51567.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14203.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13657.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":29746.97},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":54900.85},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":27553.38},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":45280.11},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14067.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14067.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":25550.01},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":85134.7},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":64621.05},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14613.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13930.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32167.43},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13657.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13930.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27413.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14476.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28788.91},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40762.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14599.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":37908.81},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":28788.91},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13657.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15296.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13657.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":85134.7,"10th_percentile":85134.7,"90th_percentile":85134.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12618.41,"10th_percentile":12618.41,"90th_percentile":12618.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2544.08,"10th_percentile":2544.08,"90th_percentile":2544.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Mcc","code_information":[{"code":"907","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29279.38,"maximum":187300.25,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":71265.09},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":58203.79},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113451.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30450.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29279.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":65444.71},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":120784.38},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":60618.71},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":99618.32},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30157.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":30157.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":56211.19},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":187300.25},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":142169.28},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31328.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29864.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":70769.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29279.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29864.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":58769.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31036.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":63336.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":89678.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31299.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":83401.11},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":63336.93},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29279.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32792.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29279.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs Without Mcc","code_information":[{"code":"918","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7033.21,"maximum":41813.62,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":15909.49},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12993.64},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25327.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7314.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7033.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":14610.13},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":26964.37},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":13532.75},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":22239.17},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7244.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7244.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":12548.8},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":41813.62},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31738.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7525.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7173.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15798.92},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7033.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7173.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14117.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7455.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14139.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20020.14},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7518.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":18618.78},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":14139.58},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7033.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7877.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7033.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6892.91,"10th_percentile":6892.91,"90th_percentile":6892.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7226.3,"10th_percentile":7226.3,"90th_percentile":7226.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2081.01,"10th_percentile":2081.01,"90th_percentile":2081.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4949.81,"10th_percentile":4949.81,"90th_percentile":4949.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","code_information":[{"code":"929","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24665.58,"maximum":157126.73,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":59784.49},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":48827.33},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":95174.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25652.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24665.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":54901.76},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":101326.37},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":50853.21},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":83570.1},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25405.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":25405.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":47155.73},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":157126.73},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":119266.22},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26392.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25158.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59369.01},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24665.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25158.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":49508.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26145.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":53133.54},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":75231.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26367.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":69965.44},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":53133.54},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24665.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27625.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24665.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation Without Cc/Mcc","code_information":[{"code":"946","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9194.27,"maximum":55946.64,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":21286.9},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17385.49},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33887.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9562.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9194.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":19548.35},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":36078.33},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":18106.83},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":29756.02},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9470.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9470.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":16790.3},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":55946.64},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42466.0},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9837.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9378.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21138.96},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9194.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9378.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18454.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9745.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18918.76},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26786.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9828.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":24911.94},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":18918.76},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9194.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10297.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9194.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Mcc","code_information":[{"code":"957","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":57481.33,"maximum":371736.82,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":141440.58},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":115517.68},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":225168.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":59780.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57481.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":129888.82},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":239722.05},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":120310.6},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":197713.55},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":59205.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":59205.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":111562.96},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":371736.82},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":282164.9},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":61505.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":58630.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":140457.62},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57481.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":58630.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":115376.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":60930.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":125705.49},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":177985.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":61447.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":165527.09},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":125705.49},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57481.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64379.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57481.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Mcc","code_information":[{"code":"974","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22168.09,"maximum":140793.51,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":53569.93},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":43751.76},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":85281.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23054.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22168.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":49194.76},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":90793.56},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":45567.05},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":74883.04},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22833.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":22833.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":42253.93},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":140793.51},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":106868.58},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23719.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22611.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53197.64},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22168.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22611.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":44495.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23498.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":47610.34},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":67411.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23697.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":62692.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":47610.34},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22168.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24828.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22168.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":14185.75,"10th_percentile":14185.75,"90th_percentile":14185.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","code_information":[{"code":"004","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":103966.14,"maximum":675740.55,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":257109.69},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":209987.22},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":409308.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":108124.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":103966.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":236110.96},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":435765.04},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":218699.75},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":359402.28},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":107085.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":107085.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":202798.35},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":675740.55},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":512917.34},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":111243.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":106045.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":255322.86},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":103966.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":106045.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":208680.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":110204.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":228506.55},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":323541.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":111139.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":300893.96},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":228506.55},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":103966.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116442.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":103966.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":313166.3,"10th_percentile":313166.3,"90th_percentile":313166.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","code_information":[{"code":"013","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22136.76,"maximum":140588.61,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":53491.97},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":43688.09},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":85157.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23022.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22136.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":49123.16},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":90661.43},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":45500.74},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":74774.06},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22800.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":22800.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":42192.43},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":140588.61},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":106713.05},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23686.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22579.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53120.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22136.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22579.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":44432.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23464.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":47541.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":67313.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23664.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":62601.34},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":47541.05},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22136.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24793.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22136.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","code_information":[{"code":"022","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24341.83,"maximum":155009.46,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":58978.9},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":48169.38},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":93892.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25315.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24341.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":54161.96},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":99961.0},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":50167.97},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":82444.0},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25072.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":25072.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":46520.31},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":155009.46},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":117659.12},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26045.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24828.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58569.01},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24341.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24828.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":48858.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25802.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":52417.57},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":74217.71},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26021.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":69022.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":52417.57},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24341.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27262.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24341.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures Without Cc/Mcc","code_information":[{"code":"030","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17014.96,"maximum":107092.83,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":40747.3},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":33279.23},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64868.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17695.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17014.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":37419.38},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":69060.99},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":34660.01},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":56958.85},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17525.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":17525.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":32139.92},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":107092.83},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":81288.26},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18206.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17355.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40464.12},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17014.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17355.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34152.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18035.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":36214.21},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51275.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18188.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":47686.33},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":36214.21},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17014.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19056.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17014.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Cc","code_information":[{"code":"038","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12743.57,"maximum":79158.54,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":30118.7},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24598.62},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47947.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13253.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12743.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":27658.84},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":51047.0},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":25619.23},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":42101.6},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13125.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":13125.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":23756.49},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":79158.54},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":60084.88},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13635.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12998.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29909.39},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12743.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12998.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25578.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13508.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26768.03},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37900.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13622.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":35247.74},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":26768.03},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12743.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14272.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12743.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12457.98,"10th_percentile":12457.98,"90th_percentile":12457.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms Without Mcc","code_information":[{"code":"055","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8245.4,"maximum":49741.19,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":18925.82},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15457.14},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30129.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8575.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8245.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":17380.1},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":32076.62},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":16098.46},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":26455.56},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8492.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8492.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":14927.96},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":49741.19},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37755.79},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8822.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8410.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18794.29},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8245.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8410.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16550.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8740.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16820.34},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23815.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8814.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":22148.77},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":16820.34},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8245.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9234.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8245.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","code_information":[{"code":"063","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11111.4,"maximum":68484.38,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":26057.34},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21281.61},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41482.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11555.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11111.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":23929.17},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":44163.55},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":22164.6},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":36424.4},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11444.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11444.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":20553.04},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":68484.38},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":51982.71},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11889.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11333.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25876.25},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11111.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11333.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22302.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11778.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23158.49},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32789.96},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11878.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":30494.75},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":23158.49},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11111.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12444.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11111.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Cc","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8293.14,"maximum":50053.41,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":19044.61},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15554.16},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30318.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8624.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":17489.2},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":32277.96},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":16199.51},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":26621.62},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8541.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8541.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":15021.67},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":50053.41},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37992.78},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8873.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8459.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18912.26},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8293.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8459.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16645.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8790.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16925.92},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23965.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8865.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":22287.8},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":16925.92},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8293.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9288.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Mcc","code_information":[{"code":"082","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17689.32,"maximum":111503.0,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":42425.31},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":34649.7},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":67539.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18396.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17689.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":38960.34},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":71904.98},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":36087.34},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":59304.46},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18220.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":18220.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":33463.47},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":111503.0},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":84635.77},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18927.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18043.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42130.46},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17689.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18043.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":35506.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18750.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":37705.54},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53387.04},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18909.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":49650.09},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":37705.54},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17689.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19812.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17689.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion Without Cc/Mcc","code_information":[{"code":"090","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6780.32,"maximum":40159.81,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":15280.24},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12479.71},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24325.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7051.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6780.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":14032.27},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":25897.87},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":12997.5},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":21359.57},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6983.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6983.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":12052.47},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":40159.81},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30483.1},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7254.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6915.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15174.05},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6780.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6915.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13609.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7187.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13580.33},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19228.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7248.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":17882.37},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":13580.33},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6780.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7593.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6780.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","code_information":[{"code":"098","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17758.69,"maximum":111956.7,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":42597.93},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":34790.68},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":67814.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18469.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17758.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":39118.87},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":72197.55},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":36234.18},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":59545.77},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18291.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":18291.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":33599.63},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":111956.7},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":84980.15},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19001.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18113.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42301.89},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17758.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18113.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":35645.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18824.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":37858.97},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53604.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18984.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":49852.11},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":37858.97},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17758.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19889.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17758.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extraocular Procedures Except Orbit","code_information":[{"code":"115","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12089.36,"maximum":74880.1,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":28490.81},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23269.08},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45356.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12572.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12089.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":26163.91},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":48287.95},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":24234.54},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":39826.05},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12452.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12452.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":22472.47},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":74880.1},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":56837.35},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12935.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12331.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28292.81},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12089.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12331.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24265.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12814.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25321.25},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35852.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12923.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":33342.63},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":25321.25},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12089.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13540.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12089.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures With Cc/Mcc","code_information":[{"code":"135","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16826.98,"maximum":105863.45,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":40279.54},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":32897.2},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64123.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17500.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16826.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":36989.82},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":68268.2},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":34262.13},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":56304.99},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17331.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":17331.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":31770.97},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":105863.45},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":80355.1},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18004.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17163.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39999.61},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16826.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17163.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33775.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17836.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":35798.49},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50686.86},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17988.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":47138.91},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":35798.49},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16826.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18846.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16826.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","code_information":[{"code":"143","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28587.87,"maximum":182777.88,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":69544.39},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":56798.46},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":110712.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29731.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28587.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":63864.54},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":117868.04},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":59155.07},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":97213.03},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29445.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":29445.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":54853.97},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":182777.88},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":138736.6},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30589.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29159.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":69061.08},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28587.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29159.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":57381.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30303.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":61807.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":87513.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30560.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":81387.39},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":61807.66},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28587.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32018.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28587.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis Without Mcc","code_information":[{"code":"151","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6114.92,"maximum":35808.19,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":13624.51},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11127.44},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21689.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6359.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6114.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":12511.76},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":23091.64},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":11589.13},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":19045.1},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6298.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6298.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":10746.49},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":35808.19},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27180.02},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6542.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6237.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13529.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6114.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6237.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12273.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6481.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12108.8},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17144.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6536.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":15944.68},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":12108.8},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6114.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6848.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6114.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases Without Cc/Mcc","code_information":[{"code":"159","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5924.7,"maximum":34564.17,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":13151.18},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10740.86},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20936.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6161.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5924.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":12077.09},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":22289.41},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":11186.51},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":18383.45},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6102.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6102.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":10373.15},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":34564.17},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26235.76},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6339.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6043.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13059.78},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5924.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6043.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11892.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6280.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11688.12},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16549.14},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6333.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":15390.75},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":11688.12},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5924.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6635.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5924.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7575.3,"10th_percentile":7575.3,"90th_percentile":7575.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10886.12,"maximum":67011.08,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":25496.76},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20823.78},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40589.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11321.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10886.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":23414.39},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":43213.46},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":21687.77},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":35640.8},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11212.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11212.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":20110.88},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":67011.08},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":50864.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11648.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11103.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25319.57},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10886.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11103.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21850.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11539.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22660.28},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32084.55},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11637.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":29838.71},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":22660.28},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10886.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12192.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10886.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":23341.58,"10th_percentile":23341.58,"90th_percentile":23341.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10212.81,"10th_percentile":10212.81,"90th_percentile":10212.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10858.28,"10th_percentile":10858.28,"90th_percentile":10858.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8975.11,"10th_percentile":8975.11,"90th_percentile":8975.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8715.41,"10th_percentile":8715.41,"90th_percentile":8715.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Mcc","code_information":[{"code":"183","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12052.06,"maximum":74636.17,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":28398.0},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23193.28},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45208.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12534.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12052.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":26078.68},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":48130.65},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":24155.59},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":39696.32},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12413.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12413.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":22399.27},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":74636.17},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":56652.2},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12895.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12293.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28200.65},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12052.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12293.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24190.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12775.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25238.76},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35735.4},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12883.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":33234.02},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":25238.76},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12052.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13498.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12052.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10325.33,"10th_percentile":10325.33,"90th_percentile":10325.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6928.03,"maximum":41125.76,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":15647.77},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12779.88},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24910.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7205.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6928.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":14369.78},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":26520.78},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":13310.13},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":21873.32},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7135.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7135.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":12342.36},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":41125.76},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31216.29},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7412.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7066.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15539.02},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6928.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7066.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13905.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7343.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13906.97},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19690.79},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7406.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":18312.49},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":13906.97},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6928.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7759.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6928.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5920.12,"10th_percentile":5920.12,"90th_percentile":5920.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":13310.13,"10th_percentile":13310.13,"90th_percentile":13310.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6527.72,"10th_percentile":6527.72,"90th_percentile":6527.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5057.73,"10th_percentile":5057.73,"90th_percentile":6052.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Mcc","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13799.11,"maximum":86061.62,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":32745.22},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26743.76},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52129.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14351.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13799.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":30070.85},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":55498.59},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":27853.37},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":45773.1},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14213.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14213.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":25828.19},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":86061.62},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":65324.62},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14765.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14075.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32517.66},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13799.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14075.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27697.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14627.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29102.36},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41205.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14751.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":38321.54},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":29102.36},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13799.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15455.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13799.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":27853.37,"10th_percentile":27853.37,"90th_percentile":27853.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12904.08,"10th_percentile":12904.08,"90th_percentile":12904.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support >96 Hours","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48640.15,"maximum":313916.84,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":119440.9},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":97550.05},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190145.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50585.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48640.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":109685.9},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":202435.66},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":101597.48},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":166961.16},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":50099.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":50099.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":94210.44},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":313916.84},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":238276.94},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52044.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":49612.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":118610.83},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48640.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":49612.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":97630.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":51558.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":106153.25},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150301.72},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51996.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":139780.99},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":106153.25},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48640.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54476.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48640.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":58685.37,"10th_percentile":58685.37,"90th_percentile":58685.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26897.91,"10th_percentile":26897.91,"90th_percentile":47539.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45824.55,"10th_percentile":45824.55,"90th_percentile":45824.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","code_information":[{"code":"218","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":49688.98,"maximum":320776.01,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":122050.72},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":99681.55},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194300.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51676.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49688.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":112082.56},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":206858.94},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":103817.41},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":170609.31},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":51179.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":51179.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":96268.97},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":320776.01},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":243483.36},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53167.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":50682.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":121202.5},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49688.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":50682.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":99735.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":52670.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":108472.72},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":153585.86},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53117.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":142835.24},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":108472.72},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49688.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":55651.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49688.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","code_information":[{"code":"233","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":57670.06,"maximum":372971.08,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":141910.2},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":115901.23},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":225915.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":59976.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57670.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":130320.08},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":240517.99},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":120710.06},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":198370.0},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":59400.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":59400.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":111933.37},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":372971.08},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":283101.76},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":61706.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":58823.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":140923.97},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57670.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":58823.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":115755.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":61130.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":126122.86},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":178576.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":61649.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":166076.68},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":126122.86},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57670.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64590.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57670.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36737.34,"10th_percentile":36737.34,"90th_percentile":36737.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Cc","code_information":[{"code":"243","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16535.31,"maximum":103955.96,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":39553.77},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":32304.44},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":62968.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17196.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16535.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":36323.32},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":67038.11},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":33644.78},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":55290.46},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17031.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":17031.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":31198.51},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":103955.96},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":78907.23},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17692.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16866.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39278.88},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16535.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16866.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33189.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17527.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":35153.46},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49773.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17676.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":46289.54},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":35153.46},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16535.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18519.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16535.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15025.48,"10th_percentile":14983.28,"90th_percentile":16183.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16170.28,"10th_percentile":16170.28,"90th_percentile":16170.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25679.51,"10th_percentile":25679.51,"90th_percentile":25679.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16162.28,"10th_percentile":15607.72,"90th_percentile":16206.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","code_information":[{"code":"255","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20761.2,"maximum":131592.66,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":50069.14},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":40892.58},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":79708.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21591.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20761.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":45979.88},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":84860.2},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":42589.25},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":69989.44},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21384.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":21384.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":39492.63},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":131592.66},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":99884.72},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22214.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21176.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49721.17},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20761.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21176.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":41671.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22006.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":44499.01},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":63005.87},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22193.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":58595.62},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":44499.01},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20761.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23252.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20761.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein Ligation And Stripping","code_information":[{"code":"263","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23446.68,"maximum":149155.26,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":56751.46},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":46350.18},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":90346.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24384.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23446.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":52116.44},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":96185.8},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":48273.29},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":79330.36},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24150.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":24150.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":44763.39},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":149155.26},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":113215.52},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25087.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23915.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56357.05},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23446.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23915.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":47062.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24853.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":50437.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":71414.75},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25064.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":66415.9},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":50437.93},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23446.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26260.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23446.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25425.07,"10th_percentile":25425.07,"90th_percentile":25425.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Cc","code_information":[{"code":"271","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27168.3,"maximum":173494.1,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":66012.04},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":53913.51},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105088.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28255.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27168.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":60620.69},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":111881.2},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":56150.42},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":92275.32},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27983.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":27983.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":52067.79},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":173494.1},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":131689.79},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29070.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27711.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65553.28},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27168.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27711.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":54532.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28798.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":58668.28},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":83068.06},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29042.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":77253.5},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":58668.28},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27168.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30428.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27168.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":120206.98,"10th_percentile":120206.98,"90th_percentile":120206.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26073.89,"10th_percentile":26073.89,"90th_percentile":26073.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":99091.04,"10th_percentile":99091.04,"90th_percentile":99091.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26201.16,"10th_percentile":26201.16,"90th_percentile":26201.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":193210.97,"10th_percentile":193210.97,"90th_percentile":193210.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24060.71,"10th_percentile":24060.71,"90th_percentile":24060.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":96001.68,"10th_percentile":96001.68,"90th_percentile":96001.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26556.79,"10th_percentile":26556.79,"90th_percentile":26556.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","code_information":[{"code":"279","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27542.02,"maximum":175938.22,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":66942.0},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":54673.02},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":106569.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28643.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27542.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":61474.69},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":113457.34},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":56941.45},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":93575.26},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28368.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":28368.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":52801.3},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":175938.22},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":133544.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29469.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28092.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":66476.77},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27542.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28092.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55282.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29194.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":59494.78},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":84238.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29442.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":78341.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":59494.78},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27542.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30847.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27542.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24566.28,"10th_percentile":24566.28,"90th_percentile":24566.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","code_information":[{"code":"287","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8622.11,"maximum":52204.83,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":19863.2},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16222.72},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31621.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8966.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8622.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":18240.92},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":33665.35},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":16895.81},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":27765.88},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8880.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8880.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":15667.33},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":52204.83},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39625.8},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9225.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8794.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19725.15},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8622.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8794.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17306.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9139.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17653.44},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24995.4},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9217.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":23245.78},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":17653.44},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8622.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9656.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8622.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":18184.21,"10th_percentile":18184.21,"90th_percentile":18184.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":30930.52,"10th_percentile":30930.52,"90th_percentile":30930.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":11902.82,"10th_percentile":11902.82,"90th_percentile":11902.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8858.44,"10th_percentile":8858.44,"90th_percentile":8858.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8781.17,"10th_percentile":8781.17,"90th_percentile":8781.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":14591.0,"10th_percentile":14591.0,"90th_percentile":14591.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8405.89,"10th_percentile":8405.89,"90th_percentile":8405.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4646.67,"10th_percentile":4646.67,"90th_percentile":4646.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8252.02,"10th_percentile":7693.42,"90th_percentile":8473.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6669.32,"10th_percentile":6669.32,"90th_percentile":7577.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Cc","code_information":[{"code":"297","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5368.96,"maximum":30929.69,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":11768.31},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9611.44},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18734.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5583.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5368.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":10807.16},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":19945.64},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":10010.23},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":16450.4},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5530.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":5530.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":9282.39},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":30929.69},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23477.02},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5744.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5476.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11686.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5368.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5476.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10776.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5691.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10459.1},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14808.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5739.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":13772.38},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":10459.1},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5368.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6013.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5368.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension Without Mcc","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6272.32,"maximum":36837.55,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":14016.17},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11447.32},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22313.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6523.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6272.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":12871.43},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":23755.45},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":11922.27},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":19592.58},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6460.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6460.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":11055.42},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":36837.55},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27961.35},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6711.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6397.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13918.76},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6272.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6397.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12589.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6648.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12456.88},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17637.63},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6705.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":16403.04},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":12456.88},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6272.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7025.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6272.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":12831.41,"10th_percentile":12831.41,"90th_percentile":12831.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4803.71,"10th_percentile":4803.71,"90th_percentile":4803.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":5979.25,"10th_percentile":5979.25,"90th_percentile":5979.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"1 through 10","median_amount":2794.6,"10th_percentile":2794.6,"90th_percentile":2794.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6256.85,"10th_percentile":6256.85,"90th_percentile":6256.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5543.87,"10th_percentile":5396.87,"90th_percentile":5739.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":13486.96,"10th_percentile":13486.96,"90th_percentile":13486.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4260.07,"10th_percentile":150.59,"90th_percentile":6073.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chest Pain","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6010.49,"maximum":35125.2,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":13364.64},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10915.2},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21276.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6250.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6010.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":12273.12},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":22651.2},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":11368.08},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":18681.84},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6190.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6190.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":10541.52},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":35125.2},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26661.6},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6431.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6130.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13271.76},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6010.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6130.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12064.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6371.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11877.84},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16817.76},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6425.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":15640.56},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":11877.84},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6010.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6731.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6010.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10915.2,"10th_percentile":10915.2,"90th_percentile":10915.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":9187.22,"10th_percentile":9187.22,"90th_percentile":9187.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4714.67,"10th_percentile":2657.74,"90th_percentile":5881.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5396.3,"10th_percentile":5396.3,"90th_percentile":5396.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"1 through 10","median_amount":2400.11,"10th_percentile":2400.11,"90th_percentile":2400.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5800.92,"10th_percentile":5800.92,"90th_percentile":5800.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2494.56,"10th_percentile":2494.56,"90th_percentile":2494.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3950.27,"10th_percentile":3950.27,"90th_percentile":4675.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures With Mcc","code_information":[{"code":"319","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33931.21,"maximum":217722.58,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":82840.35},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":67657.56},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":131878.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35288.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33931.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":76074.59},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":140402.83},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":70464.73},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":115798.87},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34949.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":34949.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":65341.32},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":217722.58},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":165261.19},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36306.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34609.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":82264.64},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33931.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34609.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":68106.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35967.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":73624.46},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":104244.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36272.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":96947.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":73624.46},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33931.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38002.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33931.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Cc","code_information":[{"code":"327","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18872.42,"maximum":119240.3,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":45369.24},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":37054.07},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":72226.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19627.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18872.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":41663.83},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":76894.53},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":38591.47},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":63419.66},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19438.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":19438.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":35785.53},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":119240.3},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":90508.73},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20193.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19249.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45053.94},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18872.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19249.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":37880.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20004.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":40321.97},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57091.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20174.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":53095.36},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":40321.97},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18872.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21137.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18872.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18449.42,"10th_percentile":18449.42,"90th_percentile":18449.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9769.59,"10th_percentile":9769.59,"90th_percentile":9769.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Mcc","code_information":[{"code":"335","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27277.21,"maximum":174206.36,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":66283.05},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":54134.84},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105520.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28368.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27277.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":60869.56},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":112340.51},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":56380.94},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":92654.14},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28095.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":28095.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":52281.55},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":174206.36},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":132230.43},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29186.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27822.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65822.4},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27277.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27822.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":54750.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28913.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":58909.14},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":83409.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29159.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":77570.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":58909.14},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27277.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30550.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27277.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28020.97,"10th_percentile":28020.97,"90th_percentile":28020.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26660.74,"10th_percentile":26660.74,"90th_percentile":26660.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures Without Cc/Mcc","code_information":[{"code":"349","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7133.91,"maximum":42472.22,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":16160.08},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13198.3},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25726.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7419.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7133.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":14840.25},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":27389.08},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":13745.9},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":22589.46},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7347.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7347.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":12746.45},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":42472.22},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32238.32},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7633.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7276.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16047.77},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7133.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7276.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14319.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7561.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14362.29},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20335.47},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7626.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":18912.04},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":14362.29},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7133.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7989.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7133.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":9081.12,"10th_percentile":9081.12,"90th_percentile":9081.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Cc","code_information":[{"code":"357","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17986.96,"maximum":113449.52,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":43165.93},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":35254.58},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":68718.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18706.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17986.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":39640.47},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":73160.23},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":36717.32},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":60339.75},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18526.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":18526.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":34047.65},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":113449.52},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":86113.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19246.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18346.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42865.94},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17986.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18346.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36103.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19066.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":38363.77},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54319.03},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19228.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":50516.84},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":38363.77},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17986.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20145.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17986.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8968.13,"10th_percentile":8968.13,"90th_percentile":8968.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","code_information":[{"code":"372","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8255.84,"maximum":49809.49,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":18951.8},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15478.36},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30170.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8586.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8255.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":17403.97},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":32120.66},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":16120.57},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":26491.89},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8503.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8503.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":14948.46},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":49809.49},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37807.63},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8833.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8420.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18820.09},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8255.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8420.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16571.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8751.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16843.44},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23848.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8825.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":22179.18},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":16843.44},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8255.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9246.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8255.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4694.26,"10th_percentile":4694.26,"90th_percentile":4694.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8118.45,"10th_percentile":8118.45,"90th_percentile":8118.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6144.75,"10th_percentile":6144.75,"90th_percentile":7585.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Mcc","code_information":[{"code":"380","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15276.87,"maximum":95725.93,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":36422.36},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29746.95},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57983.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15887.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15276.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":33447.66},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":61730.81},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":30981.18},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":50913.2},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15735.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":15735.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":28728.57},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":95725.93},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":72660.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16346.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15582.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36169.23},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15276.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15582.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30663.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16193.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32370.41},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45833.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16330.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":42624.87},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":32370.41},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15276.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17110.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15276.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14193.39,"10th_percentile":14193.39,"90th_percentile":14193.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Mcc","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11655.95,"maximum":72045.69,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":27412.36},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22388.29},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43639.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12122.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11655.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":25173.53},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":46460.13},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":23317.2},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":38318.53},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12005.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12005.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":21621.83},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":72045.69},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":54685.9},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12471.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11889.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27221.85},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11655.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11889.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23395.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12355.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24362.77},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34495.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12460.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":32080.53},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":24362.77},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11655.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13054.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11655.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11425.31,"10th_percentile":11425.31,"90th_percentile":11425.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2692.71,"10th_percentile":2692.71,"90th_percentile":2692.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9467.8,"10th_percentile":9467.8,"90th_percentile":9467.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Mcc","code_information":[{"code":"397","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18504.66,"maximum":116835.2,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":44454.13},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":36306.68},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":70769.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19244.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18504.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":40823.47},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":75343.55},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":37813.08},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":62140.47},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19059.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":19059.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":35063.73},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":116835.2},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":88683.15},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19799.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18874.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44145.19},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18504.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18874.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":37142.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19614.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":39508.67},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":55940.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19781.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":52024.41},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":39508.67},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18504.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20725.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18504.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","code_information":[{"code":"409","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16881.44,"maximum":106219.58,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":40415.04},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":33007.87},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64339.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17556.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16881.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":37114.26},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":68497.86},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":34377.39},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":56494.4},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17387.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":17387.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":31877.85},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":106219.58},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":80625.42},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18063.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17219.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40134.17},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16881.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17219.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33884.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17894.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":35918.92},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50857.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18046.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":47297.49},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":35918.92},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16881.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18907.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16881.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","code_information":[{"code":"417","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18441.25,"maximum":116420.52,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":44296.36},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":36177.82},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":70518.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19178.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18441.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":40678.57},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":75076.14},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":37678.87},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":61919.92},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18994.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":18994.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":34939.28},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":116420.52},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":88368.39},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19732.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18810.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43988.51},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18441.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18810.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":37015.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19547.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":39368.44},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":55741.53},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19713.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":51839.77},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":39368.44},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18441.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20654.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18441.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":22908.44,"10th_percentile":22908.44,"90th_percentile":22908.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18939.6,"10th_percentile":18939.6,"90th_percentile":18939.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16751.03,"10th_percentile":16751.03,"90th_percentile":16751.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18039.73,"10th_percentile":18039.73,"90th_percentile":18039.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","code_information":[{"code":"425","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11831.25,"maximum":73192.14,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":27848.57},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22744.55},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44333.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12304.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11831.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":25574.11},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":47199.44},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":23688.24},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":38928.28},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12186.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12186.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":21965.89},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":73192.14},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":55556.11},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12659.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12067.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27655.03},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11831.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12067.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23747.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12541.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24750.45},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35044.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12647.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":32591.02},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":24750.45},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11831.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13251.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11831.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"434","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5954.54,"maximum":34759.31,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":13225.43},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10801.5},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21054.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6192.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5954.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":12145.28},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":22415.25},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":11249.66},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":18487.24},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6133.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6133.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":10431.71},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":34759.31},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26383.88},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6371.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6073.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13133.51},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5954.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6073.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11951.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6311.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11754.11},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16642.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6365.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":15477.64},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":11754.11},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5954.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6669.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5954.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","code_information":[{"code":"442","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7840.34,"maximum":47092.16,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":17917.9},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14633.95},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28524.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8153.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7840.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":16454.5},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":30368.34},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":15241.12},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":25046.64},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8075.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8075.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":14132.96},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":47092.16},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35745.06},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8389.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7997.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17793.37},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7840.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7997.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15737.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8310.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15924.55},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22547.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8381.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":20969.21},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":15924.55},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7840.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8781.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7840.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2077.74,"10th_percentile":2077.74,"90th_percentile":2077.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6684.35,"10th_percentile":6684.35,"90th_percentile":6684.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"451","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24737.2,"maximum":157595.06,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":59962.68},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":48972.86},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":95458.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25726.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24737.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":55065.4},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":101628.38},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":51004.79},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":83819.19},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25479.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":25479.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":47296.29},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":157595.06},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":119621.71},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26468.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25231.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59545.96},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24737.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25231.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":49652.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26221.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":53291.91},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":75455.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26444.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":70173.98},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":53291.91},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24737.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27705.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24737.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"465","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14243.7,"maximum":88969.2,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":33851.52},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27647.29},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53890.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14813.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14243.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":31086.79},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":57373.6},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":28794.4},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":47319.54},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14671.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14671.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":26700.79},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":88969.2},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":67531.61},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15240.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14528.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33616.26},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14243.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14528.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28589.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15098.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30085.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42597.98},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15226.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":39616.24},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":30085.58},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14243.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15952.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14243.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion Without Cc/Mcc","code_information":[{"code":"473","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18850.78,"maximum":119098.82,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":45315.41},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":37010.11},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":72140.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19604.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18850.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":41614.4},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":76803.3},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":38545.69},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":63344.41},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19416.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":19416.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":35743.07},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":119098.82},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":90401.34},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20170.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19227.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45000.48},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18850.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19227.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":37837.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19981.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":40274.13},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57023.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20151.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":53032.36},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":40274.13},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18850.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21112.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18850.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Cc","code_information":[{"code":"481","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16263.78,"maximum":102180.18,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":38878.11},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31752.62},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":61892.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16914.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16263.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":35702.85},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":65892.97},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":33070.06},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":54345.99},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16751.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":16751.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":30665.57},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":102180.18},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":77559.34},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17402.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16589.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38607.92},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16263.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16589.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32644.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17239.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34552.97},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48923.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17385.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":45498.82},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":34552.97},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16263.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18215.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16263.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15901.9,"10th_percentile":15901.9,"90th_percentile":15901.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":32789.37,"10th_percentile":32789.37,"90th_percentile":32789.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":79623.58,"10th_percentile":79623.58,"90th_percentile":79623.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16221.33,"10th_percentile":16221.33,"90th_percentile":16221.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14328.9,"10th_percentile":14328.9,"90th_percentile":14328.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15897.41,"10th_percentile":15378.97,"90th_percentile":16789.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","code_information":[{"code":"492","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28028.39,"maximum":179119.01,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":68152.24},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":55661.46},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":108495.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29149.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28028.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":62586.09},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":115508.54},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":57970.89},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":95267.01},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28869.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":28869.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":53755.9},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":179119.01},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":135959.35},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29990.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28588.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":67678.6},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28028.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28588.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":56258.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29710.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":60570.39},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":85761.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29962.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":79758.17},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":60570.39},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28028.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31391.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28028.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26475.75,"10th_percentile":26475.75,"90th_percentile":26475.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20110.24,"10th_percentile":20110.24,"90th_percentile":20110.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Mcc","code_information":[{"code":"500","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24247.84,"maximum":154394.77,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":58745.02},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":47978.37},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":93519.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25217.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24247.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":53947.18},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":99564.61},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":49969.03},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":82117.07},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24975.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":24975.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":46335.84},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":154394.77},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":117192.54},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25945.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24732.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58336.76},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24247.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24732.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":48670.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25702.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":52209.71},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":73923.4},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25920.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":68748.95},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":52209.71},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24247.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27157.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24247.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","code_information":[{"code":"508","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11936.43,"maximum":73880.0,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":28110.29},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22958.3},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44750.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12413.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11936.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":25814.46},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":47643.02},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":23910.86},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":39294.14},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12294.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12294.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":22172.33},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":73880.0},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":56078.23},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12771.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12175.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27914.94},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11936.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12175.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23958.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12652.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24983.06},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35373.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12760.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":32897.31},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":24983.06},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11936.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13368.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11936.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","code_information":[{"code":"517","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12102.79,"maximum":74967.91,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":28524.23},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23296.37},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45409.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12586.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12102.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":26194.59},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":48344.58},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":24262.96},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":39872.75},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12465.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12465.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":22498.82},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":74967.91},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":56904.0},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12949.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12344.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28325.99},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12102.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12344.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24292.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12828.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25350.94},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35894.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12937.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":33381.73},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":25350.94},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12102.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13555.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12102.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11841.8,"10th_percentile":11841.8,"90th_percentile":11841.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11850.2,"10th_percentile":11850.2,"90th_percentile":11850.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis With Mcc","code_information":[{"code":"535","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10202.81,"maximum":62542.37,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":23796.48},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19435.12},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37883.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10610.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10202.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":21852.97},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":40331.72},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":20241.5},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":33264.05},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10508.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":10508.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":18769.76},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":62542.37},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":47472.46},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10917.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10406.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23631.11},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10202.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10406.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20479.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10814.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21149.15},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29944.96},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10906.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":27848.89},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":21149.15},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10202.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11427.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10202.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","code_information":[{"code":"543","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8308.06,"maximum":50150.98,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":19081.74},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15584.48},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30377.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8640.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8308.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":17523.29},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":32340.88},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":16231.09},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":26673.52},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8557.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8557.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":15050.95},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":50150.98},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":38066.84},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8889.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8474.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18949.12},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8308.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8474.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16675.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8806.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16958.92},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24012.02},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8881.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":22331.24},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":16958.92},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8308.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9305.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8308.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":750.0,"10th_percentile":750.0,"90th_percentile":750.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3821.65,"10th_percentile":3821.65,"90th_percentile":3821.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems With Mcc","code_information":[{"code":"551","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13142.66,"maximum":81768.54,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":31111.77},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25409.68},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49528.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13668.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13142.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":28570.8},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":52730.11},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":26463.94},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":43489.77},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13536.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":13536.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":24539.78},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":81768.54},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":62065.98},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14062.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13405.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30895.55},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13142.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13405.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26379.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13931.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27650.62},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39150.34},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14049.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":36409.92},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":27650.62},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13142.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14719.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13142.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":49528.76,"10th_percentile":49528.76,"90th_percentile":49528.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":50229.65,"10th_percentile":50229.65,"90th_percentile":50229.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6929.61,"10th_percentile":6929.61,"90th_percentile":6929.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11882.74,"10th_percentile":11882.74,"90th_percentile":11882.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"559","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14551.04,"maximum":90979.15,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":34616.27},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":28271.88},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":55107.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15133.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14551.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":31789.09},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":58669.75},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":29444.91},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":48388.56},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14987.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14987.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":27304.0},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":90979.15},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":69057.25},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15569.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14842.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34375.7},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14551.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14842.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":29206.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15424.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30765.26},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43560.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15555.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":40511.22},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":30765.26},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14551.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16297.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14551.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14219.21,"10th_percentile":14219.21,"90th_percentile":14219.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Mcc","code_information":[{"code":"570","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22579.12,"maximum":143481.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":54592.7},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":44587.08},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":86909.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23482.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22579.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":50133.99},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":92527.01},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":46437.03},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":76312.72},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23256.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":23256.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":43060.65},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":143481.56},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":108908.93},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24159.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23030.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54213.3},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22579.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23030.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":45320.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23933.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":48519.33},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":68698.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24137.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":63889.52},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":48519.33},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22579.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25288.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22579.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"578","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12622.72,"maximum":78368.22,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":29818.0},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24353.02},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47469.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13127.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12622.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":27382.69},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":50537.34},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":25363.45},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":41681.26},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13001.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":13001.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":23519.3},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":78368.22},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":59484.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13506.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12875.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29610.77},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12622.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12875.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25336.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13380.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26500.78},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37522.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13493.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":34895.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":26500.78},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12622.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14137.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12622.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Mcc","code_information":[{"code":"592","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15076.2,"maximum":94413.61,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":35923.04},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29339.15},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57188.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15679.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15076.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":32989.12},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":60884.54},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":30556.45},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":50215.23},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15528.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":15528.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":28334.73},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":94413.61},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":71664.16},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16131.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15377.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35673.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15076.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15377.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30260.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15980.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":31926.64},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45204.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16116.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":42040.52},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":31926.64},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15076.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16885.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15076.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders With Cc/Mcc","code_information":[{"code":"600","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8409.51,"maximum":50814.46,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":19334.18},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15790.66},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30779.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8745.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8409.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":17755.11},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":32768.74},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":16445.82},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":27026.4},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8661.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8661.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":15250.07},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":50814.46},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":38570.45},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8998.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8577.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19199.81},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8409.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8577.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16879.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8914.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17183.28},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24329.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8989.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":22626.68},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":17183.28},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8409.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9418.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8409.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures With Cc/Mcc","code_information":[{"code":"614","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16989.6,"maximum":106926.96,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":40684.19},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":33227.69},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64767.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17669.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16989.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":37361.42},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":68954.03},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":34606.33},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":56870.63},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17499.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":17499.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":32090.14},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":106926.96},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":81162.35},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18178.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17329.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40401.45},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16989.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17329.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34101.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18008.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":36158.12},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51196.06},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18161.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":47612.47},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":36158.12},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16989.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19028.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16989.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"622","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27189.93,"maximum":173635.57,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":66065.87},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":53957.47},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105174.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28277.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27189.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":60670.12},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":111972.43},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":56196.21},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":92350.56},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28005.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":28005.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":52110.25},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":173635.57},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":131797.18},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29093.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27733.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65606.73},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27189.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27733.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":54575.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28821.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":58716.12},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":83135.79},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29066.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":77316.5},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":58716.12},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27189.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30452.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27189.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","code_information":[{"code":"640","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10602.65,"maximum":65157.25,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":24791.41},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20247.7},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39466.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11026.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10602.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":22766.64},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":42017.98},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":21087.79},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":34654.81},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10920.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":10920.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":19554.52},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":65157.25},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":49457.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11344.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10814.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24619.11},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10602.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10814.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21281.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11238.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22033.39},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31196.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11334.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":29013.24},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":22033.39},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10602.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11874.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10602.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6298.71,"10th_percentile":4595.08,"90th_percentile":10398.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8405.58,"10th_percentile":8405.58,"90th_percentile":8405.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9855.0,"10th_percentile":9855.0,"90th_percentile":9855.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3556.28,"10th_percentile":3556.28,"90th_percentile":10398.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8604.97,"10th_percentile":8595.17,"90th_percentile":10383.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant","code_information":[{"code":"652","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24730.48,"maximum":157551.16,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":59945.98},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":48959.22},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":95431.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25719.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24730.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":55050.06},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":101600.07},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":50990.58},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":83795.84},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25472.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":25472.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":47283.11},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":157551.16},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":119588.39},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26461.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25225.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59529.37},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24730.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25225.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":49639.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26214.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":53277.06},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":75434.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26436.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":70154.43},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":53277.06},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24730.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27698.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24730.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Cc","code_information":[{"code":"660","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10498.96,"maximum":64479.13,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":24533.4},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20036.97},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39056.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10918.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10498.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":22529.7},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":41580.68},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":20868.32},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":34294.15},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10813.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":10813.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":19351.01},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":64479.13},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":48942.55},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11233.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10708.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24362.9},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10498.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10708.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21073.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11128.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21804.08},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30872.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11223.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":28711.29},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":21804.08},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10498.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11758.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10498.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12704.66,"10th_percentile":12704.66,"90th_percentile":12704.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":18803.77,"10th_percentile":18803.77,"90th_percentile":18803.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10262.73,"10th_percentile":10262.73,"90th_percentile":10696.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":39176.16,"10th_percentile":39176.16,"90th_percentile":39176.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":24927.46,"10th_percentile":24927.46,"90th_percentile":24927.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":61442.44,"10th_percentile":61442.44,"90th_percentile":61442.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7861.43,"10th_percentile":7861.43,"90th_percentile":10015.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10065.63,"10th_percentile":10065.63,"90th_percentile":10065.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Mcc","code_information":[{"code":"668","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22421.72,"maximum":142452.2,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":54201.04},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":44267.2},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":86286.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23318.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22421.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":49774.32},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":91863.2},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":46103.88},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":75765.24},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23094.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":23094.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":42751.72},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":142452.2},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":108127.6},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23991.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22870.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53824.36},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22421.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22870.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":45004.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23767.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":48171.24},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":68205.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23968.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":63431.16},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":48171.24},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22421.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25112.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22421.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20243.38,"10th_percentile":20243.38,"90th_percentile":20243.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":7720.79,"10th_percentile":7720.79,"90th_percentile":7720.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Mcc","code_information":[{"code":"682","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11687.28,"maximum":72250.59,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":27490.32},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22451.96},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43763.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12154.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11687.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":25245.13},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":46592.26},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":23383.51},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":38427.51},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12037.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12037.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":21683.32},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":72250.59},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":54841.43},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12505.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11921.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27299.27},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11687.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11921.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23458.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12388.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24432.06},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34593.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12493.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":32171.76},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":24432.06},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11687.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13089.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11687.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11435.13,"10th_percentile":11402.85,"90th_percentile":11438.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10091.99,"10th_percentile":10091.99,"90th_percentile":10091.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11657.27,"10th_percentile":11657.27,"90th_percentile":11657.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11649.54,"10th_percentile":11649.54,"90th_percentile":11649.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4537.48,"10th_percentile":4537.48,"90th_percentile":4537.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10474.12,"10th_percentile":10474.12,"90th_percentile":10474.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum HealthCare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11424.12,"10th_percentile":11424.12,"90th_percentile":11424.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10685.47,"10th_percentile":8787.79,"90th_percentile":11449.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones With Mcc","code_information":[{"code":"693","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10669.04,"maximum":65591.43,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":24956.61},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20382.62},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39729.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11095.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10669.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":22918.35},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":42297.97},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":21228.31},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":34885.74},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10989.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":10989.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":19684.82},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":65591.43},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":49786.84},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11415.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10882.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24783.17},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10669.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10882.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21414.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11309.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22180.22},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31404.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11405.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":29206.57},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":22180.22},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10669.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11949.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10669.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures With Cc/Mcc","code_information":[{"code":"707","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15561.08,"maximum":97584.64,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":37129.57},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30324.55},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":59108.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16183.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15561.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":34097.11},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":62929.44},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":31582.74},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":51901.78},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16027.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":16027.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":29286.39},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":97584.64},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":74071.11},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16650.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15872.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36871.53},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15561.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15872.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":31234.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16494.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32998.95},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46723.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16634.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":43452.52},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":32998.95},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15561.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17428.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15561.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","code_information":[{"code":"715","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17329.02,"maximum":109146.68,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":41528.76},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":33917.47},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":66112.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18022.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17329.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":38137.02},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":70385.46},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":35324.73},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":58051.22},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17848.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":17848.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":32756.31},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":109146.68},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":82847.22},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18542.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17675.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41240.15},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17329.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17675.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34782.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18368.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":36908.74},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52258.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18524.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":48600.87},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":36908.74},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17329.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19408.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17329.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy Without Mcc","code_information":[{"code":"726","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6025.41,"maximum":35222.77,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":13401.76},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10945.52},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21335.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6266.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6025.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":12307.21},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":22714.12},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":11399.66},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":18733.73},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6206.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6206.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":10570.8},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":35222.77},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26735.66},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6447.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6145.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13308.63},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6025.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6145.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12094.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6386.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11910.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16864.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6441.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":15684.01},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":11910.83},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6025.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6025.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5057.55,"10th_percentile":5057.55,"90th_percentile":5057.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","code_information":[{"code":"737","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16010.9,"maximum":100526.37,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":38248.86},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31238.7},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60890.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16651.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16010.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":35124.99},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":64826.48},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":32534.81},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":53466.39},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16491.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":16491.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":30169.24},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":100526.37},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":76304.02},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17131.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16331.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37983.04},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16010.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16331.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32137.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16971.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":33993.72},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48131.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17115.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":44762.41},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":33993.72},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16010.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17932.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16010.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","code_information":[{"code":"745","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9124.89,"maximum":55492.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":21114.28},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17244.5},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33613.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9489.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9124.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":19389.83},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":35785.75},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":17959.99},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":29514.71},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9398.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9398.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":16654.14},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":55492.94},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42121.63},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9763.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9307.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20967.54},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9124.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9307.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18315.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9672.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18765.34},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26569.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9754.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":24709.91},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":18765.34},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9124.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10219.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9124.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"756","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7804.53,"maximum":46857.99,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":17828.8},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14561.18},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28382.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8116.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7804.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":16372.68},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":30217.33},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":15165.33},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":24922.09},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8038.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8038.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":14062.68},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":46857.99},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35567.32},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8350.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7960.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17704.9},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7804.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7960.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15665.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8272.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15845.37},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22435.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8343.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":20864.94},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":15845.37},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7804.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8741.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7804.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion With D&C, Aspiration Curettage Or Hysterotomy","code_information":[{"code":"770","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8119.33,"maximum":48916.72,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":18612.12},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15200.93},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29629.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8444.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8119.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":17092.02},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":31544.94},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":15831.63},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":26017.06},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8362.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8362.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":14680.53},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":48916.72},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37129.98},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8687.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8281.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18482.77},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8119.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8281.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16297.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8606.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16541.54},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23421.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8679.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":21781.65},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":16541.54},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8119.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9093.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8119.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4247.82,"10th_percentile":4247.82,"90th_percentile":4247.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization Without Cc/Mcc","code_information":[{"code":"788","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7791.85,"maximum":46775.06,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":17797.25},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14535.41},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28332.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8103.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7791.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":16343.7},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":30163.85},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":15138.49},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":24877.98},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8025.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8025.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":14037.79},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":46775.06},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35504.36},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8337.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7947.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17673.56},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7791.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7947.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15639.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8259.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15817.32},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22395.65},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8329.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":20828.01},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":15817.32},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7791.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8726.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7791.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":12630.0,"10th_percentile":12630.0,"90th_percentile":12630.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":9861.0,"10th_percentile":8961.0,"90th_percentile":14503.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":41980.97,"10th_percentile":41980.97,"90th_percentile":41980.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"1 through 10","median_amount":91700.04,"10th_percentile":91700.04,"90th_percentile":91700.04},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"1 through 10","median_amount":3306.45,"10th_percentile":3306.45,"90th_percentile":3306.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3275.55,"10th_percentile":3275.55,"90th_percentile":3275.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"20","median_amount":3399.15,"10th_percentile":3399.15,"90th_percentile":4343.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":7891.1,"10th_percentile":7891.1,"90th_percentile":7891.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3090.14,"10th_percentile":3090.14,"90th_percentile":3090.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Mcc","code_information":[{"code":"796","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9344.95,"maximum":56932.1,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":21661.85},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17691.72},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34484.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9718.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9344.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":19892.68},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":36713.82},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":18425.76},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":30280.15},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9625.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9625.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":17086.05},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":56932.1},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":43214.01},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9999.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9531.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21511.31},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9344.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9531.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18757.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9905.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19252.0},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27258.79},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9989.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":25350.74},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":19252.0},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9344.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10466.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9344.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","code_information":[{"code":"804","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10754.83,"maximum":66152.46,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":25170.07},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20556.96},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40069.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11185.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10754.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":23114.38},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":42659.76},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":21409.88},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":35184.13},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11077.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11077.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":19853.2},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":66152.46},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":50212.68},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11507.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10969.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24995.15},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10754.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10969.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21587.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11400.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22369.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31673.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11496.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":29456.39},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":22369.93},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10754.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12045.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10754.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Without Mcc","code_information":[{"code":"812","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7488.99,"maximum":44794.39,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":17043.63},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13919.91},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27132.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7788.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7488.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":15651.64},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":28886.57},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":14497.46},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":23824.54},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7713.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7713.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":13443.37},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":44794.39},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34000.95},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8013.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7638.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16925.18},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7488.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7638.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15031.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7938.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15147.55},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21447.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8005.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":19946.06},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":15147.55},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7488.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8387.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7488.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7320.97,"10th_percentile":7320.97,"90th_percentile":7320.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":14147.46,"10th_percentile":14147.46,"90th_percentile":14147.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6154.08,"10th_percentile":6154.08,"90th_percentile":6154.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":3964.54,"10th_percentile":3964.54,"90th_percentile":55863.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":44794.39,"10th_percentile":44794.39,"90th_percentile":44794.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7494.44,"10th_percentile":7494.44,"90th_percentile":7494.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7365.57,"10th_percentile":7365.57,"90th_percentile":7365.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3475.78,"10th_percentile":3475.78,"90th_percentile":3475.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","code_information":[{"code":"820","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44388.9,"maximum":286114.27,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":108862.42},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":88910.37},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":173304.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46164.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44388.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":99971.38},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":184506.61},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":92599.33},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":152173.97},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":45720.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":45720.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":85866.54},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":286114.27},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":217173.54},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47496.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":45276.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":108105.86},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44388.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":45276.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":89097.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":47052.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":96751.61},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":136990.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47451.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":127401.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":96751.61},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44388.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49715.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44388.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","code_information":[{"code":"828","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13349.29,"maximum":83119.88,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":31625.94},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25829.61},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50347.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13883.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13349.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":29042.97},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":53601.55},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":26901.3},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":44208.5},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13749.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":13749.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":24945.34},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":83119.88},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":63091.71},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14283.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13616.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31406.15},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13349.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13616.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26794.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14150.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28107.59},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39797.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14270.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":37011.65},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":28107.59},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13349.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14951.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13349.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia Without Cc/Mcc","code_information":[{"code":"836","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9736.58,"maximum":59493.31,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":22636.36},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18487.62},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36036.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10126.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9736.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":20787.6},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":38365.47},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":19254.69},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":31642.37},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10028.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":10028.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":17854.7},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":59493.31},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":45158.09},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10418.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9931.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22479.04},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9736.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9931.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19543.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10320.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20118.09},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28485.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10408.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":26491.2},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":20118.09},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9736.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10904.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9736.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","code_information":[{"code":"844","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9720.92,"maximum":59390.86,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":22597.38},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18455.78},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35974.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10109.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9720.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":20751.8},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":38299.4},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":19221.53},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":31587.88},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10012.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":10012.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":17823.95},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":59390.86},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":45080.32},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10401.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9915.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22440.33},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9720.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9915.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19511.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10304.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20083.45},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28436.03},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10391.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":26445.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":20083.45},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9720.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10887.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9720.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Cc","code_information":[{"code":"854","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15544.67,"maximum":97477.31,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":37088.73},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30291.2},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":59043.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16166.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15544.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":34059.61},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":62860.23},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":31548.0},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":51844.7},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16011.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":16011.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":29254.18},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":97477.31},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":73989.64},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16632.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15855.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36830.98},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15544.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15855.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":31201.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16477.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32962.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46671.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16617.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":43404.73},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":32962.66},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15544.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17410.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15544.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":38704.44,"10th_percentile":38704.44,"90th_percentile":38704.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14185.55,"10th_percentile":14185.55,"90th_percentile":14185.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness With Mcc","code_information":[{"code":"865","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11816.33,"maximum":73094.57,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":27811.44},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22714.23},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44274.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12288.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11816.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":25540.02},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":47136.52},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":23656.66},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":38876.39},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12170.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12170.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":21936.61},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":73094.57},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":55482.05},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12643.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12052.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27618.16},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11816.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12052.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23717.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12525.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24717.46},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34997.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12631.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":32547.57},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":24717.46},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11816.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13234.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11816.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Principal Diagnosis Of Mental Illness","code_information":[{"code":"876","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29470.34,"maximum":188549.15,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":71740.27},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":58591.88},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":114207.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30649.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29470.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":65881.09},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":121589.75},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":61022.91},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":100282.56},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30354.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":30354.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":56586.0},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":188549.15},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":143117.25},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31533.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30059.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":71241.7},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29470.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30059.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":59152.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31238.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":63759.26},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":90276.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31503.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":83957.22},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":63759.26},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29470.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33006.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29470.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Mental Disorder Diagnoses","code_information":[{"code":"887","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8628.08,"maximum":52243.86,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":19878.05},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16234.84},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31645.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8973.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8628.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":18254.56},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":33690.51},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":16908.44},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":27786.64},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8886.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8886.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":15679.05},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":52243.86},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39655.43},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9232.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8800.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19739.9},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8628.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8800.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17318.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9145.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17666.64},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25014.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9223.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":23263.16},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":17666.64},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8628.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9663.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8628.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries With Cc/Mcc","code_information":[{"code":"904","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28039.58,"maximum":179192.18,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":68180.08},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":55684.2},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":108540.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29161.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28039.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":62611.66},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":115555.73},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":57994.58},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":95305.93},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28880.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":28880.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":53777.86},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":179192.18},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":136014.89},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30002.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28600.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":67706.25},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28039.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28600.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":56281.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29721.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":60595.13},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":85796.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29974.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":79790.75},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":60595.13},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28039.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31404.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28039.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions With Mcc","code_information":[{"code":"915","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13183.69,"maximum":82036.86,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":31213.86},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25493.06},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49691.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13711.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13183.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":28664.55},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":52903.14},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":26550.78},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":43632.48},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13579.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":13579.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":24620.31},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":82036.86},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":62269.65},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14106.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13447.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30996.93},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13183.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13447.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26462.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13974.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27741.36},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39278.81},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14093.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":36529.4},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":27741.36},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13183.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14765.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13183.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":150.0,"10th_percentile":150.0,"90th_percentile":150.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","code_information":[{"code":"923","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8231.23,"maximum":49648.49,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":18890.55},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15428.33},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30073.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8560.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8231.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":17347.71},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":32016.84},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":16068.47},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":26406.26},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8478.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8478.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":14900.15},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":49648.49},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37685.43},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8807.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8395.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18759.26},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8231.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8395.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16521.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8725.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16789.0},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23771.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8799.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":22107.5},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":16789.0},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8231.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9218.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8231.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","code_information":[{"code":"940","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18072.0,"maximum":114005.67,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":43377.54},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":35427.4},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69055.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18794.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18072.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":39834.8},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":73518.87},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":36897.31},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":60635.54},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18614.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":18614.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":34214.55},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":114005.67},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":86535.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19337.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18433.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43076.08},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18072.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18433.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36274.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19156.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":38551.84},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54585.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19318.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":50764.48},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":38551.84},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18072.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20240.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18072.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Factors Influencing Health Status","code_information":[{"code":"951","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4787.11,"maximum":27124.46,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":10320.47},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":8428.96},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16429.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4978.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4787.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":9477.58},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":17491.76},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":8778.68},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":14426.53},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4930.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":4930.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":8140.4},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":27124.46},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20588.68},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5122.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4882.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10248.75},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4787.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4882.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9608.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5074.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":9172.33},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12987.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5117.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":12077.99},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":9172.33},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4787.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5361.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4787.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1441.13,"10th_percentile":1441.13,"90th_percentile":1441.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":277.99,"10th_percentile":277.99,"90th_percentile":277.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"965","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7655.34,"maximum":45882.29,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":17457.56},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14257.98},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27791.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7961.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7655.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":16031.76},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":29588.13},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":14849.55},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":24403.15},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7885.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7885.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":13769.86},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":45882.29},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34826.72},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8191.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7808.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17336.24},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7655.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7808.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15365.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8114.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15515.43},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21968.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8183.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":20430.48},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":15515.43},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7655.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8573.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7655.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"982","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18979.09,"maximum":119937.92,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":45634.68},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":37270.86},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":72648.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19738.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18979.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":41907.59},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":77344.41},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":38817.26},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":63790.7},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19548.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":19548.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":35994.9},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":119937.92},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":91038.26},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20307.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19358.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45317.53},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18979.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19358.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":38094.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20117.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":40557.87},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57425.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20288.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":53406.0},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":40557.87},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18979.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21256.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18979.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16845.48,"10th_percentile":16845.48,"90th_percentile":16845.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"988","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12900.22,"maximum":80183.03,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":30508.5},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24916.98},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48568.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13416.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12900.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":28016.81},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":51707.66},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":25950.8},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":42646.49},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13287.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":13287.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":24063.95},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":80183.03},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":60862.51},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13803.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13158.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30296.48},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12900.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13158.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25893.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13674.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27114.47},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38391.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13790.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":35703.92},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":27114.47},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12900.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14448.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12900.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11111.72,"10th_percentile":11111.72,"90th_percentile":11111.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","code_information":[{"code":"321","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20935.76,"maximum":132734.23,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":50503.49},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":41247.33},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80399.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21773.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20935.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":46378.76},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":85596.37},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":42958.71},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":70596.6},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21563.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":21563.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":39835.23},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":132734.23},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":100751.22},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22401.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21354.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50152.51},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20935.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21354.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":42022.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22191.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":44885.04},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":63552.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22380.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":59103.94},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":44885.04},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20935.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23448.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20935.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19326.2,"10th_percentile":13641.95,"90th_percentile":19345.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":91867.41,"10th_percentile":91867.41,"90th_percentile":91867.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":39357.54,"10th_percentile":39357.54,"90th_percentile":39357.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":133004.05,"10th_percentile":133004.05,"90th_percentile":133004.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19483.0,"10th_percentile":19483.0,"90th_percentile":19483.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":11217.13,"10th_percentile":11217.13,"90th_percentile":11217.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20268.0,"10th_percentile":18912.39,"90th_percentile":20510.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Mcc","code_information":[{"code":"329","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34927.82,"maximum":224240.25,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":85320.23},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":69682.94},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135826.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36324.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34927.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":78351.94},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":144605.89},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":72574.14},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":119265.39},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35975.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":35975.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":67297.36},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":224240.25},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":170208.4},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37372.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35626.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":84727.28},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34927.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35626.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":70107.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37023.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":75828.46},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":107365.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37337.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":99849.77},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":75828.46},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34927.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39119.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34927.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":49729.7,"10th_percentile":49729.7,"90th_percentile":49729.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35869.95,"10th_percentile":35869.95,"90th_percentile":35869.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":183175.8,"10th_percentile":183175.8,"90th_percentile":183175.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"1 through 10","median_amount":205578.88,"10th_percentile":205578.88,"90th_percentile":205578.88},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33744.69,"10th_percentile":33744.69,"90th_percentile":34137.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":19122.92,"10th_percentile":19122.92,"90th_percentile":19122.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36483.57,"10th_percentile":36483.57,"90th_percentile":36483.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38234.53,"10th_percentile":38234.53,"90th_percentile":38234.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis Without Cc/Mcc","code_information":[{"code":"337","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12090.1,"maximum":74884.98,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":28492.67},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23270.6},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45359.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12573.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12090.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":26165.61},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":48291.1},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":24236.12},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":39828.65},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12452.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12452.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":22473.94},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":74884.98},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":56841.05},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12936.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12331.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28294.66},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12090.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12331.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24267.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12815.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25322.9},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35854.53},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12924.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":33344.81},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":25322.9},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12090.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13540.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12090.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11551.32,"10th_percentile":11551.32,"90th_percentile":11551.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11822.82,"10th_percentile":11822.82,"90th_percentile":11822.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Cc","code_information":[{"code":"351","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12011.78,"maximum":74372.73,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":28297.77},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23111.42},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45048.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12492.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12011.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":25986.63},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":47960.77},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":24070.33},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":39556.2},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12372.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12372.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":22320.2},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":74372.73},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":56452.24},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12852.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12252.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28101.11},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12011.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12252.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24110.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12732.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25149.68},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35609.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12840.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":33116.71},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":25149.68},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12011.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13453.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12011.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":21902.24,"10th_percentile":21902.24,"90th_percentile":21902.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11757.27,"10th_percentile":11757.27,"90th_percentile":11757.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","code_information":[{"code":"359","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26290.29,"maximum":167752.1,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":63827.29},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":52129.18},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101610.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27341.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26290.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":58614.38},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":108178.36},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":54292.06},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":89221.35},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27079.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":27079.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":50344.54},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":167752.1},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":127331.36},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28130.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26816.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":63383.71},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26290.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26816.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":52769.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27867.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":56726.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80318.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28104.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":74696.71},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":56726.58},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26290.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29445.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26290.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":52459.38,"10th_percentile":52459.38,"90th_percentile":52459.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":168871.01,"10th_percentile":168871.01,"90th_percentile":168871.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24856.23,"10th_percentile":24856.23,"90th_percentile":24856.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23927.29,"10th_percentile":23927.29,"90th_percentile":23927.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Mcc","code_information":[{"code":"374","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16593.49,"maximum":104336.48,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":39698.55},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":32422.69},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":63198.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17257.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16593.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":36456.28},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":67283.5},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":33767.93},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":55492.85},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17091.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":17091.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":31312.71},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":104336.48},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":79196.06},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17755.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16925.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39422.66},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16593.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16925.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33306.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17589.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":35282.13},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49955.75},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17738.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":46458.98},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":35282.13},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16593.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18584.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16593.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14513.94,"10th_percentile":14513.94,"90th_percentile":14925.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16219.14,"10th_percentile":16219.14,"90th_percentile":16219.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer Without Cc/Mcc","code_information":[{"code":"382","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6611.74,"maximum":39057.27,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":14860.74},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12137.1},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23657.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6876.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6611.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":13647.03},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":25186.88},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":12640.67},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":20773.17},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6810.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6810.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":11721.58},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":39057.27},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29646.22},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7074.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6743.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14757.46},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6611.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6743.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13271.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7008.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13207.5},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18700.41},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7067.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":17391.43},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":13207.5},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6611.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7405.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6611.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction Without Cc/Mcc","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4697.59,"maximum":26539.04,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":10097.73},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":8247.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16075.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4885.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4697.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":9273.02},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":17114.24},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":8589.22},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":14115.17},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4838.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":4838.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":7964.7},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":26539.04},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":20144.32},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5026.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4791.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10027.55},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4697.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4791.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9429.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4979.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":8974.37},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12706.75},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5021.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":11817.31},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":8974.37},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4697.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5261.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4697.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4448.38,"10th_percentile":4448.38,"90th_percentile":4448.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":9039.19,"10th_percentile":9039.19,"90th_percentile":9039.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4621.84,"10th_percentile":4621.84,"90th_percentile":4621.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":8888.36,"10th_percentile":8888.36,"90th_percentile":8888.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4237.23,"10th_percentile":4237.23,"90th_percentile":4237.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures Without Cc/Mcc","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9178.6,"maximum":55844.19,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":21247.92},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17353.65},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33825.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9545.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9178.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":19512.56},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":36012.26},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":18073.67},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":29701.53},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9453.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9453.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":16759.55},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":55844.19},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42388.24},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9821.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9362.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21100.26},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9178.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9362.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18423.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9729.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18884.12},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26737.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9811.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":24866.32},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":18884.12},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9178.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10280.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9178.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8978.09,"10th_percentile":8978.09,"90th_percentile":8978.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":68258.36,"10th_percentile":68258.36,"90th_percentile":68258.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"1 through 10","median_amount":17079.85,"10th_percentile":17079.85,"90th_percentile":17079.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Mcc","code_information":[{"code":"411","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25281.0,"maximum":161151.49,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":61315.85},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":50078.03},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97612.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26292.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25281.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":56308.05},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":103921.82},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":52155.8},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":85710.73},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26039.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":26039.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":48363.62},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":161151.49},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":122321.2},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27050.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25786.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60889.73},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25281.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25786.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":50744.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26797.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":54494.54},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":77158.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27025.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":71757.59},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":54494.54},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25281.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28314.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25281.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","code_information":[{"code":"419","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10827.93,"maximum":66630.55,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":25351.98},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20705.53},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40359.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11261.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10827.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":23281.43},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":42968.07},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":21564.62},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":35438.41},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11152.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11152.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":19996.68},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":66630.55},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":50575.57},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11585.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11044.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25175.79},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10827.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11044.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21733.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11477.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22531.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31902.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11575.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":29669.27},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":22531.6},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10827.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12127.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10827.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":23209.04,"10th_percentile":23209.04,"90th_percentile":23209.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10590.63,"10th_percentile":10590.63,"90th_percentile":10590.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":13219.0,"10th_percentile":13219.0,"90th_percentile":13219.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":66159.03,"10th_percentile":66159.03,"90th_percentile":66630.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"1 through 10","median_amount":70558.64,"10th_percentile":70558.64,"90th_percentile":70558.64},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"1 through 10","median_amount":4861.34,"10th_percentile":4861.34,"90th_percentile":4861.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10600.24,"10th_percentile":10600.24,"90th_percentile":10600.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"1 through 10","median_amount":20812.54,"10th_percentile":20812.54,"90th_percentile":20812.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10104.04,"10th_percentile":10104.04,"90th_percentile":10104.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","code_information":[{"code":"427","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":54487.77,"maximum":352159.4,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":133991.65},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":109433.98},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":213309.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56667.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54487.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":123048.26},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":227097.16},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":113974.48},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":187301.01},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":56122.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":56122.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":105687.52},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":352159.4},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":267304.76},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58301.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55577.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":133060.45},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54487.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55577.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":109367.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":57757.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":119085.24},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":168612.06},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58247.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":156809.65},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":119085.24},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54487.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":61026.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54487.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Cc","code_information":[{"code":"436","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9077.15,"maximum":55180.71,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":20995.48},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17147.48},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33424.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9440.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9077.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":19280.73},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":35584.41},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":17858.94},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":29348.65},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9349.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9349.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":16560.44},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":55180.71},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":41884.63},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9712.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9258.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20849.57},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9077.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9258.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18219.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9621.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18659.76},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26420.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9703.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":24570.89},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":18659.76},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9077.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10166.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9077.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":18735.07,"10th_percentile":18735.07,"90th_percentile":18735.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1558.4,"10th_percentile":1558.4,"90th_percentile":1558.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Mcc","code_information":[{"code":"444","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13103.87,"maximum":81514.86,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":31015.25},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25330.84},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49375.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13628.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13103.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":28482.16},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":52566.51},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":26381.84},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":43354.84},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13496.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":13496.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":24463.65},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":81514.86},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":61873.43},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14021.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13365.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30799.7},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13103.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13365.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26302.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13890.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27564.84},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39028.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14008.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":36296.96},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":27564.84},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13103.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14676.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13103.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12829.6,"10th_percentile":12829.6,"90th_percentile":12829.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":11568.01,"10th_percentile":11568.01,"90th_percentile":11568.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11853.1,"10th_percentile":11853.1,"90th_percentile":11853.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"457","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45122.18,"maximum":290909.83,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":110687.06},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":90400.6},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":176209.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46927.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45122.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":101647.0},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":187599.13},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":94151.39},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":154724.56},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":46475.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":46475.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":87305.75},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":290909.83},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":220813.59},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48280.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":46024.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":109917.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45122.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":46024.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":90569.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":47829.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":98373.26},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139286.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48235.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":129536.42},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":98373.26},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45122.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50536.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45122.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Cc","code_information":[{"code":"467","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26946.74,"maximum":172045.18,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":65460.75},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":53463.26},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":104211.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28024.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26946.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":60114.42},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":110946.84},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":55681.49},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":91504.69},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27755.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":27755.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":51632.95},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":172045.18},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":130590.0},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28833.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27485.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65005.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26946.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27485.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":54087.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28563.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":58178.32},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":82374.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28806.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":76608.33},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":58178.32},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26946.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30180.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26946.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19955.71,"10th_percentile":19955.71,"90th_percentile":19955.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26372.07,"10th_percentile":26372.07,"90th_percentile":26372.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","code_information":[{"code":"475","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17615.47,"maximum":111020.02,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":42241.54},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":34499.61},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":67246.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18320.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17615.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":38791.58},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":71593.52},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":35931.03},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":59047.59},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18143.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":18143.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":33318.52},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":111020.02},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":84269.17},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18848.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17967.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41947.98},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17615.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17967.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":35357.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18672.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":37542.22},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53155.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18830.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":49435.03},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":37542.22},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17615.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19729.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17615.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18401.08,"10th_percentile":18401.08,"90th_percentile":18401.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","code_information":[{"code":"483","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21316.95,"maximum":135227.14,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":51452.01},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":42022.0},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":81909.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22169.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21316.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":47249.81},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":87203.97},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":43765.53},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":71922.49},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21956.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":21956.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":40583.39},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":135227.14},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":102643.46},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22809.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21743.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51094.43},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21316.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21743.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":42787.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22595.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":45728.03},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64746.04},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22787.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":60213.98},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":45728.03},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21316.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23874.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21316.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20838.06,"10th_percentile":20838.06,"90th_percentile":20838.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","code_information":[{"code":"494","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15607.33,"maximum":97887.1,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":37244.65},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30418.54},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":59292.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16231.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15607.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":34202.8},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":63124.49},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":31680.63},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":52062.66},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16075.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":16075.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":29377.17},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":97887.1},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":74300.7},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16699.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15919.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36985.81},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15607.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15919.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":31327.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16543.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":33101.23},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46867.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16684.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":43587.2},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":33101.23},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15607.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17480.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15607.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15284.33,"10th_percentile":15284.33,"90th_percentile":15284.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15263.33,"10th_percentile":15263.33,"90th_percentile":15263.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14271.28,"10th_percentile":14271.28,"90th_percentile":14271.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures Without Cc/Mcc","code_information":[{"code":"502","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10679.48,"maximum":65659.73,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":24982.6},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20403.84},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39771.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11106.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10679.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":22942.21},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":42342.01},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":21250.42},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":34922.07},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10999.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":10999.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":19705.32},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":65659.73},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":49838.68},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11427.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10893.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24808.97},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10679.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10893.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21435.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11320.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22203.31},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31437.53},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11416.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":29236.99},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":22203.31},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10679.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11961.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10679.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":64202.26,"10th_percentile":64202.26,"90th_percentile":64202.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","code_information":[{"code":"511","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16151.14,"maximum":101443.53,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":38597.82},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31523.7},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":61446.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16797.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16151.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":35445.45},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":65417.92},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":32831.65},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":53954.19},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16635.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":16635.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":30444.5},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":101443.53},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":77000.18},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17281.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16474.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38329.58},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16151.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16474.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32418.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17120.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34303.86},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48570.63},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17265.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":45170.81},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":34303.86},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16151.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18089.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16151.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14311.57,"10th_percentile":14311.57,"90th_percentile":14311.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":7133.23,"10th_percentile":7133.23,"90th_percentile":7133.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13361.31,"10th_percentile":13361.31,"90th_percentile":13361.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Cc","code_information":[{"code":"519","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15560.33,"maximum":97579.76,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":37127.71},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30323.03},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":59105.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16182.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15560.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":34095.41},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":62926.29},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":31581.16},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":51899.19},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16027.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":16027.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":29284.93},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":97579.76},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":74067.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16649.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15871.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36869.69},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15560.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15871.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":31232.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16493.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32997.3},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46720.67},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16633.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":43450.34},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":32997.3},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15560.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17427.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15560.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15219.29,"10th_percentile":15219.29,"90th_percentile":15219.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","code_information":[{"code":"537","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7758.28,"maximum":46555.53,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":17713.72},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14467.19},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28199.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8068.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7758.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":16267.0},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":30022.28},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":15067.44},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":24761.22},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7991.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7991.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":13971.91},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":46555.53},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35337.73},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8301.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7913.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17590.61},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7758.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7913.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15572.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8223.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15743.09},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22290.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8293.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":20730.26},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":15743.09},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7758.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8689.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7758.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Mcc","code_information":[{"code":"545","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19152.15,"maximum":121069.73,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":46065.32},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":37622.57},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":73334.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19918.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19152.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":42303.06},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":78074.28},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":39183.56},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":64392.67},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19726.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":19726.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":36334.57},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":121069.73},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":91897.35},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20492.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19535.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45745.18},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19152.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19535.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":38442.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20301.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":40940.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57967.55},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20473.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":53909.97},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":40940.6},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19152.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21450.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19152.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies With Mcc","code_information":[{"code":"553","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10309.49,"maximum":63240.0,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":24061.92},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19651.91},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38305.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10721.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10309.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":22096.73},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":40781.6},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":20467.28},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":33635.1},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10618.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":10618.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":18979.13},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":63240.0},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":48001.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11031.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10515.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23894.7},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10309.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10515.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20693.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10928.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21385.06},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30278.98},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11020.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":28159.52},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":21385.06},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10309.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11546.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10309.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"561","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6636.35,"maximum":39218.26,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":14921.99},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12187.12},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23755.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6901.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6636.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":13703.28},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":25290.69},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":12692.78},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":20858.79},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6835.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6835.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":11769.9},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":39218.26},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29768.42},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7100.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6769.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14818.29},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6636.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6769.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13320.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7034.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13261.94},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18777.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7094.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":17463.12},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":13261.94},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6636.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7432.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6636.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement Without Cc/Mcc","code_information":[{"code":"572","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9190.54,"maximum":55922.25,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":21277.62},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17377.91},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33873.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9558.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9190.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":19539.83},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":36062.6},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":18098.93},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":29743.05},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9466.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9466.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":16782.98},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":55922.25},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42447.49},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9833.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9374.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21129.75},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9190.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9374.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18447.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9741.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18910.51},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26775.28},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9824.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":24901.07},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":18910.51},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9190.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10293.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9190.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1857.34,"10th_percentile":1857.34,"90th_percentile":1857.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","code_information":[{"code":"580","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13529.82,"maximum":84300.48,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":32075.14},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26196.48},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51062.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14071.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13529.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":29455.49},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":54362.88},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":27283.39},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":44836.42},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13935.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":13935.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":25299.65},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":84300.48},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":63987.84},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14476.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13800.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31852.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13529.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13800.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27157.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14341.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28506.82},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40362.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14463.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":37537.34},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":28506.82},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13529.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15153.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13529.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13259.69,"10th_percentile":13259.69,"90th_percentile":13259.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6976.13,"10th_percentile":6976.13,"90th_percentile":6976.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":39003.52,"10th_percentile":39003.52,"90th_percentile":39003.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers Without Cc/Mcc","code_information":[{"code":"594","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7105.57,"maximum":42286.84,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":16089.54},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13140.69},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25613.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7389.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7105.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":14775.47},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":27269.53},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":13685.91},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":22490.86},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7318.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7318.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":12690.82},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":42286.84},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32097.6},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7602.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7247.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15977.72},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7105.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7247.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14262.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7531.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14299.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20246.71},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7595.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":18829.5},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":14299.6},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7105.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7958.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7105.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis With Mcc","code_information":[{"code":"602","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11241.94,"maximum":69338.12,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":26382.17},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21546.91},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41999.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11691.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11241.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":24227.48},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":44714.1},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":22440.91},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":36878.47},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11579.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11579.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":20809.25},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":69338.12},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":52630.74},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12028.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11466.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26198.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11241.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11466.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22564.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11916.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23447.19},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33198.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12017.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":30874.9},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":23447.19},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11241.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12590.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11241.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":22440.91,"10th_percentile":22440.91,"90th_percentile":22440.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9028.88,"10th_percentile":9028.88,"90th_percentile":10204.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4137.89,"10th_percentile":4137.89,"90th_percentile":4137.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":228.99,"10th_percentile":228.99,"90th_percentile":228.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"616","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26654.33,"maximum":170132.81,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":64733.12},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":52868.98},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":103052.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27720.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26654.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":59446.22},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":109713.6},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":55062.56},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":90487.57},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27453.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":27453.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":51059.02},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":170132.81},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":129138.42},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28520.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27187.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64283.24},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26654.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27187.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":53500.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28253.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":57531.64},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":81458.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28493.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":75756.79},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":57531.64},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26654.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29852.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26654.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26085.96,"10th_percentile":26085.96,"90th_percentile":26085.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum HealthCare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26573.0,"10th_percentile":26573.0,"90th_percentile":26573.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"624","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9978.28,"maximum":61073.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":23237.77},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18978.8},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36993.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10377.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9978.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":21339.89},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":39384.77},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":19766.25},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":32483.05},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10277.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":10277.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":18329.07},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":61073.94},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":46357.86},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10676.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10177.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23076.27},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9978.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10177.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20028.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10576.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20652.59},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29241.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10666.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":27195.02},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":20652.59},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9978.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11175.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9978.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lung Transplant","code_information":[{"code":"007","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":97243.51,"maximum":631775.51,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":240381.61},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":196325.03},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":382678.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101133.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97243.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":220749.11},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":407413.29},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":204470.71},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":336018.84},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":100160.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":100160.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":189603.88},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":631775.51},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":479545.91},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":104050.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":99188.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":238711.04},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97243.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":99188.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":195187.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":103078.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":213639.45},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":302490.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":103953.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":281317.19},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":213639.45},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97243.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":108912.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97243.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant Without Cc/Mcc","code_information":[{"code":"017","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41162.6,"maximum":265014.76,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":100834.35},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":82353.67},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":160524.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42809.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41162.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":92598.99},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":170900.16},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":85770.58},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":140951.89},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":42397.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":42397.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":79534.3},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":265014.76},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":201158.07},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44043.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41985.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":100133.59},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41162.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41985.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":82621.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43632.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":89616.65},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":126887.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44002.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":118005.85},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":89616.65},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41162.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46102.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41162.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Mcc","code_information":[{"code":"025","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34556.33,"maximum":221810.76,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":84395.85},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":68927.97},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":134354.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35938.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34556.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":77503.05},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":143039.18},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":71787.85},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":117973.22},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35593.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":35593.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":66568.23},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":221810.76},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":168364.3},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36975.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35247.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":83809.32},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34556.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35247.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":69361.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36629.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":75006.91},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":106201.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36940.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":98767.96},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":75006.91},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34556.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38703.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34556.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures Without Cc/Mcc","code_information":[{"code":"033","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13044.19,"maximum":81124.58,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":30866.75},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25209.56},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49138.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13565.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13044.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":28345.79},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":52314.83},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":26255.53},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":43147.27},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13435.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":13435.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":24346.52},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":81124.58},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":61577.19},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13957.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13305.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30652.24},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13044.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13305.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26182.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13826.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27432.86},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38842.02},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13944.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":36123.18},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":27432.86},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13044.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14609.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13044.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","code_information":[{"code":"041","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17041.07,"maximum":107263.58,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":40812.27},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":33332.29},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64971.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17722.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17041.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":37479.04},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":69171.1},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":34715.27},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":57049.67},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17552.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":17552.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":32191.17},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":107263.58},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":81417.86},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18233.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17381.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40528.64},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17041.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17381.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34204.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18063.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":36271.95},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51357.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18216.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":47762.36},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":36271.95},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17041.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19086.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17041.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15554.07,"10th_percentile":15554.07,"90th_percentile":15554.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Mcc","code_information":[{"code":"058","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13391.81,"maximum":83397.96,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":31731.74},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25916.02},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50515.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13927.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13391.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":29140.14},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":53780.87},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":26991.3},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":44356.4},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13793.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":13793.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":25028.79},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":83397.96},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":63302.79},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14329.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13659.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31511.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13391.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13659.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26880.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14195.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28201.62},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39930.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14315.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":37135.47},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":28201.62},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13391.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14998.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13391.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5744.92,"maximum":33388.45,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":12703.83},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10375.5},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20224.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5974.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5744.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":11666.28},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":21531.22},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":10805.99},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":17758.13},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5917.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":5917.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":10020.3},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":33388.45},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25343.33},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6147.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5859.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12615.55},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5744.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5859.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11531.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6089.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11290.55},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15986.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6141.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":14867.22},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":11290.55},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5744.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6434.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5744.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5902.98,"10th_percentile":5902.98,"90th_percentile":5902.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders Without Mcc","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8328.95,"maximum":50287.58,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":19133.71},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15626.93},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30460.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8662.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8328.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":17571.02},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":32428.97},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":16275.3},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":26746.17},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8578.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8578.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":15091.94},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":50287.58},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":38170.52},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8911.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8495.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19000.74},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8328.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8495.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16717.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8828.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17005.11},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24077.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8903.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":22392.07},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":17005.11},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8328.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9328.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8328.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8308.05,"10th_percentile":8308.05,"90th_percentile":8308.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7158.77,"10th_percentile":7158.77,"90th_percentile":8141.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":3244.62,"10th_percentile":3244.62,"90th_percentile":3244.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Mcc","code_information":[{"code":"085","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17587.12,"maximum":110834.64,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":42171.01},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":34442.0},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":67134.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18290.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17587.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":38726.81},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":71473.97},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":35871.03},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":58948.99},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18114.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":18114.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":33262.89},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":110834.64},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":84128.46},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18818.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17938.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41877.93},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17587.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17938.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":35300.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18642.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":37479.53},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53067.04},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18800.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":49352.48},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":37479.53},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17587.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19697.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17587.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7359.98,"10th_percentile":7359.98,"90th_percentile":7359.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System Without Cc/Mcc","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6579.66,"maximum":38847.5,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":14780.92},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12071.91},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23530.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6842.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6579.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":13573.73},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":25051.6},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":12572.78},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":20661.6},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6777.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6777.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":11658.63},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":38847.5},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29486.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7040.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6711.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14678.2},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6579.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6711.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13206.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6974.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13136.56},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18599.98},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7033.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":17298.02},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":13136.56},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6579.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7369.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6579.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2044.25,"10th_percentile":2044.25,"90th_percentile":2044.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures Without Mcc","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7372.62,"maximum":44033.34,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":16754.06},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13683.42},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26671.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7667.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7372.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":15385.72},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":28395.8},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":14251.15},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":23419.76},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7593.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7593.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":13214.97},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":44033.34},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33423.28},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7888.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7520.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16637.63},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7372.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7520.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14798.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7814.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14890.19},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21082.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7881.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":19607.18},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":14890.19},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7372.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8257.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7372.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":44033.34,"10th_percentile":44033.34,"90th_percentile":44033.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"1 through 10","median_amount":27915.45,"10th_percentile":27915.45,"90th_percentile":27915.45},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3254.02,"10th_percentile":3254.02,"90th_percentile":3254.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7468.82,"10th_percentile":7468.82,"90th_percentile":7468.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections With Cc/Mcc","code_information":[{"code":"121","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9317.35,"maximum":56751.59,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":21593.17},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17635.63},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34375.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9690.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9317.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":19829.61},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":36597.42},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":18367.34},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":30184.15},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9596.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9596.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":17031.88},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":56751.59},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":43077.0},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9969.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9503.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21443.11},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9317.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9503.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18701.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9876.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19190.96},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27172.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9960.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":25270.37},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":19190.96},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9317.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10435.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9317.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures Without Cc/Mcc","code_information":[{"code":"138","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7250.28,"maximum":43233.27,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":16449.64},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13434.79},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26187.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7540.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7250.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":15106.17},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":27879.85},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":13992.21},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":22994.23},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7467.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7467.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":12974.85},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":43233.27},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32815.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7757.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7395.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16335.32},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7250.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7395.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14552.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7685.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14619.64},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20699.86},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7750.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":19250.92},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":14619.64},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7250.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8120.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7250.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Mcc","code_information":[{"code":"146","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16434.6,"maximum":103297.36,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":39303.18},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":32099.78},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":62569.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17091.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16434.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":36093.2},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":66613.4},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":33431.63},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":54940.18},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16927.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":16927.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":31000.85},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":103297.36},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":78407.32},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17585.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16763.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39030.03},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16434.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16763.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32987.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17420.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34930.75},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49458.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17568.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":45996.28},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":34930.75},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16434.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18406.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16434.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","code_information":[{"code":"154","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12302.7,"maximum":76275.35,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":29021.69},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23702.66},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46201.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12794.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12302.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":26651.42},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":49187.71},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":24686.1},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":40568.13},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12671.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12671.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":22891.2},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":76275.35},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":57896.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13163.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12548.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28820.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12302.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12548.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24693.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13040.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25793.06},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36520.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13151.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":33963.91},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":25793.06},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12302.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13779.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12302.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8783.32,"10th_percentile":8783.32,"90th_percentile":8783.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures Without Cc/Mcc","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14918.8,"maximum":93384.25,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":35531.38},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29019.27},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56564.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15515.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14918.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":32629.45},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":60220.73},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":30223.3},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":49667.75},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15366.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":15366.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":28025.8},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":93384.25},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":70882.83},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15963.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15217.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35284.45},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14918.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15217.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":29945.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15813.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":31578.56},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44711.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15948.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":41582.17},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":31578.56},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14918.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16709.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14918.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14624.4,"10th_percentile":14624.4,"90th_percentile":14624.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":40166.24,"10th_percentile":40166.24,"90th_percentile":40166.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Cc","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7920.16,"maximum":47614.16,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":18116.51},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14796.16},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28840.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8236.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7920.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":16636.9},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":30704.96},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":15410.06},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":25324.27},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8157.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8157.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":14289.62},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":47614.16},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36141.28},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8474.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8078.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17990.61},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7920.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8078.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15897.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8395.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16101.07},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22797.41},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8466.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":21201.65},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":16101.07},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7920.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8870.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7920.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8056.66,"10th_percentile":8056.66,"90th_percentile":8056.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7007.36,"10th_percentile":7007.36,"90th_percentile":7007.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7742.37,"10th_percentile":6287.07,"90th_percentile":8274.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Mcc","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12265.41,"maximum":76031.42,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":28928.88},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23626.86},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46053.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12756.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12265.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":26566.19},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":49030.41},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":24607.16},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":40438.4},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12633.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12633.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":22818.0},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":76031.42},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":57711.26},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13123.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12510.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28727.83},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12265.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12510.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24619.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13001.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25710.57},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36403.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13111.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":33855.3},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":25710.57},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12265.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13737.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12265.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12233.81,"10th_percentile":12233.81,"90th_percentile":12233.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Cc","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6651.27,"maximum":39315.83,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":14959.12},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12217.44},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23814.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6917.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6651.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":13737.37},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":25353.61},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":12724.36},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":20910.69},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6850.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6850.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":11799.18},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":39315.83},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29842.48},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7116.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6784.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14855.15},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6651.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6784.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13350.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7050.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13294.93},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18824.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7110.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":17506.57},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":13294.93},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6651.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7449.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6651.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6218.04,"10th_percentile":6012.24,"90th_percentile":6523.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":21437.14,"10th_percentile":20054.7,"90th_percentile":22566.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":9613.33,"10th_percentile":9613.33,"90th_percentile":9613.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":17308.48,"10th_percentile":17308.48,"90th_percentile":17308.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6634.94,"10th_percentile":6634.94,"90th_percentile":6634.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6832.27,"10th_percentile":6832.27,"90th_percentile":6832.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":5505.35,"10th_percentile":5505.35,"90th_percentile":5505.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":38445.34,"10th_percentile":38445.34,"90th_percentile":38445.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6510.04,"10th_percentile":6510.04,"90th_percentile":6510.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6509.44,"10th_percentile":6509.44,"90th_percentile":6536.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2751.21,"10th_percentile":2751.21,"90th_percentile":2751.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":14724.27,"10th_percentile":14724.27,"90th_percentile":14724.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5200.35,"10th_percentile":2999.21,"90th_percentile":10626.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma With Cc/Mcc","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7884.35,"maximum":47379.99,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":18027.41},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14723.39},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28698.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8199.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7884.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":16555.08},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":30553.95},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":15334.28},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":25199.73},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8120.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8120.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":14219.34},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":47379.99},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35963.54},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8436.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8042.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17902.13},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7884.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8042.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15825.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8357.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16021.89},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22685.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8428.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":21097.38},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":16021.89},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7884.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8830.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7884.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":12011.57,"10th_percentile":12011.57,"90th_percentile":12011.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2657.74,"10th_percentile":2657.74,"90th_percentile":2657.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":28124.03,"10th_percentile":28124.03,"90th_percentile":28124.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6923.39,"10th_percentile":6923.39,"90th_percentile":6923.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Aortic And Mitral Valve Procedures","code_information":[{"code":"212","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":81756.53,"maximum":530492.97,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":201845.04},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":164851.36},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":321329.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":85026.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81756.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":185359.91},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":342099.19},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":171691.16},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":282150.27},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":84209.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":84209.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":159207.7},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":530492.97},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":402667.92},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":87479.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":83391.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":200442.29},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":81756.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":83391.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":164101.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":86661.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":179390.03},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":253997.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":87397.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":236218.07},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":179390.03},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":81756.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":91567.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81756.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","code_information":[{"code":"221","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38237.67,"maximum":245886.16,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":93556.19},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":76409.43},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148937.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39767.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38237.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":85915.25},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":158564.69},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":79579.72},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":130778.07},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39384.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":39384.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":73793.57},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":245886.16},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":186638.61},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40914.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39002.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":92906.01},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38237.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39002.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":76750.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40531.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":83148.18},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":117728.99},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40876.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":109488.26},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":83148.18},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38237.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42826.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38237.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37377.71,"10th_percentile":37377.71,"90th_percentile":37377.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization Without Mcc","code_information":[{"code":"236","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31886.52,"maximum":204350.61,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":77752.51},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":63502.21},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":123779.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33161.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31886.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":71402.28},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":131779.65},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":66136.96},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":108686.79},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32843.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":32843.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":61328.22},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":204350.61},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":155111.26},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34118.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32524.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":77212.15},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31886.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32524.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64002.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33799.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":69102.63},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97841.99},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34086.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":90993.3},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":69102.63},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31886.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35712.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31886.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30700.09,"10th_percentile":30700.09,"90th_percentile":30700.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31165.59,"10th_percentile":31165.59,"90th_percentile":31165.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":120449.99,"10th_percentile":120449.99,"90th_percentile":120449.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30540.59,"10th_percentile":30540.59,"90th_percentile":30540.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","code_information":[{"code":"250","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16920.23,"maximum":106473.26,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":40511.57},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":33086.7},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64492.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17597.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16920.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":37202.9},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":68661.45},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":34459.49},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":56629.33},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17427.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":17427.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":31953.98},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":106473.26},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":80817.98},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18104.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17258.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40230.02},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16920.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17258.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33962.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17935.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":36004.7},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50978.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18087.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":47410.45},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":36004.7},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16920.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18950.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16920.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16538.47,"10th_percentile":16538.47,"90th_percentile":16538.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11106.05,"10th_percentile":11106.05,"90th_percentile":11106.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement With Mcc","code_information":[{"code":"258","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24078.51,"maximum":153287.35,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":58323.66},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":47634.24},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":92849.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25041.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24078.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":53560.24},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":98850.47},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":49610.62},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":81528.07},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24800.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":24800.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":46003.49},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":153287.35},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":116351.96},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25764.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24560.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57918.33},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24078.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24560.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":48330.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25523.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":51835.22},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":73393.17},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25739.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":68255.84},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":51835.22},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24078.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26967.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24078.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","code_information":[{"code":"266","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46355.26,"maximum":298973.99,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":113755.36},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":92906.54},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181094.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48209.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46355.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":104464.71},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":192799.46},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":96761.31},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":159013.59},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":47745.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":47745.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":89725.9},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":298973.99},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":226934.65},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49600.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":47282.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":112964.8},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46355.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":47282.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":93044.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":49136.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":101100.21},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143147.17},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49553.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":133127.23},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":101100.21},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46355.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51917.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46355.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36032.71,"10th_percentile":36032.71,"90th_percentile":36032.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":400.0,"10th_percentile":400.0,"90th_percentile":400.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":48778.32,"10th_percentile":48778.32,"90th_percentile":48778.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures Without Mcc","code_information":[{"code":"274","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25194.47,"maximum":160585.58,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":61100.54},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":49902.17},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97269.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26202.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25194.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":56110.32},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":103556.88},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":51972.65},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":85409.74},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25950.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":25950.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":48193.78},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":160585.58},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":121891.65},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26958.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25698.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60675.91},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25194.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25698.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":50570.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26706.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":54303.17},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":76887.53},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26932.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":71505.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":54303.17},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25194.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28217.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25194.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":24625.2,"10th_percentile":23898.09,"90th_percentile":24660.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":127476.25,"10th_percentile":127476.25,"90th_percentile":145259.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":49793.55,"10th_percentile":49793.55,"90th_percentile":94360.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27294.74,"10th_percentile":25881.59,"90th_percentile":31519.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":162646.86,"10th_percentile":162646.86,"90th_percentile":206573.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26414.01,"10th_percentile":26414.01,"90th_percentile":26414.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":24633.2,"10th_percentile":24611.95,"90th_percentile":30110.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":24630.1,"10th_percentile":24623.55,"90th_percentile":28155.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","code_information":[{"code":"282","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6033.61,"maximum":35276.43,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":13422.18},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10962.2},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21367.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6274.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6033.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":12325.96},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":22748.73},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":11417.03},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":18762.28},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6214.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6214.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":10586.91},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":35276.43},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26776.39},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6455.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6154.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13328.9},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6033.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6154.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12110.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6395.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11928.98},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16890.17},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6449.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":15707.9},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":11928.98},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6033.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6757.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6033.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5910.18,"10th_percentile":5910.18,"90th_percentile":5910.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"1 through 10","median_amount":32004.45,"10th_percentile":32004.45,"90th_percentile":32004.45},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6206.03,"10th_percentile":6206.03,"90th_percentile":6206.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"1 through 10","median_amount":10515.7,"10th_percentile":10515.7,"90th_percentile":10515.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis Without Cc/Mcc","code_information":[{"code":"290","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7574.78,"maximum":45355.41,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":17257.09},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14094.25},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27472.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7877.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7574.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":15847.67},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":29248.36},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":14679.03},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":24122.93},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7802.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7802.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":13611.74},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":45355.41},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34426.79},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8105.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7726.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17137.16},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7574.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7726.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15204.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8029.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15337.26},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21715.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8097.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":20195.87},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":15337.26},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7574.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8483.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7574.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Cc","code_information":[{"code":"300","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8602.72,"maximum":52077.99,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":19814.94},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16183.3},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31544.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8946.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8602.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":18196.61},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":33583.55},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":16854.76},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":27698.42},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8860.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8860.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":15629.27},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":52077.99},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39529.53},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9204.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8774.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19677.23},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8602.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8774.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17267.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9118.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17610.55},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24934.67},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9196.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":23189.3},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":17610.55},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8602.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9635.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8602.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4893.79,"10th_percentile":4893.79,"90th_percentile":4893.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"1 through 10","median_amount":3157.21,"10th_percentile":3157.21,"90th_percentile":3157.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8413.45,"10th_percentile":8413.45,"90th_percentile":8413.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7449.05,"10th_percentile":7449.05,"90th_percentile":7449.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9620.96,"maximum":58737.14,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":22348.65},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18252.64},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35578.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10005.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9620.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":20523.38},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":37877.84},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":19009.96},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":31240.19},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9909.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9909.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":17627.76},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":58737.14},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":44584.12},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10294.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9813.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22193.33},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9620.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9813.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19311.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10198.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19862.39},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28123.03},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10284.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":26154.49},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":19862.39},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9620.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10775.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9620.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9402.19,"10th_percentile":9402.19,"90th_percentile":9409.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8618.19,"10th_percentile":8618.19,"90th_percentile":9424.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9164.53,"10th_percentile":7478.93,"90th_percentile":9407.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses Without Cc/Mcc","code_information":[{"code":"316","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5727.77,"maximum":33276.25,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":12661.14},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10340.64},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20156.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5956.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5727.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":11627.08},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":21458.87},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":10769.68},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":17698.45},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5899.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":5899.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":9986.63},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":33276.25},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25258.16},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6128.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5842.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12573.15},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5727.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5842.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11496.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6071.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11252.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15932.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6122.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":14817.26},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":11252.6},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5727.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6415.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5727.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","code_information":[{"code":"630","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11526.9,"maximum":71201.71,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":27091.24},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22126.02},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43128.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11987.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11526.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":24878.64},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":45915.87},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":23044.05},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":37869.65},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11872.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11872.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":21368.54},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":71201.71},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":54045.29},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12333.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11757.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26902.96},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11526.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11757.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23136.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12218.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24077.37},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34091.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12322.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":31704.72},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":24077.37},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11526.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12910.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11526.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Cc","code_information":[{"code":"644","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8285.68,"maximum":50004.63,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":19026.05},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15539.0},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30288.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8617.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8285.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":17472.15},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":32246.5},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":16183.73},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":26595.68},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8534.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8534.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":15007.03},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":50004.63},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37955.75},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8865.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8451.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18893.83},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8285.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8451.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16631.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8782.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16909.43},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23941.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8857.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":22266.08},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":16909.43},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8285.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9279.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8285.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4991.76,"10th_percentile":4991.76,"90th_percentile":4991.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7306.11,"10th_percentile":7306.11,"90th_percentile":7306.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Mcc","code_information":[{"code":"656","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24389.58,"maximum":155321.68,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":59097.7},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":48266.41},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94081.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25365.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24389.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":54271.05},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":100162.35},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":50269.02},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":82610.06},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25121.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":25121.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":46614.02},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":155321.68},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":117896.11},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26096.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24877.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58686.99},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24389.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24877.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":48954.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25852.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":52523.15},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":74367.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26072.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":69161.69},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":52523.15},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24389.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27316.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24389.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures Without Cc/Mcc","code_information":[{"code":"664","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8449.05,"maximum":51073.02,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":19432.56},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15871.0},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30935.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8787.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8449.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":17845.46},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":32935.47},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":16529.5},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":27163.91},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8702.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8702.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":15327.66},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":51073.02},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":38766.71},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9040.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8618.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19297.51},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8449.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8618.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16958.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8955.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17270.71},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24453.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9032.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":22741.81},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":17270.71},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8449.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9462.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8449.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures Without Cc/Mcc","code_information":[{"code":"672","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8692.23,"maximum":52663.41,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":20037.68},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16365.22},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31899.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9039.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8692.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":18401.16},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":33961.07},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":17044.23},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":28009.79},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8953.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8953.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":15804.96},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":52663.41},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39973.89},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9300.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8866.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19898.42},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8692.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8866.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17447.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9213.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17808.51},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25214.96},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9291.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":23449.98},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":17808.51},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8692.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9735.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8692.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Cc","code_information":[{"code":"687","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8455.76,"maximum":51116.92,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":19449.26},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15884.65},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30962.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8793.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8455.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":17860.8},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":32963.79},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":16543.71},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":27187.27},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8709.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8709.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":15340.84},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":51116.92},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":38800.03},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9047.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8624.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19314.1},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8455.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8624.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16972.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8963.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17285.56},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24474.51},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9039.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":22761.36},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":17285.56},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8455.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9470.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8455.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8265.84,"10th_percentile":8265.84,"90th_percentile":8265.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5840.34,"10th_percentile":5840.34,"90th_percentile":5840.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Stricture","code_information":[{"code":"697","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8679.55,"maximum":52580.47,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":20006.12},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16339.45},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31848.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9026.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8679.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":18372.18},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":33907.59},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":17017.38},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":27965.68},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8939.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8939.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":15780.07},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":52580.47},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39910.93},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9287.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8853.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19867.09},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8679.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8853.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17421.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9200.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17780.47},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25175.25},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9278.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":23413.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":17780.47},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8679.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9721.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8679.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures With Cc/Mcc","code_information":[{"code":"711","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16183.96,"maximum":101658.18,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":38679.5},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31590.41},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":61576.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16831.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16183.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":35520.45},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":65556.35},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":32901.12},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":54068.36},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16669.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":16669.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":30508.92},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":101658.18},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":77163.11},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17316.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16507.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38410.69},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16183.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16507.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32484.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17155.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34376.45},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48673.4},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17300.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":45266.39},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":34376.45},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16183.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18126.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16183.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Mcc","code_information":[{"code":"722","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14139.27,"maximum":88286.21,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":33591.65},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27435.05},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53476.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14704.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14139.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":30848.15},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":56933.16},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":28573.35},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":46956.29},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14563.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14563.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":26495.82},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":88286.21},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":67013.19},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15129.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14422.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33358.2},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14139.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14422.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28380.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14987.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29854.62},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42270.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15114.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":39312.11},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":29854.62},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14139.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15835.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14139.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses Without Cc/Mcc","code_information":[{"code":"730","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5652.43,"maximum":32783.52,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":12473.66},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10187.52},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19857.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5878.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5652.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":11454.91},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":21141.12},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":10610.21},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":17436.38},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5822.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":5822.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":9838.75},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":32783.52},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":24884.16},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6048.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5765.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12386.98},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5652.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5765.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11345.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5991.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11085.98},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15696.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6042.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":14597.86},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":11085.98},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5652.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6330.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5652.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"741","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11277.75,"maximum":69572.29,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":26471.27},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21619.68},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42141.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11728.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11277.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":24309.3},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":44865.11},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":22516.69},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":37003.02},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11616.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11616.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":20879.53},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":69572.29},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":52808.48},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12067.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11503.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26287.3},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11277.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11503.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22636.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11954.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23526.37},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33310.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12055.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":30979.17},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":23526.37},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11277.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12631.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11277.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures With Cc/Mcc","code_information":[{"code":"749","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19792.94,"maximum":125260.37,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":47659.79},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":38924.82},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":75872.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20584.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19792.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":43767.31},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":80776.7},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":40539.84},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":66621.52},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20386.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":20386.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":37592.23},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":125260.37},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":95078.23},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21178.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20188.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47328.57},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19792.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20188.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":39728.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20980.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":42357.7},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":59974.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21158.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":55775.97},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":42357.7},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19792.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22168.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19792.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","code_information":[{"code":"760","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8155.14,"maximum":49150.89,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":18701.22},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15273.7},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29771.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8481.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8155.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":17173.85},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":31695.95},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":15907.42},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":26141.6},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8399.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8399.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":14750.81},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":49150.89},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37307.73},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8726.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8318.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18571.25},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8155.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8318.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16369.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8644.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16620.73},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23533.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8717.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":21885.92},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":16620.73},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8155.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9133.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8155.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":7480.83,"10th_percentile":7480.83,"90th_percentile":7480.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Cc","code_information":[{"code":"784","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8547.52,"maximum":51716.98,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":19677.58},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16071.12},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31325.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8889.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8547.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":18070.46},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":33350.75},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":16737.92},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":27506.41},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8803.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8803.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":15520.92},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":51716.98},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39255.5},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9145.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8718.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19540.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8547.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8718.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17156.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9060.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17488.47},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24761.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9137.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":23028.55},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":17488.47},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8547.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9573.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8547.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":49312.67,"10th_percentile":49312.67,"90th_percentile":49312.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3286.89,"10th_percentile":3286.89,"90th_percentile":3286.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4343.74,"10th_percentile":4343.74,"90th_percentile":4451.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity Without Major Problems","code_information":[{"code":"792","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18909.72,"maximum":119484.22,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":45462.05},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":37129.87},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":72373.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19666.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18909.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":41749.06},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":77051.83},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":38670.42},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":63549.39},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19477.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":19477.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":35858.74},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":119484.22},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":90693.88},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20233.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19287.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45146.1},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18909.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19287.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":37955.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20044.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":40404.45},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57208.41},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20214.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":53203.97},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":40404.45},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18909.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21178.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18909.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":998.06,"10th_percentile":998.06,"90th_percentile":998.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":909.25,"10th_percentile":715.33,"90th_percentile":3227.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":2623.6,"10th_percentile":2623.6,"90th_percentile":2623.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Cc","code_information":[{"code":"800","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21596.68,"maximum":137056.58,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":52148.08},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":42590.5},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":83017.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22460.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21596.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":47889.03},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":88383.72},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":44357.62},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":72895.5},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22244.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":22244.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":41132.43},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":137056.58},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":104032.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23108.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22028.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51785.67},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21596.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22028.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":43348.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22892.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":46346.67},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65621.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23086.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":61028.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":46346.67},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21596.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24188.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21596.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"808","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17109.7,"maximum":107712.4,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":40983.04},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":33471.76},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65243.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17794.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17109.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":37635.86},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":69460.53},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":34860.53},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":57288.38},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17622.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":17622.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":32325.86},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":107712.4},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":81758.54},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18307.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17451.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40698.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17109.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17451.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34342.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18136.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":36423.73},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51572.13},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18290.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":47962.21},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":36423.73},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17109.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19162.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17109.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16331.65,"10th_percentile":16331.65,"90th_percentile":16331.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","code_information":[{"code":"816","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5354.04,"maximum":30832.12,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":11731.18},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9581.12},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18675.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5568.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5354.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":10773.07},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":19882.72},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":9978.65},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":16398.5},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5514.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":5514.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":9253.11},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":30832.12},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23402.96},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5728.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5461.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11649.66},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5354.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5461.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10746.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5675.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10426.1},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14762.26},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5723.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":13728.94},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":10426.1},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5354.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5996.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5354.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","code_information":[{"code":"824","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17540.12,"maximum":110527.3,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":42054.07},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":34346.5},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":66948.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18241.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17540.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":38619.42},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":71275.78},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":35771.56},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":58785.52},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18066.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":18066.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":33170.65},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":110527.3},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":83895.17},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18767.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17890.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41761.8},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17540.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17890.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":35206.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18592.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":37375.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52919.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18750.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":49215.63},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":37375.6},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17540.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19644.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17540.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Cc","code_information":[{"code":"832","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6022.42,"maximum":35203.26,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":13394.34},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10939.46},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21323.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6263.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6022.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":12300.39},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":22701.54},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":11393.34},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":18723.36},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6203.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6203.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":10564.95},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":35203.26},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26720.85},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6443.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6142.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13301.25},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6022.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6142.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12088.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6383.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11904.24},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16855.13},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6437.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":15675.32},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":11904.24},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6022.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6745.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6022.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":13555.17,"10th_percentile":13555.17,"90th_percentile":13555.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":5772.28,"10th_percentile":5772.28,"90th_percentile":5772.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Mcc","code_information":[{"code":"840","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24770.76,"maximum":157814.6,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":60046.21},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":49041.08},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":95591.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25761.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24770.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":55142.11},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":101769.95},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":51075.84},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":83935.95},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25513.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":25513.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":47362.17},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":157814.6},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":119788.35},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26504.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25266.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59628.91},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24770.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25266.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":49719.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26257.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":53366.15},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":75560.79},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26479.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":70271.73},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":53366.15},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24770.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27743.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24770.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"848","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6975.77,"maximum":41437.98,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":15766.56},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12876.9},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25099.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7254.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6975.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":14478.87},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":26722.12},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":13411.18},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":22039.38},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7185.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7185.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":12436.07},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":41437.98},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31453.28},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7464.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7115.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15656.99},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6975.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7115.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14001.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7394.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14012.55},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19840.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7457.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":18451.52},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":14012.55},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6975.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7812.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6975.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"858","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11030.09,"maximum":67952.63,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":25855.01},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21116.36},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41160.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11471.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11030.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":23743.37},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":43820.63},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":21992.5},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":36141.58},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11360.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11360.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":20393.45},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":67952.63},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":51579.09},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11802.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11250.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25675.33},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11030.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11250.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22139.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11691.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22978.67},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32535.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11791.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":30257.97},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":22978.67},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11030.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12353.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11030.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","code_information":[{"code":"869","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6082.85,"maximum":35598.41,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":13544.69},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11062.25},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21562.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6326.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6082.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":12438.47},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":22956.36},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":11521.23},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":18933.53},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6265.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6265.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":10683.54},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":35598.41},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27020.79},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6204.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13450.56},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6082.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6204.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12209.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6447.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12037.86},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17044.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6502.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":15851.27},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":12037.86},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6082.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6812.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6082.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Personality And Impulse Control","code_information":[{"code":"883","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15307.45,"maximum":95925.95,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":36498.46},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29809.11},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58104.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15919.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15307.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":33517.55},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":61859.8},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":31045.91},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":51019.59},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15766.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":15766.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":28788.6},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":95925.95},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":72812.09},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16378.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15613.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36244.81},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15307.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15613.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30725.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16225.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32438.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45928.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16363.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":42713.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":32438.05},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15307.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17144.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15307.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","code_information":[{"code":"897","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7224.92,"maximum":43067.4,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":16386.53},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13383.25},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26086.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7513.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7224.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":15048.21},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":27772.89},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":13938.53},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":22906.01},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7441.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7441.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":12925.07},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":43067.4},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32690.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7730.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7369.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16272.65},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7224.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7369.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14501.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7658.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14563.55},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20620.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7723.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":19177.06},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":14563.55},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7224.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8091.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7224.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6622.09,"10th_percentile":6622.09,"90th_percentile":6622.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":6876.44,"10th_percentile":6876.44,"90th_percentile":6876.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":13938.53,"10th_percentile":13938.53,"90th_percentile":13938.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7423.24,"10th_percentile":7423.24,"90th_percentile":7423.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":11184.62,"10th_percentile":11184.62,"90th_percentile":11184.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":4930.16,"10th_percentile":4930.16,"90th_percentile":4930.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"1 through 10","median_amount":34109.86,"10th_percentile":34109.86,"90th_percentile":34109.86},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7207.03,"10th_percentile":7207.03,"90th_percentile":7207.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1673.27,"10th_percentile":1673.27,"90th_percentile":1673.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":19371.13,"10th_percentile":19371.13,"90th_percentile":23150.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6342.59,"10th_percentile":6342.59,"90th_percentile":6342.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Cc","code_information":[{"code":"908","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15523.03,"maximum":97335.83,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":37034.9},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30247.23},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58958.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16143.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15523.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":34010.18},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":62768.99},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":31502.21},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":51769.45},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15988.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":15988.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":29211.72},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":97335.83},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":73882.26},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16609.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15833.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36777.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15523.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15833.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":31157.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16454.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32914.81},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46603.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16594.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":43341.73},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":32914.81},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15523.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17385.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15523.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":21362.43,"10th_percentile":21362.43,"90th_percentile":21362.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"1 through 10","median_amount":201601.17,"10th_percentile":201601.17,"90th_percentile":201601.17},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Mcc","code_information":[{"code":"919","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14296.67,"maximum":89315.58,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":33983.31},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27754.93},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54100.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14868.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14296.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":31207.82},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":57596.97},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":28906.5},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":47503.77},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14725.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14725.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":26804.74},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":89315.58},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":67794.52},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15297.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14582.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33747.14},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14296.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14582.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28696.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15154.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30202.71},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42763.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15283.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":39770.47},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":30202.71},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14296.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16012.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14296.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14683.46,"10th_percentile":14683.46,"90th_percentile":14683.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12019.75,"10th_percentile":12019.75,"90th_percentile":12019.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","code_information":[{"code":"933","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29688.91,"maximum":189978.55,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":72284.14},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":59036.07},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":115073.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30876.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29688.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":66380.53},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":122511.53},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":61485.52},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":101042.81},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30579.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":30579.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":57014.98},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":189978.55},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":144202.23},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31767.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30282.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":71781.79},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29688.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30282.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":59591.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31470.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":64242.62},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":90960.72},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31737.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":84593.71},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":64242.62},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29688.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33251.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29688.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms With Mcc","code_information":[{"code":"947","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10108.82,"maximum":61927.68,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":23562.6},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19244.1},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37510.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10513.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10108.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":21638.19},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":39935.32},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":20042.56},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":32937.12},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10412.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":10412.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":18585.29},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":61927.68},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":47005.88},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10816.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10311.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23398.85},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10108.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10311.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20290.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10715.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20941.29},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29650.65},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10806.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":27575.18},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":20941.29},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10108.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11321.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10108.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8764.23,"10th_percentile":8764.23,"90th_percentile":8764.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Cc","code_information":[{"code":"958","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32073.76,"maximum":205575.11,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":78218.41},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":63882.72},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":124520.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33356.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32073.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":71830.14},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":132569.29},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":66533.27},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":109338.06},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33035.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":33035.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":61695.71},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":205575.11},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":156040.72},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34318.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32715.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":77674.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32073.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32715.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64378.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33998.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":69516.71},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":98428.28},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34286.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":91538.55},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":69516.71},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32073.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35922.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32073.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Cc","code_information":[{"code":"975","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10299.79,"maximum":63176.58,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":24037.79},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19632.2},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38267.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10711.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10299.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":22074.57},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":40740.7},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":20446.76},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":33601.37},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10608.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":10608.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":18960.1},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":63176.58},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":47953.85},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11020.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10505.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23870.74},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10299.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10505.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20673.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10917.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21363.62},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30248.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11010.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":28131.29},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":21363.62},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10299.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11535.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10299.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Cc","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7324.88,"maximum":43721.12,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":16635.26},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13586.39},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26482.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7617.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7324.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":15276.63},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":28194.45},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":14150.1},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":23253.7},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7544.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7544.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":13121.26},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":43721.12},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33186.29},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7837.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7471.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16519.65},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7324.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7471.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14702.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7764.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14784.61},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20933.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7830.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":19468.15},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":14784.61},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7324.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8203.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7324.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1915.89,"10th_percentile":1915.89,"90th_percentile":1915.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7198.58,"10th_percentile":7198.58,"90th_percentile":7198.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":27594.45,"10th_percentile":27594.45,"90th_percentile":27594.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"1 through 10","median_amount":34042.03,"10th_percentile":34042.03,"90th_percentile":34042.03},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1991.69,"10th_percentile":1991.69,"90th_percentile":1991.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3088.39,"10th_percentile":2127.05,"90th_percentile":4214.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":20262.19,"10th_percentile":20262.19,"90th_percentile":20262.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5401.48,"10th_percentile":5401.48,"90th_percentile":5401.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis With Mcc","code_information":[{"code":"650","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35710.34,"maximum":229357.8,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":87267.39},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":71273.22},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138926.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37138.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35710.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":80140.06},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":147906.04},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":74230.4},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":121987.23},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36781.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":36781.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":68833.2},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":229357.8},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":174092.84},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38210.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36424.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":86660.91},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35710.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36424.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71677.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37852.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":77559.0},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":109815.3},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38174.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":102128.51},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":77559.0},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35710.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39995.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35710.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","code_information":[{"code":"658","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12215.43,"maximum":75704.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":28804.51},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23525.29},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45855.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12704.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12215.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":26451.98},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":48819.63},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":24501.37},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":40264.55},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12581.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12581.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":22719.9},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":75704.56},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":57463.15},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13070.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12459.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28604.33},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12215.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12459.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24518.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12948.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25600.04},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36246.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13058.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":33709.75},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":25600.04},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12215.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13681.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12215.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Cc","code_information":[{"code":"666","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13688.71,"maximum":85339.6,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":32470.51},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26519.39},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51691.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14236.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13688.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":29818.57},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":55032.98},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":27619.7},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":45389.09},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14099.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14099.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":25611.5},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":85339.6},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":64776.58},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14646.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13962.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32244.85},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13688.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13962.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27475.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14510.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28858.2},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40860.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14633.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":38000.04},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":28858.2},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13688.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15331.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13688.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1795.0,"10th_percentile":1795.0,"90th_percentile":1795.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Cc","code_information":[{"code":"674","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18084.68,"maximum":114088.6,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":43409.09},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":35453.18},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69105.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18808.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18084.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":39863.78},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":73572.36},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":36924.16},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":60679.65},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18627.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":18627.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":34239.44},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":114088.6},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":86598.36},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19350.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18446.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43107.41},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18084.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18446.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36299.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19169.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":38579.88},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54625.02},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19332.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":50801.41},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":38579.88},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18084.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20254.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18084.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17671.81,"10th_percentile":17671.81,"90th_percentile":17671.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16721.04,"10th_percentile":16721.04,"90th_percentile":16721.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections With Mcc","code_information":[{"code":"689","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9294.97,"maximum":56605.24,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":21537.49},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17590.15},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34286.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9666.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9294.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":19778.47},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":36503.04},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":18319.98},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":30106.3},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9573.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9573.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":16987.95},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":56605.24},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42965.91},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9945.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9480.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21387.81},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9294.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9480.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18656.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9852.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19141.47},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27102.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9936.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":25205.2},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":19141.47},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9294.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10410.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9294.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5409.64,"10th_percentile":4792.24,"90th_percentile":5695.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":12319.98,"10th_percentile":12319.98,"90th_percentile":12319.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9271.46,"10th_percentile":9271.46,"90th_percentile":9271.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9271.46,"10th_percentile":9271.46,"90th_percentile":9271.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6528.48,"10th_percentile":5254.48,"90th_percentile":9086.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3762.36,"10th_percentile":3762.36,"90th_percentile":6264.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7447.59,"10th_percentile":7447.59,"90th_percentile":7447.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7851.29,"10th_percentile":7851.29,"90th_percentile":7851.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4182.62,"10th_percentile":4182.62,"90th_percentile":4182.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Cc","code_information":[{"code":"699","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8211.09,"maximum":49516.78,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":18840.43},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15387.4},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29993.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8539.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8211.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":17301.69},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":31931.9},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":16025.84},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":26336.21},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8457.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8457.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":14860.62},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":49516.78},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37585.45},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8785.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8375.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18709.5},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8211.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8375.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16481.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8703.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16744.46},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23708.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8777.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":22048.85},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":16744.46},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8211.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9196.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8211.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7748.72,"10th_percentile":7748.72,"90th_percentile":7748.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6098.96,"10th_percentile":6098.96,"90th_percentile":6098.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy With Cc/Mcc","code_information":[{"code":"713","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11854.38,"maximum":73343.37,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":27906.11},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22791.54},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44425.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12328.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":25626.96},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":47296.96},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":23737.18},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":39008.72},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12210.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12210.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":22011.28},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":73343.37},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":55670.9},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12684.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12091.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27712.17},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11854.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12091.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23794.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12565.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24801.59},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35116.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12672.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":32658.36},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":24801.59},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11854.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13276.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5947.46,"10th_percentile":5947.46,"90th_percentile":5947.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System Without Cc/Mcc","code_information":[{"code":"724","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5530.83,"maximum":31988.32,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":12171.1},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9940.41},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19375.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5752.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5530.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":11177.06},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":20628.32},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":10352.85},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":17013.45},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5696.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":5696.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":9600.1},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":31988.32},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":24280.57},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5917.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5641.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12086.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5530.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5641.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11101.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5862.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10817.08},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15315.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5912.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":14243.77},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":10817.08},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5530.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6194.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5530.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","code_information":[{"code":"735","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10676.5,"maximum":65640.22,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":24975.17},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20397.78},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39759.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11103.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10676.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":22935.39},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":42329.43},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":21244.1},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":34911.69},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10996.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":10996.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":19699.47},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":65640.22},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":49823.87},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11423.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10890.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24801.6},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10676.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10890.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21429.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11317.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22196.71},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31428.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11413.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":29228.3},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":22196.71},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10676.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11957.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10676.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","code_information":[{"code":"743","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9894.73,"maximum":60527.55,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":23029.87},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18809.01},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36662.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10290.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9894.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":21148.97},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":39032.42},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":19589.41},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":32192.44},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10191.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":10191.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":18165.09},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":60527.55},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":45943.12},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10587.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10092.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22869.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9894.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10092.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19860.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10488.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20467.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28980.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10577.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":26951.73},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":20467.83},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9894.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11082.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9894.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":26635.52,"10th_percentile":26635.52,"90th_percentile":26635.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":56271.52,"10th_percentile":56271.52,"90th_percentile":56271.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9671.68,"10th_percentile":9671.68,"90th_percentile":9671.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":25123.77,"10th_percentile":25123.77,"90th_percentile":25123.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Mcc","code_information":[{"code":"754","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14377.98,"maximum":89847.33,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":34185.64},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27920.17},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54422.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14953.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14377.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":31393.62},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":57939.88},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":29078.6},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":47786.59},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14809.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14809.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":26964.33},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":89847.33},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":68198.15},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15384.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14665.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33948.06},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14377.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14665.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28859.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15240.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30382.52},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43018.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15370.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":40007.25},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":30382.52},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14377.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16103.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14377.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","code_information":[{"code":"768","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8633.3,"maximum":52278.01,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":19891.04},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16245.46},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31665.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8978.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8633.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":18266.49},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":33712.54},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":16919.49},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":27804.81},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8892.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8892.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":15689.3},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":52278.01},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39681.35},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9237.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8805.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19752.8},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8633.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8805.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17328.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9151.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17678.19},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25030.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9229.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":23278.37},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":17678.19},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8633.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9669.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8633.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":15164.27,"10th_percentile":15164.27,"90th_percentile":15164.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":16210.09,"10th_percentile":16210.09,"90th_percentile":16210.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2635.56,"10th_percentile":2635.56,"90th_percentile":2635.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10927.38,"10th_percentile":10927.38,"90th_percentile":10927.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2304.8,"10th_percentile":2304.8,"90th_percentile":2304.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Mcc","code_information":[{"code":"786","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12944.23,"maximum":80470.86,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":30618.02},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25006.42},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48742.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13462.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12944.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":28117.38},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":51893.27},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":26043.96},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":42799.58},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13332.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":13332.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":24150.33},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":80470.86},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":61080.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13850.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13203.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30405.23},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12944.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13203.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25981.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13720.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27211.8},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38529.02},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13837.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":35832.09},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":27211.8},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12944.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14497.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12944.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3275.55,"10th_percentile":3275.55,"90th_percentile":3275.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":9482.87,"10th_percentile":9482.87,"90th_percentile":9482.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":14273.0,"10th_percentile":14273.0,"90th_percentile":14273.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonate With Other Significant Problems","code_information":[{"code":"794","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11649.24,"maximum":72001.78,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":27395.66},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22374.64},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43612.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12115.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11649.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":25158.19},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":46431.81},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":23302.99},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":38295.18},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11998.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11998.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":21608.65},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":72001.78},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":54652.58},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12464.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11882.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27205.26},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11649.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11882.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23382.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12348.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24347.92},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34474.07},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12453.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":32060.98},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":24347.92},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11649.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13047.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11649.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5282.34,"10th_percentile":5282.34,"90th_percentile":5282.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":4193.39,"10th_percentile":4193.39,"90th_percentile":4193.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":6947.21,"10th_percentile":6947.21,"90th_percentile":6947.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":13882.11,"10th_percentile":13882.11,"90th_percentile":13882.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"1 through 10","median_amount":2719.63,"10th_percentile":2719.63,"90th_percentile":2719.63},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"1 through 10","median_amount":1006.89,"10th_percentile":944.47,"90th_percentile":4400.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":964.06,"10th_percentile":964.06,"90th_percentile":1873.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":684.06,"10th_percentile":629.16,"90th_percentile":2943.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"31","median_amount":1025.85,"10th_percentile":715.33,"90th_percentile":3220.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1386.75,"10th_percentile":1386.75,"90th_percentile":1386.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","code_information":[{"code":"802","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30359.53,"maximum":194364.32,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":73952.86},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":60398.96},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":117730.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31573.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30359.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":67912.97},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":125339.79},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":62904.95},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":103375.44},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31270.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":31270.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":58331.21},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":194364.32},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":147531.22},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32484.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30966.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":73438.92},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30359.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30966.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":60937.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32181.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":65725.7},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":93060.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32454.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":86546.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":65725.7},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30359.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34002.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30359.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"810","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8446.81,"maximum":51058.38,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":19426.99},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15866.46},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30927.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8784.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8446.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":17840.34},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":32926.04},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":16524.77},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":27156.13},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8700.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8700.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":15323.27},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":51058.38},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":38755.6},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9038.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8615.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19291.98},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8446.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8615.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16954.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8953.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17265.76},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24446.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9029.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":22735.29},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":17265.76},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8446.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9460.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8446.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Cc","code_information":[{"code":"818","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9286.77,"maximum":56551.57,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":21517.07},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17573.47},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34254.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9658.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9286.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":19759.72},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":36468.43},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":18302.61},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":30077.76},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9565.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9565.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":16971.85},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":56551.57},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42925.18},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9936.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9472.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21367.53},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9286.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9472.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18640.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9843.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19123.32},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27076.59},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9927.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":25181.3},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":19123.32},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9286.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10401.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9286.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":25927.23,"10th_percentile":25927.23,"90th_percentile":25927.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","code_information":[{"code":"826","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35534.29,"maximum":228206.47,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":86829.32},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":70915.45},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138228.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36955.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35534.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":79737.78},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":147163.59},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":73857.78},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":121374.88},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36600.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":36600.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":68487.67},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":228206.47},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":173218.93},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38021.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36244.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":86225.89},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35534.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36244.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71324.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37666.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":77169.67},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":109264.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37986.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":101615.85},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":77169.67},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35534.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39798.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35534.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Mcc","code_information":[{"code":"834","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41592.28,"maximum":267824.77,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":101903.52},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":83226.88},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":162226.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43255.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41592.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":93580.84},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":172712.25},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":86680.03},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":142446.44},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":42840.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":42840.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":80377.63},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":267824.77},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":203291.0},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44503.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":42424.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":101195.33},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41592.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":42424.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":83484.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44087.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":90566.88},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":128233.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44462.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":119257.1},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":90566.88},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41592.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46583.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41592.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","code_information":[{"code":"842","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8176.77,"maximum":49292.36,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":18755.04},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15317.66},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29857.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8503.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8176.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":17223.28},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":31787.18},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":15953.21},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":26216.85},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8422.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8422.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":14793.27},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":49292.36},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37415.11},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8749.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8340.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18624.7},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8176.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8340.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16412.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8667.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16668.57},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23600.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8740.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":21948.92},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":16668.57},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8176.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9157.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8176.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Other Procedures","code_information":[{"code":"850","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":65236.38,"maximum":422453.71,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":160737.64},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":131278.02},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":255888.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":67845.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65236.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":147609.84},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":272427.87},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":136724.85},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":224688.05},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":67193.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":67193.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":126783.74},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":422453.71},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":320661.29},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69802.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":66541.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":159620.56},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65236.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":66541.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":130942.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":69150.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":142855.77},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":202268.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69737.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":188110.32},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":142855.77},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65236.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":73064.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65236.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections Without Mcc","code_information":[{"code":"863","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8083.53,"maximum":48682.55,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":18523.02},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15128.16},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29487.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8406.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8083.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":17010.2},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":31393.93},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":15755.84},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":25892.51},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8326.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8326.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":14610.25},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":48682.55},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36952.24},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8649.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8245.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18394.29},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8083.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8245.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16225.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8568.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16462.36},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23308.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8641.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":21677.38},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":16462.36},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8083.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9053.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8083.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":16957.31,"10th_percentile":16957.31,"90th_percentile":16957.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7918.02,"10th_percentile":7918.02,"90th_percentile":7918.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5792.13,"10th_percentile":5792.13,"90th_percentile":5792.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7922.72,"10th_percentile":7922.72,"90th_percentile":7922.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","code_information":[{"code":"871","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15129.91,"maximum":94764.86,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":36056.69},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29448.3},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57400.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15735.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15129.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":33111.86},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":61111.05},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":30670.13},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":50402.05},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15583.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":15583.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":28440.14},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":94764.86},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":71930.78},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16189.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15432.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35806.1},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15129.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15432.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30368.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16037.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32045.42},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45372.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16173.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":42196.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":32045.42},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15129.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16945.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15129.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14805.81,"10th_percentile":13936.13,"90th_percentile":14823.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":61111.05,"10th_percentile":61111.05,"90th_percentile":61111.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":19286.5,"10th_percentile":19286.5,"90th_percentile":19286.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":50402.05,"10th_percentile":50402.05,"90th_percentile":50402.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15543.26,"10th_percentile":15543.26,"90th_percentile":15543.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":27247.45,"10th_percentile":27247.45,"90th_percentile":27247.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":64716.29,"10th_percentile":64716.29,"90th_percentile":64716.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14525.0,"10th_percentile":14525.0,"90th_percentile":14525.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":11928.14,"10th_percentile":5718.24,"90th_percentile":14788.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24024.46,"10th_percentile":24024.46,"90th_percentile":24024.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":10177.26,"10th_percentile":10177.26,"90th_percentile":10177.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":11194.99,"10th_percentile":11194.99,"90th_percentile":11194.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"21","median_amount":13108.03,"10th_percentile":8507.8,"90th_percentile":14826.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5322.51,"10th_percentile":5322.51,"90th_percentile":5322.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Psychoses","code_information":[{"code":"885","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11059.18,"maximum":68142.89,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":25927.4},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21175.49},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41275.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11501.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11059.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":23809.85},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":43943.33},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":22054.08},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":36242.77},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11390.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11390.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":20450.55},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":68142.89},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":51723.5},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11833.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11280.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25747.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11059.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11280.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22197.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11722.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23043.01},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32626.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11822.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":30342.69},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":23043.01},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11059.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12386.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11059.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10072.41,"10th_percentile":10072.41,"90th_percentile":10072.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5016.82,"10th_percentile":5016.82,"90th_percentile":5016.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":25963.24,"10th_percentile":25963.24,"90th_percentile":25963.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9065.85,"10th_percentile":9065.85,"90th_percentile":9065.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Cc","code_information":[{"code":"902","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14921.04,"maximum":93398.88,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":35536.95},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29023.82},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56573.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15517.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14921.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":32634.57},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":60230.17},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":30228.04},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":49675.53},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15368.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":15368.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":28030.19},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":93398.88},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":70893.94},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15965.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15219.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35289.98},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14921.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15219.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":29949.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15816.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":31583.51},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44718.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15950.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":41588.68},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":31583.51},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14921.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16711.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14921.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury With Mcc","code_information":[{"code":"913","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12833.08,"maximum":79743.96,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":30341.45},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24780.54},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48302.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13346.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12833.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":27863.39},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":51424.52},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":25808.7},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":42412.97},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13218.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":13218.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":23932.18},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":79743.96},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":60529.24},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13731.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13089.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30130.58},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12833.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13089.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25758.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13603.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26966.0},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38180.99},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13718.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":35508.42},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":26966.0},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12833.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14373.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12833.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment Without Cc/Mcc","code_information":[{"code":"921","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5774.76,"maximum":33583.59,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":12778.08},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10436.14},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20342.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6005.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5774.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":11734.47},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":21657.06},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":10869.15},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":17861.91},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5948.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":5948.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":10078.86},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":33583.59},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25491.45},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6178.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5890.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12689.28},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5774.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5890.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11591.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6121.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11356.53},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16079.65},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6173.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":14954.11},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":11356.53},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5774.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6467.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5774.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5467.79,"10th_percentile":5467.79,"90th_percentile":5467.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive Burns","code_information":[{"code":"935","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16006.42,"maximum":100497.1,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":38237.72},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31229.6},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60873.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16646.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16006.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":35114.76},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":64807.6},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":32525.34},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":53450.82},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16486.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":16486.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":30160.46},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":100497.1},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":76281.8},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17126.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16326.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37971.98},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16006.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16326.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32128.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16966.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":33983.82},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48117.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17110.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":44749.38},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":33983.82},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16006.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17927.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16006.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare With Cc/Mcc","code_information":[{"code":"949","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9514.29,"maximum":58039.51,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":22083.21},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18035.85},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35155.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9894.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9514.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":20279.63},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":37427.96},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":18784.17},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":30869.15},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9799.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9799.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":17418.4},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":58039.51},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":44054.59},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10180.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9704.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21929.74},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9514.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9704.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19097.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10085.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19626.48},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27789.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10170.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":25843.85},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":19626.48},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9514.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10656.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9514.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Mcc","code_information":[{"code":"963","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21032.73,"maximum":133368.43,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":50744.8},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":41444.41},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80783.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21874.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21032.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":46600.35},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":86005.35},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":43163.97},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":70933.91},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21663.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":21663.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":40025.57},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":133368.43},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":101232.61},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22505.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21453.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50392.14},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21032.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21453.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":42216.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22294.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":45099.5},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":63856.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22483.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":59386.34},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":45099.5},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21032.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23556.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21032.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Or Without Other Related Condition","code_information":[{"code":"977","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10319.93,"maximum":63308.29,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":24087.91},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19673.13},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38347.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10732.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10319.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":22120.59},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":40825.64},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":20489.39},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":33671.42},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10629.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":10629.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":18999.63},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":63308.29},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":48053.83},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11042.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10526.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23920.5},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10319.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10526.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20714.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10939.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21408.16},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30311.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11032.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":28189.94},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":21408.16},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10319.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11558.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10319.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","code_information":[{"code":"003","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":158972.11,"maximum":1035471.38,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":393982.16},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":321774.03},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":627204.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":165330.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":158972.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":361804.76},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":667744.79},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":335124.68},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":550730.26},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":163741.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":163741.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":310758.15},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":1035471.38},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":785969.16},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":170100.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":162151.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":391244.11},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":158972.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":162151.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":319088.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":168510.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":350152.12},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":495778.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":169941.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":461075.02},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":350152.12},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":158972.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":178048.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":158972.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":151232.66,"10th_percentile":151232.66,"90th_percentile":151232.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","code_information":[{"code":"012","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32089.43,"maximum":205677.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":78257.39},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":63914.56},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":124582.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33373.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32089.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":71865.94},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":132635.36},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":66566.42},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":109392.55},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33052.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":33052.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":61726.46},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":205677.56},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":156118.48},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34335.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32731.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":77713.53},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32089.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32731.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64409.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34014.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":69551.35},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":98477.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34303.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":91584.17},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":69551.35},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32089.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35940.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32089.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","code_information":[{"code":"021","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40129.44,"maximum":258258.03,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":98263.52},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":80254.01},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":156431.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41734.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40129.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":90238.11},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":166542.95},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":83583.81},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":137358.23},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41333.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":41333.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":77506.53},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":258258.03},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":196029.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42938.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40932.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":97580.62},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40129.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40932.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":80547.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":42537.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":87331.82},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":123652.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42898.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":114997.22},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":87331.82},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40129.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44944.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40129.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Cc Or Spinal Neurostimulators","code_information":[{"code":"029","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26088.88,"maximum":166434.91,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":63326.12},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":51719.86},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":100812.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27132.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26088.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":58154.13},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":107328.94},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":53865.75},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":88520.79},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26871.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":26871.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":49949.24},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":166434.91},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":126331.55},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27915.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26610.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62886.02},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26088.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26610.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":52365.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27654.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":56281.17},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":79688.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27889.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":74110.19},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":56281.17},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26088.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29219.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26088.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Mcc","code_information":[{"code":"037","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25197.46,"maximum":160605.1,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":61107.96},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":49908.24},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97281.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26205.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25197.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":56117.14},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":103569.47},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":51978.97},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":85420.12},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25953.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":25953.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":48199.64},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":160605.1},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":121906.46},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26961.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25701.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60683.28},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25197.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25701.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":50576.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26709.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":54309.77},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":76896.87},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26936.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":71514.29},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":54309.77},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25197.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28221.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25197.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms With Mcc","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12029.68,"maximum":74489.82,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":28342.32},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23147.8},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45119.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12510.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12029.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":26027.54},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":48036.27},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":24108.22},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":39618.47},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12390.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12390.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":22355.34},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":74489.82},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":56541.11},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12871.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12270.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28145.35},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12029.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12270.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24145.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12751.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25189.27},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35665.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12859.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":33168.85},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":25189.27},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12029.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13473.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12029.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","code_information":[{"code":"062","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13747.64,"maximum":85725.0,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":32617.15},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26639.15},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51925.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14297.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13747.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":29953.23},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":55281.51},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":27744.43},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":45594.07},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14160.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14160.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":25727.17},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":85725.0},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":65069.12},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14709.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14022.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32390.47},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13747.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14022.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27594.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14572.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28988.53},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41044.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14696.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":38171.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":28988.53},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13747.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15397.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13747.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Mcc","code_information":[{"code":"070","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13058.37,"maximum":81217.27,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":30902.02},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25238.37},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49194.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13580.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13058.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":28378.18},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":52374.61},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":26285.53},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":43196.57},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13450.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":13450.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":24374.34},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":81217.27},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":61647.54},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13972.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13319.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30687.26},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13058.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13319.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26210.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13841.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27464.21},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38886.4},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13959.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":36164.45},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":27464.21},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13058.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14625.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13058.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10823.73,"10th_percentile":10823.73,"90th_percentile":10823.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma Without Mcc","code_information":[{"code":"081","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7320.4,"maximum":43691.85,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":16624.13},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13577.3},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26464.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7613.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7320.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":15266.4},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":28175.58},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":14140.63},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":23238.13},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7540.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7540.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":13112.48},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":43691.85},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33164.07},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7832.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7466.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16508.59},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7320.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7466.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14693.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7759.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14774.71},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20919.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7825.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":19455.12},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":14774.71},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7320.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8198.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7320.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Cc","code_information":[{"code":"089","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8834.71,"maximum":53595.2,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":20392.21},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16654.78},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32463.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9188.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8834.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":18726.74},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":34561.96},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":17345.8},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":28505.37},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9099.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9099.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":16084.6},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":53595.2},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40681.16},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9453.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9011.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20250.49},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8834.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9011.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17733.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9364.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18123.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25661.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9444.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":23864.89},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":18123.6},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8834.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9894.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8834.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","code_information":[{"code":"097","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27582.31,"maximum":176201.66,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":67042.23},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":54754.89},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":106728.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28685.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27582.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":61566.74},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":113627.23},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":57026.71},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":93715.37},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28409.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":28409.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":52880.36},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":176201.66},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":133744.95},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29513.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28133.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":66576.31},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27582.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28133.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55363.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29237.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":59583.86},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":84364.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29485.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":78459.13},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":59583.86},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27582.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30892.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27582.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures Without Cc/Mcc","code_information":[{"code":"114","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10732.45,"maximum":66006.11,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":25114.39},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20511.48},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39981.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11161.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10732.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":23063.24},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":42565.38},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":21362.52},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":35106.29},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11054.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11054.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":19809.27},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":66006.11},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":50101.59},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11483.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10947.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24939.85},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10732.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10947.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21542.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11376.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22320.44},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31603.37},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11472.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":29391.22},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":22320.44},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10732.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12020.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10732.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye Without Mcc","code_information":[{"code":"125","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6367.06,"maximum":37457.12,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":14251.9},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11639.85},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22688.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6621.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6367.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":13087.92},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":24154.99},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":12122.79},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":19922.11},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6558.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6558.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":11241.36},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":37457.12},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28431.63},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6812.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6494.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14152.86},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6367.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6494.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12779.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6749.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12666.4},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17934.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6806.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":16678.92},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":12666.4},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6367.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7131.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6367.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures Without Cc/Mcc","code_information":[{"code":"142","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12548.13,"maximum":77880.37,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":29632.38},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24201.42},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47173.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13050.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12548.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":27212.23},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":50222.74},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":25205.56},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":41421.79},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12924.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12924.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":23372.89},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":77880.37},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":59114.69},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13426.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12799.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29426.44},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12548.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12799.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25186.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13301.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26335.81},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37288.71},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13413.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":34678.6},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":26335.81},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12548.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14053.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12548.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis With Mcc","code_information":[{"code":"150","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10572.06,"maximum":64957.23,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":24715.3},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20185.54},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39345.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10994.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10572.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":22696.75},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":41888.99},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":21023.05},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":34548.43},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10889.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":10889.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":19494.49},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":64957.23},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":49305.45},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11312.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10783.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24543.54},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10572.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10783.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21220.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11206.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21965.76},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31101.18},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11301.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":28924.17},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":21965.76},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10572.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11840.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10572.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Cc","code_information":[{"code":"158","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7426.33,"maximum":44384.59,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":16887.71},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13792.57},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26884.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7723.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7426.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":15508.45},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":28622.31},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":14364.83},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":23606.58},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7649.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7649.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":13320.38},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":44384.59},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33689.89},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7946.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7574.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16770.34},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7426.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7574.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14906.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7871.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15008.97},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21251.11},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7938.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":19763.59},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":15008.97},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7426.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8317.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7426.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1816.99,"10th_percentile":1816.99,"90th_percentile":1816.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","code_information":[{"code":"173","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22842.44,"maximum":145203.67,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":55247.94},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":45122.22},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":87952.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23756.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22842.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":50735.71},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":93637.54},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":46994.38},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":77228.65},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23527.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":23527.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":43577.47},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":145203.67},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":110216.09},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24441.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23299.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54863.98},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22842.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23299.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":45849.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24212.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":49101.67},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69522.75},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24418.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":64656.34},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":49101.67},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22842.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25583.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22842.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms Without Cc/Mcc","code_information":[{"code":"182","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6262.62,"maximum":36774.13,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":13992.04},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11427.61},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22274.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6513.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6262.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":12849.27},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":23714.55},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":11901.75},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":19558.85},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6450.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6450.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":11036.39},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":36774.13},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27913.21},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6701.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6387.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13894.8},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6262.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6387.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12570.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6638.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12435.44},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17607.26},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6694.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":16374.8},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":12435.44},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6262.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7014.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6262.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8902.59,"maximum":54039.14,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":20561.13},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16792.73},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32732.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9258.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8902.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":18881.85},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":34848.24},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":17489.48},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":28741.49},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9169.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9169.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":16217.84},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":54039.14},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":41018.13},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9525.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9080.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20418.23},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8902.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9080.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17869.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9436.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18273.73},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25873.66},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9516.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":24062.57},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":18273.73},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8902.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9970.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8902.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14190.79,"10th_percentile":14190.79,"90th_percentile":14190.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6997.34,"10th_percentile":6201.3,"90th_percentile":8731.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8714.24,"10th_percentile":8714.24,"90th_percentile":8714.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3475.19,"10th_percentile":3475.19,"90th_percentile":3475.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":7968.45,"10th_percentile":7134.54,"90th_percentile":8707.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1865.85,"10th_percentile":1865.85,"90th_percentile":1865.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3576.41,"10th_percentile":3576.41,"90th_percentile":3576.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3711.37,"10th_percentile":3711.37,"90th_percentile":3711.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":6941.2,"10th_percentile":6776.84,"90th_percentile":8705.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7585.44,"10th_percentile":7346.65,"90th_percentile":8546.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease Without Cc/Mcc","code_information":[{"code":"198","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5982.14,"maximum":34939.82,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":13294.1},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10857.59},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21163.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6221.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5982.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":12208.35},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":22531.65},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":11308.08},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":18583.24},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6161.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6161.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":10485.88},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":34939.82},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26520.89},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6400.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6101.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13201.71},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5982.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6101.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12007.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6341.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11815.15},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16729.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6394.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":15558.01},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":11815.15},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5982.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6700.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5982.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses Without Mcc","code_information":[{"code":"206","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7659.82,"maximum":45911.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":17468.7},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14267.08},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27809.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7966.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7659.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":16041.99},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":29607.01},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":14859.03},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":24418.72},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7889.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7889.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":13778.65},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":45911.56},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34848.93},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8196.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7813.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17347.3},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7659.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7813.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15374.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8119.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15525.33},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21982.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8188.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":20443.52},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":15525.33},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7659.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8579.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7659.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":8071.59,"10th_percentile":8071.59,"90th_percentile":8071.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","code_information":[{"code":"217","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":49688.98,"maximum":320776.01,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":122050.72},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":99681.55},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194300.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51676.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49688.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":112082.56},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":206858.94},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":103817.41},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":170609.31},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":51179.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":51179.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":96268.97},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":320776.01},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":243483.36},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53167.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":50682.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":121202.5},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49688.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":50682.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":99735.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":52670.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":108472.72},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":153585.86},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53117.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":142835.24},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":108472.72},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49688.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":55651.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49688.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca Without Mcc","code_information":[{"code":"232","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45864.42,"maximum":295763.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":112533.98},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":91909.02},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":179149.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47699.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45864.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":103343.08},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":190729.4},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":95722.39},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":157306.28},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":47240.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":47240.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":88762.53},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":295763.94},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":224498.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49074.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":46781.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":111751.91},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45864.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":46781.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":92059.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":48616.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":100014.71},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":141610.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49029.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":131697.86},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":100014.71},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45864.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51368.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45864.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Mcc","code_information":[{"code":"242","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24456.71,"maximum":155760.75,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":59264.75},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":48402.85},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94347.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25434.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24456.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":54424.47},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":100445.49},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":50411.12},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":82843.58},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25190.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":25190.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":46745.78},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":155760.75},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":118229.38},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26168.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24945.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58852.88},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24456.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24945.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":49089.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25924.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":52671.62},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":74577.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26144.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":69357.19},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":52671.62},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24456.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27391.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24456.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24716.98,"10th_percentile":24716.98,"90th_percentile":24716.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23960.16,"10th_percentile":23960.16,"90th_percentile":23960.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":68641.5,"10th_percentile":68641.5,"90th_percentile":68641.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23904.16,"10th_percentile":22427.71,"90th_percentile":23953.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures Without Cc/Mcc","code_information":[{"code":"254","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13930.4,"maximum":86920.23,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":33071.92},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27010.57},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52649.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14487.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13930.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":30370.86},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":56052.28},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":28131.26},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":46229.77},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14348.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14348.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":26085.87},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":86920.23},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":65976.35},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14905.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14209.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32842.08},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13930.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14209.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27961.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14766.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29392.7},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41616.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14891.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":38703.87},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":29392.7},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13930.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15602.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13930.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","code_information":[{"code":"262","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12798.02,"maximum":79514.67,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":30254.2},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24709.28},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48163.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13309.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12798.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":27783.28},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":51276.65},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":25734.49},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":42291.02},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13181.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":13181.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":23863.37},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":79514.67},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":60355.2},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13693.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13053.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30043.95},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12798.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13053.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25688.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13565.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26888.46},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38071.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13681.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":35406.32},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":26888.46},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12798.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14333.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12798.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Mcc","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39998.89,"maximum":257404.3,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":97938.68},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":79988.71},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155914.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41598.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39998.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":89939.81},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":165992.4},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":83307.5},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":136904.16},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41198.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":41198.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":77250.31},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":257404.3},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":195381.39},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42798.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40798.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":97258.04},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39998.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40798.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":80285.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":42398.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":87043.12},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":123243.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42758.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":114617.06},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":87043.12},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39998.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44798.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39998.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38548.93,"10th_percentile":38548.93,"90th_percentile":38548.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39094.13,"10th_percentile":39094.13,"90th_percentile":39094.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37325.23,"10th_percentile":37325.23,"90th_percentile":39094.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","code_information":[{"code":"278","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42161.45,"maximum":271547.07,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":103319.8},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":84383.59},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":164481.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43847.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42161.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":94881.45},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":175112.65},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":87884.73},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":144426.19},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43426.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":43426.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":81494.73},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":271547.07},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":206116.39},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45112.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43004.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":102601.76},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42161.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43004.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":84626.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44691.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":91825.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":130015.3},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45070.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":120914.56},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":91825.6},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42161.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47220.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42161.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":129191.27,"10th_percentile":129191.27,"90th_percentile":129191.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","code_information":[{"code":"286","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17146.25,"maximum":107951.45,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":41073.99},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":33546.05},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65388.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17832.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17146.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":37719.39},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":69614.69},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":34937.9},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":57415.52},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17660.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":17660.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":32397.6},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":107951.45},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":81939.98},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18346.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17489.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40788.54},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17146.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17489.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34415.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18175.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":36504.56},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51686.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18329.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":48068.65},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":36504.56},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17146.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19203.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17146.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1607.74,"10th_percentile":1607.74,"90th_percentile":1607.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17950.49,"10th_percentile":17950.49,"90th_percentile":17950.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Mcc","code_information":[{"code":"296","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12290.77,"maximum":76197.29,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":28991.99},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23678.4},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46154.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12782.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12290.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":26624.15},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":49137.37},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":24660.84},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":40526.62},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12659.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12659.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":22867.78},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":76197.29},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":57837.16},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13151.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12536.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28790.5},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12290.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12536.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24670.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13028.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25766.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36482.86},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13138.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":33929.15},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":25766.66},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12290.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13765.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12290.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension With Mcc","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9516.52,"maximum":58054.15,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":22088.78},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18040.4},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35164.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9897.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9516.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":20284.74},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":37437.4},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":18788.91},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":30876.93},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9802.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9802.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":17422.79},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":58054.15},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":44065.7},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10182.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9706.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21935.27},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9516.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9706.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19101.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10087.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19631.43},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27796.02},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10173.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":25850.37},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":19631.43},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9516.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10658.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9516.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8185.36,"10th_percentile":8185.36,"90th_percentile":8185.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12528.53,"10th_percentile":12528.53,"90th_percentile":12528.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Syncope And Collapse","code_information":[{"code":"312","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7141.37,"maximum":42521.01,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":16178.64},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13213.46},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25755.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7427.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7141.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":14857.29},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":27420.54},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":13761.69},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":22615.41},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7355.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7355.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":12761.1},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":42521.01},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32275.35},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7641.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7284.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16066.2},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7141.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7284.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14334.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7569.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14378.79},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20358.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7634.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":18933.77},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":14378.79},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7141.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7998.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7141.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2819.54,"10th_percentile":2819.54,"90th_percentile":2819.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2657.74,"10th_percentile":2657.74,"90th_percentile":2657.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7337.42,"10th_percentile":7337.42,"90th_percentile":7337.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":150.59,"10th_percentile":150.59,"90th_percentile":150.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures Without Mcc","code_information":[{"code":"320","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18582.24,"maximum":117342.56,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":44647.18},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":36464.35},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":71076.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19325.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18582.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":41000.74},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":75670.74},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":37977.28},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":62410.32},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19139.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":19139.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":35216.0},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":117342.56},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":89068.26},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19883.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18953.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44336.89},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18582.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18953.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":37298.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19697.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":39680.23},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56183.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19864.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":52250.33},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":39680.23},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18582.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20812.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18582.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","code_information":[{"code":"328","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12592.14,"maximum":78168.21,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":29741.89},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24290.87},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47347.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13095.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12592.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":27312.81},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":50408.36},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":25298.71},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":41574.88},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12969.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12969.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":23459.27},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":78168.21},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":59333.17},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13473.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12843.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29535.2},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12592.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12843.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25274.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13347.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26433.14},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37426.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13461.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":34806.76},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":26433.14},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12592.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14103.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12592.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":25298.71,"10th_percentile":25298.71,"90th_percentile":25298.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":25879.13,"10th_percentile":25879.13,"90th_percentile":25879.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":30798.6,"10th_percentile":30798.6,"90th_percentile":30798.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":98298.4,"10th_percentile":98298.4,"90th_percentile":98298.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Cc","code_information":[{"code":"336","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16369.71,"maximum":102872.93,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":39141.69},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31967.89},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":62312.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17024.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16369.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":35944.9},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":66339.7},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":33294.26},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":54714.44},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16860.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":16860.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":30873.48},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":102872.93},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":78085.16},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17515.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16697.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38869.67},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16369.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16697.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32857.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17351.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34787.22},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49255.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17499.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":45807.29},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":34787.22},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16369.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18334.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16369.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15722.3,"10th_percentile":15722.3,"90th_percentile":15722.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11129.95,"10th_percentile":11129.95,"90th_percentile":11129.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Mcc","code_information":[{"code":"350","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19228.24,"maximum":121567.34,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":46254.65},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":37777.2},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":73635.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19997.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19228.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":42476.93},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":78395.17},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":39344.61},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":64657.33},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19805.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":19805.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":36483.91},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":121567.34},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":92275.06},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20574.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19612.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45933.19},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19228.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19612.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":38594.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20381.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":41108.87},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58205.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20554.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":54131.54},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":41108.87},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19228.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21535.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19228.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":35197.66,"10th_percentile":35197.66,"90th_percentile":35197.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"358","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11067.39,"maximum":68196.55,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":25947.82},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21192.16},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41307.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11510.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11067.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":23828.6},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":43977.93},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":22071.44},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":36271.31},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11399.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11399.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":20466.65},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":68196.55},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":51764.24},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11842.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11288.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25767.49},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11067.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11288.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22214.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11731.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23061.16},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32652.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11831.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":30366.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":23061.16},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11067.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12395.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11067.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6065.69,"maximum":35486.21,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":13502.0},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11027.38},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21494.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6308.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6065.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":12399.26},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":22884.0},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":11484.92},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":18873.85},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6247.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6247.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":10649.86},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":35486.21},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26935.62},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6490.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6187.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13408.16},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6065.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6187.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12175.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6429.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11999.92},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16990.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6484.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":15801.31},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":11999.92},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6065.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6793.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6065.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Cc","code_information":[{"code":"381","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8722.07,"maximum":52858.55,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":20111.93},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16425.86},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32017.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9070.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8722.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":18469.34},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":34086.91},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":17107.38},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":28113.57},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8983.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8983.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":15863.52},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":52858.55},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40122.01},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9332.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8896.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19972.16},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8722.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8896.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17506.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9245.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17874.5},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25308.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9323.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":23536.87},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":17874.5},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8722.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9768.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8722.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6174.12,"10th_percentile":6174.12,"90th_percentile":6174.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Cc","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6531.17,"maximum":38530.39,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":14660.27},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11973.37},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23338.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6792.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6531.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":13462.93},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":24847.11},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":12470.15},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":20492.94},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6727.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6727.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":11563.46},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":38530.39},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29246.29},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6988.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6661.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14558.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6531.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6661.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13109.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6923.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13029.33},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18448.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6981.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":17156.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":13029.33},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6531.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7314.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6531.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":12133.83,"10th_percentile":12133.83,"90th_percentile":12133.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":24847.11,"10th_percentile":24847.11,"90th_percentile":24847.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":2208.58,"10th_percentile":2208.58,"90th_percentile":2208.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6710.63,"10th_percentile":6710.63,"90th_percentile":6710.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6091.27,"10th_percentile":4718.87,"90th_percentile":6384.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":17316.23,"10th_percentile":17316.23,"90th_percentile":17316.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4681.44,"10th_percentile":4681.44,"90th_percentile":4681.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Cc","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11930.47,"maximum":73840.98,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":28095.44},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22946.18},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44726.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12407.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11930.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":25800.83},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":47617.86},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":23898.23},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":39273.38},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12288.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12288.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":22160.62},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":73840.98},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":56048.61},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12765.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12169.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27900.19},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11930.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12169.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23946.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12646.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24969.86},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35354.67},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12753.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":32879.93},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":24969.86},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11930.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13362.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11930.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10389.79,"10th_percentile":10389.79,"90th_percentile":10389.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"1 through 10","median_amount":24969.86,"10th_percentile":24969.86,"90th_percentile":24969.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11539.3,"10th_percentile":11539.3,"90th_percentile":11539.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"1 through 10","median_amount":28112.27,"10th_percentile":28112.27,"90th_percentile":28112.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","code_information":[{"code":"410","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12483.23,"maximum":77455.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":29470.89},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24069.53},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46916.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12982.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12483.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":27063.93},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":49949.04},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":25068.2},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":41196.05},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12857.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12857.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":23245.52},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":77455.94},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":58792.53},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13357.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12732.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29266.07},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12483.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12732.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25056.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13232.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26192.29},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37085.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13344.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":34489.61},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":26192.29},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12483.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13981.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12483.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Cc","code_information":[{"code":"418","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13258.28,"maximum":82524.71,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":31399.48},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25644.66},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49986.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13788.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13258.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":28835.01},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":53217.74},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":26708.67},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":43891.95},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13656.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":13656.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":24766.72},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":82524.71},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":62639.95},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14186.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13523.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31181.26},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13258.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13523.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26612.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14053.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27906.33},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39512.39},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14173.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":36746.63},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":27906.33},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13258.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14849.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13258.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12994.32,"10th_percentile":12994.32,"90th_percentile":13000.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":49884.41,"10th_percentile":49884.41,"90th_percentile":49884.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":19220.43,"10th_percentile":19220.43,"90th_percentile":19220.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":37520.84,"10th_percentile":37520.84,"90th_percentile":37520.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13620.72,"10th_percentile":13620.72,"90th_percentile":13620.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":81560.38,"10th_percentile":81560.38,"90th_percentile":81560.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":200154.7,"10th_percentile":200154.7,"90th_percentile":200154.7},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12959.52,"10th_percentile":12959.52,"90th_percentile":12959.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":6184.3,"10th_percentile":6184.3,"90th_percentile":6184.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":39212.39,"10th_percentile":39212.39,"90th_percentile":39212.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12959.52,"10th_percentile":12959.52,"90th_percentile":13355.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14000.16,"10th_percentile":14000.16,"90th_percentile":14000.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","code_information":[{"code":"426","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":82853.84,"maximum":537669.24,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":204575.51},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":167081.39},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":325676.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":86167.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82853.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":187867.38},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":346726.95},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":174013.73},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":285967.08},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":85339.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":85339.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":161361.39},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":537669.24},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":408115.04},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":88653.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":84510.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":203153.78},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":82853.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":84510.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":166304.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":87825.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":181816.74},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":257433.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":88570.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":239413.53},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":181816.74},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":82853.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":92796.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82853.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","code_information":[{"code":"435","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14340.68,"maximum":89603.41,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":34092.83},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27844.37},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54274.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14914.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14340.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":31308.39},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":57782.58},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":28999.66},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":47656.85},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14770.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14770.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":26891.12},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":89603.41},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":68013.0},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15344.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14627.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33855.89},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14340.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14627.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28784.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15201.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30300.04},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42901.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15330.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":39898.63},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":30300.04},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14340.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16061.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14340.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"443","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5859.06,"maximum":34134.86,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":12987.83},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10607.45},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20676.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6093.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5859.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":11927.09},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":22012.56},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":11047.56},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":18155.12},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6034.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6034.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":10244.31},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":34134.86},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25909.89},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6269.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5976.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12897.57},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5859.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5976.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11760.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6210.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11542.95},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16343.59},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6263.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":15199.58},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":11542.95},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5859.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6562.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5859.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"456","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":63325.97,"maximum":409959.87,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":155983.91},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":127395.54},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":248320.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65859.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63325.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":143244.36},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":264370.96},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":132681.28},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":218043.02},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65225.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":65225.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":123034.18},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":409959.87},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":311177.9},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":67758.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":64592.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":154899.87},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":63325.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":64592.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":127107.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":67125.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":138630.89},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":196286.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":67695.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":182547.06},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":138630.89},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":63325.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":70925.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63325.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Mcc","code_information":[{"code":"466","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39470.01,"maximum":253945.44,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":96622.63},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":78913.86},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":153819.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41048.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39470.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":88731.25},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":163761.88},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":82188.06},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":135064.51},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40654.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":40654.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":76212.26},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":253945.44},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":192755.96},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42232.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40259.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":95951.14},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39470.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40259.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":79224.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41838.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":85873.48},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":121587.73},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42193.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":113076.9},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":85873.48},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39470.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44206.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39470.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","code_information":[{"code":"474","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32663.07,"maximum":209429.13,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":79684.81},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":65080.36},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":126855.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33969.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32663.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":73176.77},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":135054.63},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":67780.6},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":111387.88},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33642.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":33642.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":62852.35},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":209429.13},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":158966.09},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34949.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33316.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":79131.03},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32663.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33316.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":65561.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34622.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":70819.97},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":100273.56},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34916.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":93254.67},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":70819.97},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32663.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36582.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32663.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","code_information":[{"code":"482","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12806.23,"maximum":79568.34,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":30274.62},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24725.96},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48196.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13318.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12806.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":27802.03},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":51311.26},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":25751.86},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":42319.56},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13190.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":13190.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":23879.47},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":79568.34},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":60395.93},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13702.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13062.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30064.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12806.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13062.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25704.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13574.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26906.61},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38096.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13689.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":35430.21},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":26906.61},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12806.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14342.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12806.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12529.11,"10th_percentile":12529.11,"90th_percentile":12535.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":55552.46,"10th_percentile":55552.46,"90th_percentile":55552.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12343.27,"10th_percentile":12343.27,"90th_percentile":12343.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","code_information":[{"code":"493","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19557.96,"maximum":123723.64,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":47075.09},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":38447.28},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":74941.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20340.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19557.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":43230.36},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":79785.71},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":40042.48},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":65804.19},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20144.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":20144.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":37131.04},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":123723.64},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":93911.78},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20927.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19949.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46747.93},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19557.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19949.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":39256.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20731.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":41838.04},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":59238.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20907.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":55091.7},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":41838.04},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19557.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21904.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19557.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14908.28,"10th_percentile":14908.28,"90th_percentile":14908.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16474.26,"10th_percentile":16474.26,"90th_percentile":16474.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"1 through 10","median_amount":1613.68,"10th_percentile":1613.68,"90th_percentile":1613.68},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":10707.53,"10th_percentile":10707.53,"90th_percentile":10707.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16416.3,"10th_percentile":16416.3,"90th_percentile":16416.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Cc","code_information":[{"code":"501","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13679.76,"maximum":85281.06,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":32448.23},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26501.2},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51656.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14226.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13679.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":29798.11},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":54995.23},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":27600.75},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":45357.95},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14090.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14090.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":25593.93},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":85281.06},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":64732.14},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14637.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13953.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32222.73},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13679.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13953.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27458.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14500.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28838.41},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40832.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14623.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":37973.98},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":28838.41},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13679.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15321.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13679.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11916.13,"10th_percentile":11916.13,"90th_percentile":11916.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","code_information":[{"code":"510","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23171.41,"maximum":147355.09,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":56066.52},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":45790.78},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":89255.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24098.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23171.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":51487.44},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":95024.93},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":47690.67},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":78372.91},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23866.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":23866.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":44223.14},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":147355.09},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":111849.12},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24793.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23634.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":55676.88},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23171.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23634.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":46509.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24561.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":49829.19},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":70552.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24770.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":65614.32},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":49829.19},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23171.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25951.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23171.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","code_information":[{"code":"518","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28518.49,"maximum":182324.18,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":69371.76},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":56657.47},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":110437.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29659.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28518.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":63706.02},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":117575.46},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":59008.23},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":96971.72},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29374.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":29374.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":54717.81},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":182324.18},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":138392.22},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30514.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29088.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":68889.65},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28518.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29088.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":57242.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30229.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":61654.24},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":87295.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30486.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":81185.37},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":61654.24},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28518.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31940.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28518.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis Without Mcc","code_information":[{"code":"536","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6663.95,"maximum":39398.77,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":14990.67},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12243.22},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23864.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6930.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6663.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":13766.35},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":25407.1},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":12751.2},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":20954.8},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6863.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6863.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":11824.07},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":39398.77},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29905.43},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7130.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6797.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14886.49},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6663.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6797.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13375.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7063.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13322.98},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18863.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7123.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":17543.49},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":13322.98},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6663.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7463.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6663.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":25407.1,"10th_percentile":25407.1,"90th_percentile":25407.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6548.63,"10th_percentile":6548.63,"90th_percentile":6548.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":18259.03,"10th_percentile":18259.03,"90th_percentile":18259.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6482.21,"10th_percentile":6482.21,"90th_percentile":6482.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","code_information":[{"code":"544","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6268.59,"maximum":36813.16,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":14006.89},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11439.74},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22298.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6519.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6268.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":12862.91},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":23739.72},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":11914.38},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":19579.61},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6456.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6456.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":11048.1},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":36813.16},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27942.84},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6707.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6393.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13909.54},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6268.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6393.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12582.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6644.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12448.64},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17625.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6701.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":16392.18},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":12448.64},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6268.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7020.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6268.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6135.72,"10th_percentile":6135.72,"90th_percentile":6135.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems Without Mcc","code_information":[{"code":"552","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7810.5,"maximum":46897.02,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":17843.65},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14573.31},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28406.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8122.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7810.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":16386.32},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":30242.5},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":15177.97},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":24942.85},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8044.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8044.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":14074.39},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":46897.02},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35596.94},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8357.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7966.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17719.64},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7810.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7966.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15677.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8279.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15858.57},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22454.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8349.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":20882.32},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":15858.57},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7810.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8747.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7810.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":16111.98,"10th_percentile":16111.98,"90th_percentile":16111.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2657.74,"10th_percentile":2657.74,"90th_percentile":7656.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":6889.59,"10th_percentile":6889.59,"90th_percentile":6889.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":9387.9,"10th_percentile":9387.9,"90th_percentile":9387.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5931.03,"10th_percentile":5931.03,"90th_percentile":5931.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8024.76,"10th_percentile":8024.76,"90th_percentile":8024.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":24379.41,"10th_percentile":24379.41,"90th_percentile":24379.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"1 through 10","median_amount":18232.69,"10th_percentile":18232.69,"90th_percentile":18232.69},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5969.21,"10th_percentile":2935.25,"90th_percentile":6753.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6757.56,"10th_percentile":5866.31,"90th_percentile":7645.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"560","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9039.85,"maximum":54936.79,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":20902.67},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17071.68},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33276.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9401.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9039.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":19195.5},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":35427.11},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":17779.99},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":29218.92},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9311.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9311.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":16487.23},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":54936.79},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":41699.48},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9672.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9220.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20757.4},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9039.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9220.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18144.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9582.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18577.27},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26303.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9663.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":24462.27},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":18577.27},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9039.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10124.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9039.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5050.5,"10th_percentile":5050.5,"90th_percentile":5050.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Cc","code_information":[{"code":"571","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13242.62,"maximum":82422.26,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":31360.5},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25612.82},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49924.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13772.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13242.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":28799.22},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":53151.67},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":26675.52},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":43837.46},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13639.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":13639.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":24735.97},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":82422.26},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":62562.19},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14169.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13507.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31142.55},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13242.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13507.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26580.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14037.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27871.68},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39463.34},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14156.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":36701.01},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":27871.68},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13242.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14831.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13242.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","code_information":[{"code":"579","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24797.62,"maximum":157990.22,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":60113.04},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":49095.66},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":95697.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25789.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24797.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":55203.47},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":101883.21},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":51132.68},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":84029.36},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25541.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":25541.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":47414.88},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":157990.22},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":119921.66},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26533.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25293.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59695.27},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24797.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25293.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":49773.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26285.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":53425.53},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":75644.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26508.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":70349.94},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":53425.53},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24797.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27773.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24797.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23231.85,"10th_percentile":23231.85,"90th_percentile":23231.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Cc","code_information":[{"code":"593","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9488.92,"maximum":57873.65,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":22020.1},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17984.31},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35055.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9868.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9488.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":20221.67},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":37321.0},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":18730.49},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":30780.93},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9773.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9773.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":17368.62},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":57873.65},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":43928.69},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10153.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9678.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21867.07},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9488.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9678.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19046.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10058.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19570.39},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27709.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10143.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":25769.99},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":19570.39},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9488.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10627.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9488.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2702.24,"10th_percentile":2702.24,"90th_percentile":2702.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7516.48,"10th_percentile":7516.48,"90th_percentile":7516.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","code_information":[{"code":"324","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24144.9,"maximum":153721.54,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":58488.86},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":47769.16},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":93112.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25110.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24144.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":53711.95},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":99130.46},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":49751.14},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":81759.0},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24869.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":24869.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":46133.79},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":153721.54},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":116681.53},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25835.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24627.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58082.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24144.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24627.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":48463.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25593.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":51982.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":73601.06},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25810.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":68449.17},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":51982.05},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24144.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27042.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24144.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":50870.04,"10th_percentile":50870.04,"90th_percentile":50870.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23599.42,"10th_percentile":23599.42,"90th_percentile":23618.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Mcc","code_information":[{"code":"332","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27648.7,"maximum":176635.85,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":67207.43},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":54889.81},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":106991.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28754.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27648.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":61718.45},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":113907.22},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":57167.23},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":93946.3},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28478.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":28478.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":53010.67},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":176635.85},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":134074.52},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29584.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28201.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":66740.36},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27648.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28201.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55496.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29307.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":59730.69},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":84572.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29556.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":78652.47},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":59730.69},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27648.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30966.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27648.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"346","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9488.18,"maximum":57868.77,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":22018.24},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17982.79},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35052.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9867.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9488.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":20219.97},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":37317.85},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":18728.91},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":30778.33},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9772.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9772.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":17367.15},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":57868.77},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":43924.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10152.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9677.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21865.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9488.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9677.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19044.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10057.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19568.74},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27707.26},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10142.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":25767.82},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":19568.74},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9488.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10626.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9488.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Cc","code_information":[{"code":"354","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13189.66,"maximum":82075.88,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":31228.71},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25505.18},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49714.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13717.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13189.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":28678.19},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":52928.3},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":26563.41},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":43653.23},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13585.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":13585.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":24632.02},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":82075.88},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":62299.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14112.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13453.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31011.68},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13189.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13453.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26474.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13981.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27754.55},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39297.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14099.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":36546.78},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":27754.55},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13189.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14772.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13189.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13404.61,"10th_percentile":13404.61,"90th_percentile":13404.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":11580.97,"10th_percentile":11580.97,"90th_percentile":11580.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13155.56,"10th_percentile":13155.56,"90th_percentile":13155.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12896.35,"10th_percentile":12896.35,"90th_percentile":12896.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Cc","code_information":[{"code":"369","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8100.68,"maximum":48794.76,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":18565.71},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15163.03},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29555.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8424.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8100.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":17049.41},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":31466.29},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":15792.16},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":25952.19},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8343.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8343.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":14643.93},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":48794.76},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37037.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8667.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8262.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18436.69},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8262.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16259.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8586.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16500.3},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23362.67},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8659.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":21727.34},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":16500.3},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9072.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8100.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7918.81,"10th_percentile":7918.81,"90th_percentile":7918.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Mcc","code_information":[{"code":"377","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14275.78,"maximum":89178.98,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":33931.34},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27712.48},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54017.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14846.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14275.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":31160.09},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":57508.88},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":28862.29},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":47431.12},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14704.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14704.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":26763.75},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":89178.98},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":67690.84},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15275.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14561.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33695.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14275.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14561.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28654.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15132.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30156.52},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42698.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15260.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":39709.64},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":30156.52},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14275.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15988.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14275.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13400.89,"10th_percentile":13400.89,"90th_percentile":13400.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13543.26,"10th_percentile":13543.26,"90th_percentile":13543.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5814.65,"10th_percentile":5814.65,"90th_percentile":7482.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":37829.25,"10th_percentile":37829.25,"90th_percentile":37829.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13233.66,"10th_percentile":13233.66,"90th_percentile":14912.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Mcc","code_information":[{"code":"385","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12442.95,"maximum":77192.51,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":29370.65},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23987.67},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46756.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12940.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12442.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":26971.89},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":49779.16},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":24982.93},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":41055.94},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12816.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12816.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":23166.45},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":77192.51},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":58592.57},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13313.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12691.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29166.54},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12442.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12691.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24975.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13189.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26103.2},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36959.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13301.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":34372.3},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":26103.2},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12442.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13936.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12442.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12569.76,"maximum":78021.85,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":29686.21},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24245.39},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47259.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13072.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12569.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":27261.67},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":50313.98},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":25251.35},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":41497.04},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12946.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12946.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":23415.35},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":78021.85},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":59222.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13449.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12821.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29479.9},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12569.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12821.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25230.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13323.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26383.65},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37356.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13437.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":34741.59},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":26383.65},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12569.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14078.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12569.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11980.07,"10th_percentile":11980.07,"90th_percentile":11980.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":67494.43,"10th_percentile":67494.43,"90th_percentile":67494.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11502.6,"10th_percentile":11502.6,"90th_percentile":11502.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":7759.0,"10th_percentile":7759.0,"90th_percentile":7759.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5573.24,"10th_percentile":5573.24,"90th_percentile":5573.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Cc","code_information":[{"code":"406","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22274.02,"maximum":141486.26,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":53833.51},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":43967.03},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":85700.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23164.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22274.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":49436.81},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":91240.29},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":45791.26},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":75251.49},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22942.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":22942.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":42461.83},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":141486.26},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":107394.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23833.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22719.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53459.39},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22274.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22719.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":44708.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23610.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":47844.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":67742.87},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23810.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":63001.04},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":47844.6},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22274.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24946.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22274.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","code_information":[{"code":"414","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27215.29,"maximum":173801.44,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":66128.98},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":54009.02},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105274.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28303.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27215.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":60728.08},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":112079.4},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":56249.89},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":92438.78},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28031.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":28031.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":52160.03},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":173801.44},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":131923.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29120.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27759.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65669.41},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27215.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27759.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":54626.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28848.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":58772.21},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":83215.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29093.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":77390.36},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":58772.21},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27215.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30481.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27215.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26635.22,"10th_percentile":26635.22,"90th_percentile":26635.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","code_information":[{"code":"422","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11079.32,"maximum":68274.61,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":25977.52},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21216.42},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41355.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11522.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11079.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":23855.88},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":44028.27},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":22096.71},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":36312.83},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11411.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11411.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":20490.08},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":68274.61},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":51823.49},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11854.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11300.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25796.98},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11079.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11300.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22238.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11744.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23087.55},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32689.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11843.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":30401.34},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":23087.55},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11079.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12408.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11079.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","code_information":[{"code":"430","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43660.09,"maximum":281347.97,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":107048.91},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":87429.24},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":170417.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45406.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43660.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":98305.99},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":181432.97},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":91056.74},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":149638.94},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44969.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":44969.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":84436.11},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":281347.97},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":213555.71},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46716.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44533.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":106304.95},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43660.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44533.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":87634.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":46279.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":95139.85},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":134707.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46672.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":125278.71},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":95139.85},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43660.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48899.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43660.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Cc","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6914.6,"maximum":41037.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":15614.35},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12752.59},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24857.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7191.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6914.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":14339.1},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":26464.15},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":13281.71},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":21826.62},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7122.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7122.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":12316.01},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":41037.94},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31149.64},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7398.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7052.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15505.84},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6914.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7052.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13878.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7329.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13877.28},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19648.75},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7391.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":18273.39},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":13877.28},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6914.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7744.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6914.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":11522.17,"10th_percentile":11522.17,"90th_percentile":11522.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":40644.84,"10th_percentile":40644.84,"90th_percentile":40644.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6759.61,"10th_percentile":6759.61,"90th_percentile":6759.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":19018.69,"10th_percentile":19018.69,"90th_percentile":19018.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6377.41,"10th_percentile":6377.41,"90th_percentile":6778.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","code_information":[{"code":"447","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50481.94,"maximum":325961.86,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":124023.86},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":101293.06},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":197441.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52501.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50481.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":113894.55},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":210203.14},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":105495.78},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":173367.48},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":51996.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":51996.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":97825.31},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":325961.86},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":247419.65},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54015.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":51491.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":123161.93},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50481.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":51491.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":101327.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":53510.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":110226.36},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":156068.81},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53965.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":145144.4},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":110226.36},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50481.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56539.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50481.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","code_information":[{"code":"462","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20482.21,"maximum":129768.1,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":49374.92},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":40325.6},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":78603.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21301.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20482.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":45342.36},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":83683.6},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":41998.74},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":69019.02},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21096.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":21096.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":38945.06},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":129768.1},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":98499.8},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21915.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20891.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49031.78},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20482.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20891.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":41111.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21711.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":43882.02},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":62132.28},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21895.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":57783.18},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":43882.02},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20482.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22940.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20482.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","code_information":[{"code":"470","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15028.46,"maximum":94101.39,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":35804.24},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29242.12},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56999.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15629.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15028.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":32880.03},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":60683.19},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":30455.4},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":50049.17},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15479.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":15479.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":28241.02},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":94101.39},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":71427.17},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16080.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15329.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35555.41},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15028.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15329.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30165.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15930.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":31821.06},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45055.25},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16065.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":41901.49},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":31821.06},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15028.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16831.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15028.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14701.17,"10th_percentile":14701.17,"90th_percentile":14701.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":54919.63,"10th_percentile":54919.63,"90th_percentile":54919.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14214.37,"10th_percentile":14214.37,"90th_percentile":14214.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"478","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18984.31,"maximum":119972.07,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":45647.67},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":37281.47},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":72669.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19743.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18984.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":41919.52},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":77366.43},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":38828.31},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":63808.86},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19553.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":19553.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":36005.15},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":119972.07},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":91064.18},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20313.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19364.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45330.43},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18984.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19364.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":38105.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20123.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":40569.42},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57441.99},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20294.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":53421.2},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":40569.42},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18984.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21262.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18984.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":14903.8,"10th_percentile":14903.8,"90th_percentile":14903.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16520.4,"10th_percentile":16520.4,"90th_percentile":16520.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"487","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12322.84,"maximum":76407.07,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":29071.8},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23743.59},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46281.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12815.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12322.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":26697.45},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":49272.65},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":24728.73},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":40638.19},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12692.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12692.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":22930.73},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":76407.07},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":57996.39},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13185.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12569.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28869.76},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12322.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12569.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24734.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13062.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25837.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36583.3},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13173.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":34022.56},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":25837.6},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12322.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13801.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12322.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","code_information":[{"code":"497","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9653.04,"maximum":58946.92,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":22428.46},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18317.83},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35705.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10039.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9653.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":20596.68},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":38013.12},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":19077.85},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":31351.76},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9942.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9942.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":17690.72},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":58946.92},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":44743.35},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10328.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9846.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22272.59},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9653.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9846.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19375.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10232.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19933.33},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28223.47},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10319.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":26247.9},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":19933.33},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9653.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10811.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9653.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures Without Cc/Mcc","code_information":[{"code":"505","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14013.2,"maximum":87461.75,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":33277.95},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27178.85},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52977.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14573.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14013.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":30560.07},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":56401.49},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":28306.52},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":46517.78},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14433.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14433.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":26248.38},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":87461.75},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":66387.38},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14994.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14293.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33046.68},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14013.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14293.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28127.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14853.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29575.82},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41876.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14980.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":38944.99},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":29575.82},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14013.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15694.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14013.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","code_information":[{"code":"514","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8265.54,"maximum":49872.91,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":18975.93},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15498.07},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30208.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8596.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8265.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":17426.13},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":32161.56},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":16141.09},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":26525.62},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8513.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8513.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":14967.49},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":49872.91},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37855.77},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8844.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8430.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18844.06},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8265.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8430.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16590.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8761.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16864.88},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23878.88},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8835.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":22207.42},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":16864.88},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8265.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9257.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8265.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7834.92,"10th_percentile":7834.92,"90th_percentile":7834.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","code_information":[{"code":"522","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16436.84,"maximum":103311.99,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":39308.75},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":32104.33},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":62578.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17094.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16436.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":36098.31},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":66622.84},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":33436.37},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":54947.96},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16929.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":16929.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":31005.25},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":103311.99},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":78418.43},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17587.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16765.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39035.56},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16436.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16765.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32992.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17423.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34935.7},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49465.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17570.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":46002.8},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":34935.7},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16436.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18409.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16436.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16393.92,"10th_percentile":16393.92,"90th_percentile":16393.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16086.04,"10th_percentile":16086.04,"90th_percentile":16086.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"1 through 10","median_amount":27590.02,"10th_percentile":27590.02,"90th_percentile":27590.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14140.34,"10th_percentile":14140.34,"90th_percentile":16066.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Cc","code_information":[{"code":"540","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10309.49,"maximum":63240.0,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":24061.92},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19651.91},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38305.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10721.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10309.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":22096.73},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":40781.6},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":20467.28},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":33635.1},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10618.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":10618.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":18979.13},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":63240.0},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":48001.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11031.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10515.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23894.7},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10309.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10515.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20693.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10928.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21385.06},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30278.98},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11020.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":28159.52},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":21385.06},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10309.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11546.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10309.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Mcc","code_information":[{"code":"548","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15043.38,"maximum":94198.96,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":35841.37},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29272.44},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57058.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15645.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15043.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":32914.12},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":60746.11},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":30486.98},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":50101.06},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15494.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":15494.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":28270.31},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":94198.96},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":71501.23},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16096.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15344.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35592.28},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15043.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15344.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30195.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15945.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":31854.06},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45101.96},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16081.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":41944.94},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":31854.06},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15043.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16848.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15043.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","code_information":[{"code":"556","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6835.53,"maximum":40520.82,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":15417.6},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12591.9},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24544.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7108.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6835.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":14158.41},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":26130.68},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":13114.34},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":21551.58},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7040.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7040.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":12160.81},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":40520.82},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30757.12},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7314.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6972.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15310.45},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6835.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6972.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13720.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7245.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13702.41},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19401.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7307.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":18043.12},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":13702.41},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6835.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7655.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6835.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6398.11,"10th_percentile":6398.11,"90th_percentile":6398.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4913.41,"10th_percentile":4913.41,"90th_percentile":4913.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","code_information":[{"code":"564","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12154.26,"maximum":75304.53,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":28652.3},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23400.98},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45613.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12640.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12154.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":26312.21},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":48561.66},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":24371.9},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":40051.79},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12518.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12518.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":22599.85},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":75304.53},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":57159.51},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13005.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12397.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28453.18},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12154.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12397.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24396.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12883.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25464.77},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36055.41},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12992.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":33531.62},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":25464.77},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12154.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13612.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12154.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11903.3,"10th_percentile":11903.3,"90th_percentile":11903.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11900.5,"10th_percentile":11900.5,"90th_percentile":11900.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":21695.05,"10th_percentile":21695.05,"90th_percentile":21695.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"575","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14044.53,"maximum":87666.65,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":33355.91},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27242.52},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53101.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14606.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14044.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":30631.66},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":56533.62},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":28372.83},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":46626.76},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14465.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14465.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":26309.88},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":87666.65},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":66542.91},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15027.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14325.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33124.1},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14044.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14325.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28190.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14887.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29645.11},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41974.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15013.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":39036.23},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":29645.11},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14044.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15729.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14044.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy Without Cc/Mcc","code_information":[{"code":"583","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13502.96,"maximum":84124.85,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":32008.31},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26141.9},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50956.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14043.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13502.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":29394.12},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":54249.62},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":27226.55},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":44743.01},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13908.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":13908.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":25246.94},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":84124.85},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":63854.53},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14448.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13773.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31785.87},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13773.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27103.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14313.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28447.43},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40278.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14434.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":37459.14},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":28447.43},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15123.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13502.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"601","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5152.63,"maximum":29514.93,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":11230.01},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9171.8},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17877.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5358.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5152.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":10312.83},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":19033.3},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":9552.35},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":15697.94},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5307.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":5307.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":8857.81},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":29514.93},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":22403.15},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5513.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5255.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11151.97},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5152.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5255.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10342.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5461.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":9980.69},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14131.59},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5508.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":13142.42},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":9980.69},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5152.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5770.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5152.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures Without Cc/Mcc","code_information":[{"code":"615","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11077.83,"maximum":68264.85,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":25973.81},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21213.39},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41349.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11520.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11077.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":23852.47},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":44021.98},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":22093.55},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":36307.64},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11410.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11410.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":20487.15},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":68264.85},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":51816.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11853.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11299.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25793.3},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11077.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11299.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22235.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11742.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23084.25},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32684.85},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11842.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":30396.99},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":23084.25},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11077.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12407.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11077.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"623","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14021.41,"maximum":87515.41,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":33298.37},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27195.52},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53009.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14582.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14021.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":30578.82},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":56436.09},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":28323.89},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":46546.32},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14442.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14442.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":26264.49},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":87515.41},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":66428.12},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15002.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14301.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33066.96},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14021.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14301.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28143.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14862.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29593.97},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41901.92},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14988.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":38968.89},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":29593.97},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14021.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15703.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14021.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11936.45,"10th_percentile":11936.45,"90th_percentile":11936.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Mcc","code_information":[{"code":"637","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11356.82,"maximum":70089.41,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":26668.03},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21780.37},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42454.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11811.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11356.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":24489.99},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":45198.58},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":22684.06},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":37278.05},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11697.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11697.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":21034.72},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":70089.41},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":53201.0},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12151.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11583.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26482.69},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11356.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11583.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22795.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12038.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23701.24},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33558.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12140.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":31209.43},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":23701.24},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11356.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12719.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11356.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":10748.41,"10th_percentile":10748.41,"90th_percentile":10748.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":40940.05,"10th_percentile":40940.05,"90th_percentile":40940.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":30895.12,"10th_percentile":30895.12,"90th_percentile":30895.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10611.13,"10th_percentile":10611.13,"90th_percentile":11126.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4060.93,"10th_percentile":4060.93,"90th_percentile":4060.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8675.63,"10th_percentile":8675.63,"90th_percentile":8675.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders Without Cc/Mcc","code_information":[{"code":"645","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6370.79,"maximum":37481.52,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":14261.18},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11647.43},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22703.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6625.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6370.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":13096.44},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":24170.72},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":12130.69},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":19935.08},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6561.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6561.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":11248.68},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":37481.52},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28450.15},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6816.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6498.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14162.07},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6370.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6498.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12787.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6753.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12674.65},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17945.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6810.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":16689.78},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":12674.65},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6370.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7135.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6370.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Cc","code_information":[{"code":"657","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14290.7,"maximum":89276.55,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":33968.46},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27742.8},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54076.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14862.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14290.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":31194.18},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":57571.8},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":28893.87},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":47483.01},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14719.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14719.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":26793.03},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":89276.55},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":67764.9},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15291.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14576.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33732.39},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14290.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14576.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28684.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15148.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30189.51},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42745.14},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15276.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":39753.09},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":30189.51},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14290.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16005.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14290.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12038.06,"10th_percentile":12038.06,"90th_percentile":12038.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Mcc","code_information":[{"code":"665","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23922.6,"maximum":152267.74,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":57935.71},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":47317.39},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":92231.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24879.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23922.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":53203.98},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":98192.95},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":49280.63},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":80985.78},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24640.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":24640.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":45697.49},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":152267.74},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":115578.04},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25597.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24401.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57533.08},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23922.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24401.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":48017.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25357.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":51490.44},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":72904.99},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25573.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":67801.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":51490.44},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23922.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26793.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23922.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Mcc","code_information":[{"code":"673","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31982.01,"maximum":204975.06,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":77990.1},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":63696.26},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":124157.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33261.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31982.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":71620.47},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":132182.34},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":66339.06},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":109018.92},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32941.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":32941.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":61515.63},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":204975.06},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":155585.25},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34220.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32621.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":77448.09},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31982.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32621.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64194.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33900.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":69313.8},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":98140.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34188.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":91271.36},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":69313.8},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31982.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35819.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31982.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31896.85,"10th_percentile":31896.85,"90th_percentile":31896.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31893.49,"10th_percentile":31893.49,"90th_percentile":31893.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","code_information":[{"code":"688","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6534.9,"maximum":38554.79,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":14669.55},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11980.95},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23353.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6796.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6534.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":13471.45},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":24862.84},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":12478.05},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":20505.91},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6730.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6730.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":11570.78},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":38554.79},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29264.81},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6992.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6665.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14567.6},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6534.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6665.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13116.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6926.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13037.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18459.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6985.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":17167.69},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":13037.58},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6534.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7319.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6534.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Mcc","code_information":[{"code":"698","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12980.79,"maximum":80709.9,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":30708.97},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25080.7},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48887.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13500.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12980.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":28200.9},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":52047.42},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":26121.32},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":42926.72},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13370.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":13370.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":24222.07},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":80709.9},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":61262.43},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13889.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13240.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30495.56},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12980.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13240.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26055.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13759.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27292.64},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38643.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13876.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":35938.53},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":27292.64},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12980.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14538.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12980.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4821.64,"10th_percentile":4821.64,"90th_percentile":10687.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":26121.32,"10th_percentile":26121.32,"90th_percentile":26121.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11472.16,"10th_percentile":11472.16,"90th_percentile":11472.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":7638.47,"10th_percentile":7638.47,"90th_percentile":7638.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8026.71,"10th_percentile":8026.71,"90th_percentile":8026.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18704.15,"10th_percentile":18704.15,"90th_percentile":18704.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11247.72,"10th_percentile":11247.72,"90th_percentile":11585.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures Without Cc/Mcc","code_information":[{"code":"712","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8842.92,"maximum":53648.86,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":20412.63},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16671.45},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32496.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9196.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8842.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":18745.49},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":34596.56},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":17363.16},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":28533.92},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9108.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9108.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":16100.71},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":53648.86},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40721.89},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9461.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9019.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20270.77},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8842.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9019.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17749.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9373.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18141.75},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25686.79},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9453.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":23888.78},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":18141.75},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8842.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9904.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8842.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Cc","code_information":[{"code":"723","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9163.68,"maximum":55746.62,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":21210.8},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17323.33},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33766.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9530.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9163.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":19478.46},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":35949.34},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":18042.09},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":29649.64},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9438.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9438.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":16730.27},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":55746.62},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42314.18},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9805.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9346.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21063.39},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9163.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9346.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18393.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9713.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18851.12},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26691.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9795.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":24822.87},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":18851.12},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9163.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10263.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9163.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","code_information":[{"code":"734","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16528.6,"maximum":103912.05,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":39537.06},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":32290.8},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":62941.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17189.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16528.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":36307.98},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":67009.8},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":33630.57},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":55267.11},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17024.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":17024.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":31185.33},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":103912.05},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":78873.9},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17685.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16859.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39262.29},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16528.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16859.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33176.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17520.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":35138.61},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49752.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17669.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":46269.99},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":35138.61},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16528.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18512.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16528.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","code_information":[{"code":"742","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14326.51,"maximum":89510.72,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":34057.56},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27815.57},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54218.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14899.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14326.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":31276.0},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":57722.81},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":28969.66},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":47607.56},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14756.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14756.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":26863.31},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":89510.72},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":67942.64},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15329.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14613.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33820.87},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14326.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14613.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28756.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15186.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30268.7},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42857.26},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15315.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":39857.36},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":30268.7},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14326.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16045.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14326.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":89510.72,"10th_percentile":89510.72,"90th_percentile":89510.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"750","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11648.49,"maximum":71996.9,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":27393.8},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22373.13},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43609.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12114.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11648.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":25156.49},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":46428.67},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":23301.41},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":38292.58},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11997.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11997.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":21607.19},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":71996.9},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":54648.87},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12463.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11881.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27203.42},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11648.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11881.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23380.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12347.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24346.27},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34471.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12452.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":32058.8},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":24346.27},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11648.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13046.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11648.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","code_information":[{"code":"761","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4895.27,"maximum":27831.84,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":10589.62},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":8648.78},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16858.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5091.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4895.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":9724.74},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":17947.93},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":9007.62},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":14802.76},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5042.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":5042.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":8352.69},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":27831.84},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":21125.62},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5237.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4993.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10516.03},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4895.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4993.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9825.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5188.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":9411.54},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13325.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5233.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":12392.97},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":9411.54},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4895.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5482.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4895.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization Without Cc/Mcc","code_information":[{"code":"785","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7784.39,"maximum":46726.27,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":17778.68},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14520.25},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28302.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8095.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7784.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":16326.66},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":30132.39},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":15122.7},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":24852.04},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8017.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8017.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":14023.15},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":46726.27},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35467.33},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8329.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7940.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17655.13},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7784.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7940.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15624.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8251.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15800.83},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22372.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8321.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":20806.29},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":15800.83},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7784.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8718.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7784.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":9691.92,"10th_percentile":9691.92,"90th_percentile":9691.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":14488.64,"10th_percentile":14488.64,"90th_percentile":14488.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3399.15,"10th_percentile":3399.15,"90th_percentile":4451.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Term Neonate With Major Problems","code_information":[{"code":"793","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31743.3,"maximum":203413.94,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":77396.12},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":63211.14},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":123211.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33013.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31743.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":71075.0},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":131175.62},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":65833.81},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":108188.61},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32695.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":32695.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":61047.11},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":203413.94},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":154400.29},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33965.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32378.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76858.24},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31743.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32378.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":63715.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33647.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":68785.89},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97393.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33933.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":90576.22},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":68785.89},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31743.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35552.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31743.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"1 through 10","median_amount":1943.82,"10th_percentile":1943.82,"90th_percentile":1943.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":64284.53,"10th_percentile":64284.53,"90th_percentile":64284.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3182.6,"10th_percentile":3182.6,"90th_percentile":3182.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1580.33,"10th_percentile":1025.85,"90th_percentile":4504.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures Without Cc/Mcc","code_information":[{"code":"801","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14879.27,"maximum":93125.69,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":35433.0},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":28938.92},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56408.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15474.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14879.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":32539.11},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":60053.99},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":30139.62},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":49530.23},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15325.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":15325.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":27948.2},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":93125.69},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":70686.57},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15920.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15176.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35186.75},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14879.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15176.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":29865.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15772.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":31491.12},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44588.09},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15905.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":41467.03},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":31491.12},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14879.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16664.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14879.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"809","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10082.71,"maximum":61756.93,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":23497.64},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19191.04},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37407.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10486.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10082.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":21578.53},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":39825.21},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":19987.3},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":32846.31},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10385.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":10385.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":18534.04},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":61756.93},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":46876.28},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10788.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10284.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23334.33},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10082.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10284.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20238.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10687.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20883.55},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29568.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10778.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":27499.15},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":20883.55},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10082.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11292.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10082.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8271.09,"10th_percentile":8271.09,"90th_percentile":8271.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8457.06,"10th_percentile":8457.06,"90th_percentile":8457.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Mcc","code_information":[{"code":"817","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17659.48,"maximum":111307.86,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":42351.06},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":34589.06},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":67421.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18365.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17659.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":38892.15},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":71779.14},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":36024.18},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":59200.68},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18189.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":18189.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":33404.91},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":111307.86},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":84487.65},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18895.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18012.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42056.73},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17659.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18012.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":35446.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18719.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":37639.56},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53293.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18877.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":49563.2},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":37639.56},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17659.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19778.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17659.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":30199.35,"10th_percentile":30199.35,"90th_percentile":30199.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","code_information":[{"code":"825","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10705.59,"maximum":65830.48,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":25047.56},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20456.9},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39874.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11133.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10705.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":23001.87},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":42452.12},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":21305.68},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":35012.88},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11026.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11026.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":19756.57},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":65830.48},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":49968.28},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11454.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10919.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24873.49},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10705.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10919.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21488.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11347.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22261.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31519.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11444.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":29313.02},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":22261.05},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10705.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11990.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10705.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","code_information":[{"code":"833","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4540.19,"maximum":25509.68,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":9706.07},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":7927.16},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15451.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4721.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4540.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":8913.35},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":16450.43},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":8256.07},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":13567.69},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4676.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":4676.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":7655.78},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":25509.68},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":19362.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4858.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4630.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9638.62},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4540.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4630.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9113.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4812.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":8626.28},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12213.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4853.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":11358.96},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":8626.28},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4540.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5085.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4540.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":5932.43,"10th_percentile":5932.43,"90th_percentile":5932.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2025.46,"10th_percentile":2025.46,"90th_percentile":2346.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Cc","code_information":[{"code":"841","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12809.21,"maximum":79587.85,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":30282.05},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24732.02},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48207.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13321.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12809.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":27808.84},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":51323.84},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":25758.17},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":42329.94},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13193.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":13193.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":23885.33},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":79587.85},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":60410.74},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13705.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13065.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30071.6},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12809.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13065.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25710.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13577.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26913.21},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38106.24},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13693.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":35438.9},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":26913.21},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12809.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14346.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12809.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":23213.36,"10th_percentile":23213.36,"90th_percentile":23213.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":26026.12,"10th_percentile":26026.12,"90th_percentile":26026.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Radiotherapy","code_information":[{"code":"849","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20851.46,"maximum":132182.96,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":50293.74},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":41076.02},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80065.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21685.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20851.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":46186.14},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":85240.87},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":42780.3},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":70303.4},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21477.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":21477.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":39669.79},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":132182.96},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":100332.79},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22311.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21268.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49944.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20851.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21268.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":41853.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22102.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":44698.62},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":63288.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22290.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":58858.47},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":44698.62},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20851.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23353.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20851.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections With Mcc","code_information":[{"code":"862","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14243.7,"maximum":88969.2,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":33851.52},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27647.29},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53890.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14813.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14243.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":31086.79},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":57373.6},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":28794.4},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":47319.54},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14671.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14671.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":26700.79},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":88969.2},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":67531.61},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15240.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14528.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33616.26},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14243.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14528.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28589.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15098.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30085.58},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42597.98},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15226.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":39616.24},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":30085.58},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14243.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15952.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14243.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13245.57,"10th_percentile":13245.57,"90th_percentile":13245.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":42297.98,"10th_percentile":42297.98,"90th_percentile":42297.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis With Mv >96 Hours","code_information":[{"code":"870","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":52199.15,"maximum":337192.16,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":128296.83},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":104782.89},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":204243.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54287.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52199.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":117818.54},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":217445.23},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":109130.41},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":179340.47},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":53765.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":53765.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":101195.66},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":337192.16},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":255943.95},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":55853.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":53243.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":127405.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52199.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":53243.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":104774.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55331.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":114023.96},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":161445.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":55800.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":150145.03},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":114023.96},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52199.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58463.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52199.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":51052.19,"10th_percentile":51052.19,"90th_percentile":51052.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Organic Disturbances And Intellectual Disability","code_information":[{"code":"884","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12641.37,"maximum":78490.19,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":29864.4},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24390.92},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47543.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13147.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12641.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":27425.31},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":50615.99},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":25402.92},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":41746.13},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13020.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":13020.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":23555.9},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":78490.19},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":59577.57},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13526.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12894.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29656.85},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12641.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12894.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25373.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13399.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26542.02},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37580.69},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13513.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":34950.13},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":26542.02},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12641.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14158.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12641.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12356.58,"10th_percentile":12356.58,"90th_percentile":12356.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11758.76,"10th_percentile":11758.76,"90th_percentile":11758.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10675.88,"10th_percentile":10675.88,"90th_percentile":10675.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Mcc","code_information":[{"code":"901","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31944.71,"maximum":204731.13,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":77897.29},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":63620.46},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":124009.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33222.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31944.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":71535.24},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":132025.04},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":66260.12},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":108889.18},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32903.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":32903.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":61442.42},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":204731.13},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":155400.1},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34180.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32583.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":77355.93},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31944.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32583.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64119.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33861.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":69231.31},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":98024.18},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34148.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":91162.74},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":69231.31},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31944.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35778.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31944.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries Without Cc/Mcc","code_information":[{"code":"909","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10431.82,"maximum":64040.07,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":24366.34},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19900.53},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38790.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10849.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10431.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":22376.28},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":41297.54},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":20726.22},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":34060.63},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10744.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":10744.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":19219.24},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":64040.07},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":48609.28},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11162.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10640.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24197.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10431.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10640.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20938.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11057.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21655.61},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30662.05},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11151.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":28515.78},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":21655.61},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10431.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11683.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10431.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Mcc","code_information":[{"code":"597","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13075.52,"maximum":81329.47,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":30944.71},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25273.24},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49262.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13598.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13075.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":28417.39},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":52446.97},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":26321.84},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":43256.24},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13467.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":13467.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":24408.01},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":81329.47},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":61732.71},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13990.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13337.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30729.65},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13075.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13337.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26245.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13860.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27502.15},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38940.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13977.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":36214.41},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":27502.15},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13075.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14644.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13075.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11825.41,"10th_percentile":11825.41,"90th_percentile":11825.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","code_information":[{"code":"605","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7472.58,"maximum":44687.06,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":17002.79},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13886.56},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27067.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7771.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7472.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":15614.14},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":28817.36},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":14462.72},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":23767.45},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7696.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7696.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":13411.16},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":44687.06},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33919.48},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7995.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7622.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16884.63},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7472.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7622.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14998.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7920.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15111.25},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21395.93},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7988.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":19898.27},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":15111.25},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7472.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8369.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7472.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7452.12,"10th_percentile":7452.12,"90th_percentile":7452.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7677.64,"10th_percentile":7677.64,"90th_percentile":7677.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"1 through 10","median_amount":2375.5,"10th_percentile":2375.5,"90th_percentile":2375.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7082.8,"10th_percentile":7082.8,"90th_percentile":7082.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2835.25,"10th_percentile":2835.25,"90th_percentile":2835.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":37648.03,"10th_percentile":37648.03,"90th_percentile":37648.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7309.94,"10th_percentile":7309.94,"90th_percentile":7309.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Mcc","code_information":[{"code":"619","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22178.54,"maximum":140861.81,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":53595.92},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":43772.98},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":85322.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23065.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22178.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":49218.62},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":90837.6},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":45589.16},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":74919.37},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22843.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":22843.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":42274.42},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":140861.81},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":106920.42},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23731.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22622.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53223.44},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22178.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22622.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":44516.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23509.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":47633.44},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":67443.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23708.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":62722.99},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":47633.44},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22178.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24839.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22178.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","code_information":[{"code":"627","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10548.19,"maximum":64801.12,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":24655.9},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20137.03},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39251.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10970.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10548.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":22642.2},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":41788.32},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":20972.53},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":34465.4},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10864.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":10864.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":19447.64},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":64801.12},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":49186.95},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11286.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10759.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24484.55},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10548.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10759.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21172.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11181.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21912.97},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31026.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11276.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":28854.66},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":21912.97},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10548.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11813.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10548.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","code_information":[{"code":"641","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6444.64,"maximum":37964.49,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":14444.95},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11797.51},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22995.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6702.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6444.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":13265.2},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":24482.17},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":12287.0},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":20191.96},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6637.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6637.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":11393.63},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":37964.49},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28816.75},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6895.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6573.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14344.56},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6444.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6573.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12935.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6831.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12837.97},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18177.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6889.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":16904.84},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":12837.97},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6444.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7218.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6444.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11797.51,"10th_percentile":11797.51,"90th_percentile":11797.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":13223.95,"10th_percentile":13223.95,"90th_percentile":13223.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6298.71,"10th_percentile":6298.71,"90th_percentile":6298.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":10411.49,"10th_percentile":10411.49,"90th_percentile":10411.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":35201.86,"10th_percentile":35201.86,"90th_percentile":35201.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6340.28,"10th_percentile":6298.71,"90th_percentile":6348.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5820.09,"10th_percentile":5820.09,"90th_percentile":6300.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Mcc","code_information":[{"code":"653","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39402.87,"maximum":253506.37,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":96455.58},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":78777.42},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":153553.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40978.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39402.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":88577.83},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":163478.74},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":82045.96},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":134830.99},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40584.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":40584.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":76080.49},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":253506.37},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":192422.69},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42161.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40190.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":95785.24},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39402.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40190.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":79089.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41767.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":85725.01},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":121377.51},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42121.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":112881.4},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":85725.01},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39402.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44131.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39402.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","code_information":[{"code":"661","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8363.26,"maximum":50511.99,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":19219.09},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15696.66},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30596.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8697.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8363.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":17649.43},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":32573.68},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":16347.93},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":26865.52},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8614.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8614.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":15159.29},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":50511.99},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":38340.86},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8948.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8530.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19085.53},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8363.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8530.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16786.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8865.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17080.99},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24184.87},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8940.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":22491.99},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":17080.99},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8363.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9366.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8363.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8181.23,"10th_percentile":8181.23,"90th_percentile":8181.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":20001.3,"10th_percentile":20001.3,"90th_percentile":20001.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7508.05,"10th_percentile":7508.05,"90th_percentile":7508.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":25621.92,"10th_percentile":25621.92,"90th_percentile":25621.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8196.39,"10th_percentile":8196.39,"90th_percentile":8196.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Cc","code_information":[{"code":"669","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12216.92,"maximum":75714.32,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":28808.22},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23528.32},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45861.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12705.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12216.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":26455.39},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":48825.92},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":24504.53},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":40269.74},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12583.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12583.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":22722.83},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":75714.32},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":57470.56},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13072.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12461.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28608.02},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12216.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12461.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24521.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12949.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25603.34},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36251.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13059.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":33714.1},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":25603.34},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12216.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13682.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12216.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11546.61,"10th_percentile":11546.61,"90th_percentile":11546.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11063.04,"10th_percentile":11063.04,"90th_percentile":11063.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Cc","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7172.7,"maximum":42725.9,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":16256.6},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13277.13},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25879.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7459.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7172.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":14928.89},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":27552.67},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":13828.01},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":22724.38},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7387.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7387.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":12822.59},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":42725.9},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32430.87},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7674.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7316.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16143.62},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7172.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7316.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14397.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7603.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14448.07},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20456.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7667.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":19025.0},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":14448.07},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7172.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8033.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7172.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"1 through 10","median_amount":9968.79,"10th_percentile":9968.79,"90th_percentile":9968.79},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6437.88,"10th_percentile":6437.88,"90th_percentile":7034.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5835.85,"10th_percentile":5051.85,"90th_percentile":7031.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5556.55,"10th_percentile":3233.18,"90th_percentile":7501.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7154.95,"10th_percentile":7154.95,"90th_percentile":7154.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones Without Mcc","code_information":[{"code":"694","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6470.75,"maximum":38135.23,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":14509.92},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11850.57},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23099.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6729.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6470.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":13324.86},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":24592.28},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":12342.26},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":20282.77},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6664.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6664.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":11444.87},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":38135.23},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28946.35},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6923.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6600.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14409.08},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6470.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6600.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12988.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6859.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12895.7},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18258.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6917.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":16980.87},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":12895.7},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6470.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7247.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6470.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":12342.26,"10th_percentile":12342.26,"90th_percentile":12342.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"1 through 10","median_amount":20135.38,"10th_percentile":20135.38,"90th_percentile":20135.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures Without Cc/Mcc","code_information":[{"code":"708","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12084.14,"maximum":74845.95,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":28477.82},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23258.47},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45335.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12567.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12084.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":26151.97},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":48265.93},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":24223.48},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":39807.89},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12446.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12446.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":22462.22},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":74845.95},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":56811.43},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12930.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12325.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28279.91},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12084.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12325.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24255.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12809.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25309.7},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35835.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12917.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":33327.43},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":25309.7},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12084.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13534.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12084.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","code_information":[{"code":"716","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11612.69,"maximum":71762.74,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":27304.7},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22300.36},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43468.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12077.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11612.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":25074.67},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":46277.66},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":23225.62},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":38168.04},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11961.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11961.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":21536.91},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":71762.74},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":54471.13},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12425.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11844.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27114.94},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11612.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11844.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23308.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12309.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24267.09},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34359.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12413.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":31954.53},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":24267.09},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11612.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13006.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11612.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System With Mcc","code_information":[{"code":"727","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11701.46,"maximum":72343.28,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":27525.59},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22480.76},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43819.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12169.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11701.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":25277.51},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":46652.03},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":23413.51},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":38476.81},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12052.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12052.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":21711.14},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":72343.28},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":54911.79},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12520.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11935.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27334.3},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11701.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11935.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23487.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12403.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24463.4},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34637.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12508.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":32213.04},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":24463.4},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11701.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13105.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11701.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"738","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11594.04,"maximum":71640.77,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":27258.3},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22262.46},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43394.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12057.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11594.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":25032.05},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":46199.01},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":23186.15},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":38103.17},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11941.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11941.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":21500.31},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":71640.77},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":54378.56},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12405.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11825.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27068.86},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11594.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11825.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23271.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12289.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24225.84},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34301.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12394.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":31900.23},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":24225.84},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11594.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12985.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11594.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures With Cc/Mcc","code_information":[{"code":"746","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13597.7,"maximum":84744.42,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":32244.05},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26334.44},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51331.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14141.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13597.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":29610.61},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":54649.17},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":27427.07},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":45072.53},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14005.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14005.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":25432.88},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":84744.42},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":64324.81},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14549.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13869.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32019.96},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13597.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13869.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27293.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14413.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28656.94},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40575.18},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14535.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":37735.02},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":28656.94},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13597.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15229.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13597.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13287.72,"10th_percentile":13287.72,"90th_percentile":13287.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11532.13,"10th_percentile":11532.13,"90th_percentile":11532.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Mcc","code_information":[{"code":"757","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11321.01,"maximum":69855.24,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":26578.93},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21707.6},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42312.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11773.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11321.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":24408.17},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":45047.57},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":22608.27},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":37153.51},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11660.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":11660.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":20964.45},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":69855.24},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":53023.26},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12113.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11547.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26394.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11321.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11547.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22723.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12000.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23622.05},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33446.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12102.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":31105.16},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":23622.05},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11321.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12679.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11321.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","code_information":[{"code":"776","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5523.37,"maximum":31939.54,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":12152.54},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9925.25},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19346.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5744.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5523.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":11160.02},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":20596.86},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":10337.06},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":16987.5},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5689.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":5689.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":9585.46},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":31939.54},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":24243.54},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5910.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5633.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12068.09},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5523.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5633.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11086.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5854.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10800.59},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15292.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5904.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":14222.05},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":10800.59},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5523.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6186.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5523.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":4337.06,"10th_percentile":4337.06,"90th_percentile":4337.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"1 through 10","median_amount":23078.56,"10th_percentile":23078.56,"90th_percentile":23078.56},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"1 through 10","median_amount":16231.13,"10th_percentile":16231.13,"90th_percentile":16231.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2665.48,"10th_percentile":2665.48,"90th_percentile":6918.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":7739.18,"10th_percentile":7739.18,"90th_percentile":7739.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonates, Died Or Transferred To Another Acute Care Facility","code_information":[{"code":"789","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14083.32,"maximum":87920.33,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":33452.44},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27321.35},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53255.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14646.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14083.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":30720.3},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":56697.21},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":28454.94},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":46761.68},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14505.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":14505.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":26386.01},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":87920.33},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":66735.47},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15069.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14364.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33219.95},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14083.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14364.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28268.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14928.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29730.89},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42095.79},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15055.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":39149.19},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":29730.89},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14083.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15773.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14083.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2932.94,"10th_percentile":2932.94,"90th_percentile":2932.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Cc","code_information":[{"code":"797","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8102.17,"maximum":48804.51,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":18569.42},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15166.06},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29561.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8426.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8102.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":17052.82},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":31472.58},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":15795.32},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":25957.38},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8345.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8345.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":14646.86},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":48804.51},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37044.81},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8669.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8264.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18440.37},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8102.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8264.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16262.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8588.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16503.6},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23367.34},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8661.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":21731.69},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":16503.6},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8102.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9074.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8102.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Mcc","code_information":[{"code":"805","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8689.99,"maximum":52648.77,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":20032.11},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16360.67},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31890.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9037.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8689.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":18396.04},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":33951.63},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":17039.49},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":28002.0},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8950.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8950.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":15800.57},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":52648.77},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39962.78},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9298.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8863.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19892.89},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8689.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8863.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17442.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9211.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17803.56},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25207.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9289.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":23443.46},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":17803.56},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8689.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9732.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8689.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"1 through 10","median_amount":65188.24,"10th_percentile":65188.24,"90th_percentile":65188.24},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"1 through 10","median_amount":4981.63,"10th_percentile":4981.63,"90th_percentile":4981.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2346.31,"10th_percentile":2346.31,"90th_percentile":2346.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coagulation Disorders","code_information":[{"code":"813","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12017.74,"maximum":74411.76,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":28312.62},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23123.55},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45072.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12498.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12017.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":26000.26},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":47985.94},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":24082.96},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":39576.96},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12378.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12378.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":22331.92},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":74411.76},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":56481.86},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12858.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12258.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28115.85},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12017.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12258.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24122.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12738.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25162.87},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35627.96},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12846.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":33134.09},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":25162.87},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12017.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13459.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12017.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11990.59,"10th_percentile":11990.59,"90th_percentile":11990.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5159.97,"10th_percentile":5159.97,"90th_percentile":5159.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"1 through 10","median_amount":34435.51,"10th_percentile":34435.51,"90th_percentile":34435.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13167.24,"10th_percentile":13167.24,"90th_percentile":13167.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures With Cc","code_information":[{"code":"821","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17338.71,"maximum":109210.1,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":41552.89},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":33937.18},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":66150.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18032.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17338.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":38159.18},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":70426.36},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":35345.26},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":58084.95},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17858.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":17858.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":32775.34},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":109210.1},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":82895.36},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18552.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17685.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41264.11},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17338.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17685.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34802.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18379.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":36930.18},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52289.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18535.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":48629.11},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":36930.18},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17338.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19419.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17338.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","code_information":[{"code":"829","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24212.04,"maximum":154160.6,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":58655.92},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":47905.6},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":93378.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25180.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24212.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":53865.36},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":99413.6},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":49893.24},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":81992.52},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24938.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":24938.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":46265.56},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":154160.6},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":117014.8},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25906.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24696.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58248.28},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24212.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24696.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":48598.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25664.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":52130.52},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":73811.28},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25882.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":68644.68},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":52130.52},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24212.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27117.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24212.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","code_information":[{"code":"837","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36477.94,"maximum":234377.78,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":89177.42},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":72833.19},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":141967.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37937.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36477.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":81894.1},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":151143.28},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":75855.09},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":124657.17},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37572.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":37572.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":70339.76},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":234377.78},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":177903.23},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39031.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37207.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":88557.66},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36477.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37207.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":73218.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38666.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":79256.54},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":112218.84},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38994.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":104363.81},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":79256.54},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36477.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40855.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36477.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","code_information":[{"code":"845","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6992.18,"maximum":41545.31,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":15807.4},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12910.26},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25164.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7271.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6992.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":14516.37},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":26791.34},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":13445.91},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":22096.47},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7201.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7201.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":12468.28},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":41545.31},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31534.75},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7481.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7132.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15697.54},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6992.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7132.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14034.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7411.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14048.85},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19891.67},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7474.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":18499.31},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":14048.85},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6992.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7831.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6992.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"855","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11808.13,"maximum":73040.9,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":27791.03},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22697.55},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44242.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12280.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11808.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":25521.27},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":47101.91},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":23639.29},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":38847.85},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12162.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12162.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":21920.51},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":73040.9},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":55441.32},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12634.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12044.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27597.89},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11808.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12044.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23701.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12516.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24699.31},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34971.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12622.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":32523.68},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":24699.31},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11808.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13225.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11808.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness Without Mcc","code_information":[{"code":"866","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7126.45,"maximum":42423.44,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":16141.52},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13183.14},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25696.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7411.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7126.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":14823.2},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":27357.62},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":13730.11},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":22563.51},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7340.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7340.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":12731.81},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":42423.44},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32201.29},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7625.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7268.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16029.34},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7126.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7268.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14304.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7554.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14345.79},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20312.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7618.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":18890.32},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":14345.79},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7126.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7981.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7126.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6966.65,"10th_percentile":6966.65,"90th_percentile":6966.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Adjustment Reaction And Psychosocial Dysfunction","code_information":[{"code":"880","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7802.3,"maximum":46843.36,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":17823.23},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14556.63},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28373.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8114.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7802.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":16367.57},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":30207.89},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":15160.6},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":24914.31},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8036.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8036.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":14058.29},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":46843.36},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35556.21},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8348.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7958.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17699.37},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7802.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7958.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15660.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8270.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15840.42},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22428.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8340.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":20858.42},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":15840.42},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7802.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8738.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7802.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1787.74,"10th_percentile":1787.74,"90th_percentile":1787.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":8178.87,"10th_percentile":8178.87,"90th_percentile":8178.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence, Left Ama","code_information":[{"code":"894","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5241.4,"maximum":30095.47,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":11450.9},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9352.2},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18229.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5451.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5241.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":10515.68},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":19407.67},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":9740.23},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":16006.7},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5398.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":5398.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":9032.03},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":30095.47},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":22843.81},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5608.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5346.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11371.32},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5241.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5346.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10520.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5555.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10177.0},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14409.55},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5603.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":13400.92},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":10177.0},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5241.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5870.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5241.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"1 through 10","median_amount":7526.82,"10th_percentile":7526.82,"90th_percentile":7526.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4028.9,"10th_percentile":4028.9,"90th_percentile":4028.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9015.11,"10th_percentile":9015.11,"90th_percentile":9015.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5590.85,"10th_percentile":5590.85,"90th_percentile":5590.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries Without Cc/Mcc","code_information":[{"code":"905","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11705.19,"maximum":72367.67,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":27534.87},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22488.34},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43834.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12173.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11705.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":25286.04},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":46667.76},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":23421.4},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":38489.78},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12056.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":12056.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":21718.46},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":72367.67},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":54930.3},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12524.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11939.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27343.51},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11705.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11939.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23494.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12407.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24471.65},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34649.26},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12512.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":32223.9},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":24471.65},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11705.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13109.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11705.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Cc","code_information":[{"code":"920","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8116.35,"maximum":48897.21,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":18604.69},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15194.87},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29617.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8441.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8116.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":17085.21},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":31532.36},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":15825.31},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":26006.68},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8359.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":8359.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":14674.67},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":48897.21},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37115.17},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8684.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8278.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18475.4},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8116.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8278.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16291.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8603.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16534.94},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23411.72},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8676.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":21772.96},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":16534.94},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8116.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9090.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8116.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34826.88,"10th_percentile":34826.88,"90th_percentile":34826.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7346.04,"10th_percentile":7346.04,"90th_percentile":7346.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7787.12,"10th_percentile":7787.12,"90th_percentile":7787.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5993.72,"10th_percentile":5993.72,"90th_percentile":7953.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn Without Skin Graft Or Inhalation Injury","code_information":[{"code":"934","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17129.84,"maximum":107844.12,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":41033.16},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":33512.7},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65323.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17815.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17129.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":37681.89},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":69545.48},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":34903.16},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":57358.44},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17643.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":17643.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":32365.39},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":107844.12},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":81858.52},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18328.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17472.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40747.99},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17129.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17472.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34383.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18157.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":36468.27},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51635.19},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18311.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":48020.86},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":36468.27},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17129.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19185.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17129.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Without Mcc","code_information":[{"code":"948","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6610.99,"maximum":39052.39,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":14858.88},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12135.58},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23654.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6875.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6610.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":13645.32},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":25183.73},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":12639.09},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":20770.57},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6809.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":6809.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":11720.12},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":39052.39},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29642.52},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7073.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6743.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14755.62},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6610.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6743.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13269.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7007.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13205.85},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18698.08},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7067.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":17389.26},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":13205.85},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6610.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7404.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6610.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6474.47,"10th_percentile":6474.47,"90th_percentile":6474.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2925.87,"10th_percentile":2925.87,"90th_percentile":2925.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":39052.39,"10th_percentile":39052.39,"90th_percentile":39052.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6015.01,"10th_percentile":6015.01,"90th_percentile":6015.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"959","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22601.5,"maximum":143627.92,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":54648.38},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":44632.56},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":86998.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23505.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22601.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":50185.13},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":92621.39},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":46484.39},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":76390.56},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23279.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":23279.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":43104.57},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":143627.92},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":109020.02},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24183.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23053.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54268.6},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22601.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23053.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":45365.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23957.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":48568.82},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":68768.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24161.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":63954.68},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":48568.82},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22601.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25313.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22601.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition Without Cc/Mcc","code_information":[{"code":"976","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7373.37,"maximum":44038.22,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":16755.92},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13684.93},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26674.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7668.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7373.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":15387.42},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":28398.94},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":14252.73},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":23422.36},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7594.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":7594.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":13216.43},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":44038.22},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33426.98},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7889.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7520.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16639.47},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7373.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7520.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14799.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7815.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14891.84},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21085.27},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7882.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":19609.35},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":14891.84},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7373.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8258.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7373.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Cc","code_information":[{"code":"078","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14608.79,"maximum":48677.67,"payers_information":[{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15126.65},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29484.99},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":31390.79},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":15754.26},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":25889.92},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":14608.79},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":48677.67},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36948.53},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16460.71},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23306.61},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":21675.21},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":16460.71}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions Without Mcc","code_information":[{"code":"916","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5609.91,"maximum":32505.45,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":12367.86},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10101.11},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19689.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5834.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5609.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":11357.75},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":20961.8},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":10520.21},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":17288.49},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5778.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":5778.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":9755.3},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":32505.45},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":24673.09},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6002.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5722.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12281.91},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5609.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5722.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11260.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5946.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10991.95},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15563.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5996.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":14474.03},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":10991.95},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5609.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6283.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5609.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","code_information":[{"code":"927","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":159906.81,"maximum":1041584.14,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":396307.98},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":323673.58},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":630907.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":166303.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":159906.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":363940.62},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":671686.73},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":337103.04},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":553981.42},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":164704.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":164704.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":312592.67},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":1041584.14},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":790609.02},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":171100.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":163104.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":393553.77},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":159906.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":163104.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":320964.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":169501.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":352219.2},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":498704.98},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":170940.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":463796.91},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":352219.2},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":159906.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":179095.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":159906.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","code_information":[{"code":"941","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15765.47,"maximum":98921.34,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":37638.17},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30739.93},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":59918.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16396.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15765.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":34564.17},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":63791.44},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":32015.36},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":52612.73},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16238.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":16238.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":29687.56},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":98921.34},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":75085.73},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16869.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16080.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37376.59},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15765.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16080.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":31644.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16711.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":33450.97},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47363.02},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16853.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":44047.73},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":33450.97},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15765.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17657.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15765.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy For Multiple Significant Trauma","code_information":[{"code":"955","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50851.19,"maximum":328376.71,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":124942.68},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":102043.48},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":198904.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52885.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50851.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":114738.33},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":211760.41},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":106277.34},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":174651.85},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":52376.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":52376.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":98550.04},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":328376.71},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":249252.63},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54410.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":51868.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":124074.37},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50851.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":51868.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":102068.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":53902.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":111042.96},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":157225.03},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54359.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":146219.69},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":111042.96},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50851.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56953.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50851.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures With Mcc","code_information":[{"code":"969","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46302.3,"maximum":298627.62,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":113623.57},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":92798.91},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":180884.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48154.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46302.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":104343.68},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":192576.1},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":96649.21},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":158829.37},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":47691.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":47691.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":89621.95},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":298627.62},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":226671.74},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49543.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":47228.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":112833.92},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46302.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":47228.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":92937.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":49080.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":100983.09},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":142981.33},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49497.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":132973.0},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":100983.09},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46302.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51858.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46302.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"983","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13425.38,"maximum":83617.49,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":31815.27},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25984.24},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50648.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13962.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13425.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":29216.84},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":53922.44},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":27062.35},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":44473.16},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13828.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":13828.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":25094.67},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":83617.49},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":63469.42},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14365.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13693.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31594.16},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13425.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13693.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26947.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14230.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28275.86},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40035.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14351.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":37233.22},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":28275.86},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13425.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15036.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13425.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13123.54,"10th_percentile":13123.54,"90th_percentile":13123.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"1 through 10","median_amount":30600.9,"10th_percentile":30600.9,"90th_percentile":30600.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Arthroscopy","code_information":[{"code":"509","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25716.92,"maximum":85690.85,"payers_information":[{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26628.54},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51904.58},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":55259.49},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":27733.38},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":45575.91},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":25716.92},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":85690.85},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":65043.2},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28976.98},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41028.33},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":38156.45},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":28976.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"989","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9585.15,"maximum":58502.97,"payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"fee schedule","standard_charge_dollar":22259.55},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18179.87},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35436.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9968.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9585.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"fee schedule","standard_charge_dollar":20441.56},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":37726.83},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":18934.17},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":31115.64},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9872.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"fee schedule","standard_charge_dollar":9872.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":17557.49},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":58502.97},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":44406.38},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10256.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9776.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22104.85},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9585.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9776.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19239.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10160.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19783.2},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28010.91},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10246.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":26050.22},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":19783.2},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9585.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10735.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9585.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Mcc","code_information":[{"code":"077","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22637.91,"maximum":75431.37,"payers_information":[{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23440.39},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45690.21},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":48643.45},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":24412.95},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":40119.25},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":22637.91},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":75431.37},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":57255.79},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25507.66},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36116.14},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":33588.1},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":25507.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy Without Cc/Mcc","code_information":[{"code":"079","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9761.15,"maximum":32524.96,"payers_information":[{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10107.17},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19700.99},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":20974.38},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":10526.53},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":17298.86},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":9761.15},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":32524.96},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":24687.9},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10998.55},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15572.78},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":14482.72},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":10998.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis Without Cc/Mcc","code_information":[{"code":"295","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11563.46,"maximum":38530.39,"payers_information":[{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11973.37},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23338.59},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":24847.11},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":12470.15},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":20492.94},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":11563.46},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":38530.39},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29246.29},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13029.33},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18448.15},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":17156.83},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":13029.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis With Cc/Mcc","code_information":[{"code":"294","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17977.68,"maximum":59903.1,"payers_information":[{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18614.96},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36284.45},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"fee schedule","standard_charge_dollar":38629.73},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"fee schedule","standard_charge_dollar":19387.31},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"fee schedule","standard_charge_dollar":31860.32},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"fee schedule","standard_charge_dollar":17977.68},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"fee schedule","standard_charge_dollar":59903.1},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":45469.14},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20256.67},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28681.29},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"fee schedule","standard_charge_dollar":26673.67},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"fee schedule","standard_charge_dollar":20256.67}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, bupivacaine liposome","code_information":[{"code":"0763","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":18049.27,"10th_percentile":18049.27,"90th_percentile":18049.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18043.5,"10th_percentile":18043.5,"90th_percentile":18043.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ketorolac tromethamine inj","code_information":[{"code":"0764","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":7924.7,"10th_percentile":7924.7,"90th_percentile":7924.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinic Visits and Related Services","code_information":[{"code":"5012","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"1 through 10","median_amount":455.0,"10th_percentile":455.0,"90th_percentile":455.0},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"19","median_amount":379.81,"10th_percentile":170.61,"90th_percentile":414.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"35","median_amount":136.25,"10th_percentile":62.08,"90th_percentile":137.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":182.81,"10th_percentile":140.24,"90th_percentile":984.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":416.2,"10th_percentile":416.2,"90th_percentile":416.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"1 through 10","median_amount":1107.88,"10th_percentile":1107.88,"90th_percentile":1107.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"16","median_amount":142.5,"10th_percentile":139.03,"90th_percentile":142.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"1 through 10","median_amount":369.89,"10th_percentile":369.89,"90th_percentile":369.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":216.76,"10th_percentile":216.75,"90th_percentile":1169.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"1 through 10","median_amount":427.06,"10th_percentile":427.06,"90th_percentile":674.08},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":244.26,"10th_percentile":244.26,"90th_percentile":244.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":138.97,"10th_percentile":138.97,"90th_percentile":138.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":135.58,"10th_percentile":135.58,"90th_percentile":135.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":89.59,"10th_percentile":89.59,"90th_percentile":170.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"20","median_amount":204.14,"10th_percentile":154.6,"90th_percentile":330.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"33","median_amount":283.59,"10th_percentile":283.59,"90th_percentile":477.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"46","median_amount":135.59,"10th_percentile":108.47,"90th_percentile":136.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":141.98,"10th_percentile":141.98,"90th_percentile":141.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Type A ED Visits","code_information":[{"code":"5021","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":450.69,"10th_percentile":450.69,"90th_percentile":680.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"1 through 10","median_amount":1136.74,"10th_percentile":1136.74,"90th_percentile":1136.74},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":91.56,"10th_percentile":72.6,"90th_percentile":191.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"25","median_amount":1109.39,"10th_percentile":318.72,"90th_percentile":1386.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"21","median_amount":87.63,"10th_percentile":85.88,"90th_percentile":88.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"29","median_amount":302.15,"10th_percentile":140.9,"90th_percentile":632.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"13","median_amount":208.5,"10th_percentile":165.0,"90th_percentile":410.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"11","median_amount":248.13,"10th_percentile":178.13,"90th_percentile":530.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":90.26,"10th_percentile":90.26,"90th_percentile":90.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"19","median_amount":90.26,"10th_percentile":88.06,"90th_percentile":90.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"1 through 10","median_amount":249.95,"10th_percentile":208.29,"90th_percentile":493.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"20","median_amount":463.73,"10th_percentile":186.33,"90th_percentile":632.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"1 through 10","median_amount":25.8,"10th_percentile":25.8,"90th_percentile":25.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"16","median_amount":877.53,"10th_percentile":100.0,"90th_percentile":1096.91},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"13","median_amount":117.43,"10th_percentile":107.33,"90th_percentile":160.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":88.02,"10th_percentile":88.02,"90th_percentile":88.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"43","median_amount":103.6,"10th_percentile":75.98,"90th_percentile":141.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"30","median_amount":87.63,"10th_percentile":85.88,"90th_percentile":87.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":165.62,"10th_percentile":165.62,"90th_percentile":165.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"1 through 10","median_amount":250.0,"10th_percentile":250.0,"90th_percentile":250.0},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":109.75,"10th_percentile":99.75,"90th_percentile":139.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"58","median_amount":116.34,"10th_percentile":78.2,"90th_percentile":176.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"1 through 10","median_amount":240.18,"10th_percentile":240.18,"90th_percentile":240.18},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"252","median_amount":122.92,"10th_percentile":78.57,"90th_percentile":167.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"24","median_amount":252.25,"10th_percentile":201.08,"90th_percentile":252.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"18","median_amount":302.0,"10th_percentile":106.4,"90th_percentile":490.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"40","median_amount":87.63,"10th_percentile":85.88,"90th_percentile":87.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"1 through 10","median_amount":302.0,"10th_percentile":302.0,"90th_percentile":302.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":98.15,"10th_percentile":98.15,"90th_percentile":98.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":839.99,"10th_percentile":839.99,"90th_percentile":880.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":101.11,"10th_percentile":101.11,"90th_percentile":111.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"11","median_amount":1513.0,"10th_percentile":700.0,"90th_percentile":1738.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":158.38,"10th_percentile":156.78,"90th_percentile":159.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"12","median_amount":1008.8,"10th_percentile":768.8,"90th_percentile":1475.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":767.0,"10th_percentile":767.0,"90th_percentile":767.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"1 through 10","median_amount":763.0,"10th_percentile":359.0,"90th_percentile":843.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":160.34,"10th_percentile":158.96,"90th_percentile":164.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":160.34,"10th_percentile":159.56,"90th_percentile":164.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"1 through 10","median_amount":468.5,"10th_percentile":468.5,"90th_percentile":468.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"12","median_amount":888.8,"10th_percentile":620.75,"90th_percentile":1261.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"1 through 10","median_amount":1762.04,"10th_percentile":207.37,"90th_percentile":2044.41},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":124.6,"10th_percentile":124.6,"90th_percentile":124.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":130.54,"10th_percentile":130.54,"90th_percentile":130.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":160.13,"10th_percentile":160.13,"90th_percentile":160.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"14","median_amount":125.66,"10th_percentile":101.02,"90th_percentile":245.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":158.77,"10th_percentile":28.97,"90th_percentile":158.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":100.31,"10th_percentile":100.31,"90th_percentile":100.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":301.56,"10th_percentile":301.56,"90th_percentile":301.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"1 through 10","median_amount":250.0,"10th_percentile":250.0,"90th_percentile":250.0},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"23","median_amount":123.44,"10th_percentile":85.38,"90th_percentile":252.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"1 through 10","median_amount":329.54,"10th_percentile":329.54,"90th_percentile":329.54},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"91","median_amount":130.42,"10th_percentile":78.57,"90th_percentile":267.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"1 through 10","median_amount":470.13,"10th_percentile":100.02,"90th_percentile":756.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"13","median_amount":397.0,"10th_percentile":297.0,"90th_percentile":547.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"1 through 10","median_amount":250.0,"10th_percentile":250.0,"90th_percentile":250.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":97.19,"10th_percentile":9.37,"90th_percentile":158.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"1 through 10","median_amount":47.0,"10th_percentile":47.0,"90th_percentile":400.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":62.44,"10th_percentile":62.44,"90th_percentile":62.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Type A ED Visits","code_information":[{"code":"5023","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"1 through 10","median_amount":585.23,"10th_percentile":585.23,"90th_percentile":655.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"18","median_amount":1410.97,"10th_percentile":1046.96,"90th_percentile":2285.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"1 through 10","median_amount":1989.0,"10th_percentile":1989.0,"90th_percentile":1989.0},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"44","median_amount":111.11,"10th_percentile":101.11,"90th_percentile":181.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":158.93,"10th_percentile":158.93,"90th_percentile":158.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"89","median_amount":1683.0,"10th_percentile":975.2,"90th_percentile":1808.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"63","median_amount":279.86,"10th_percentile":161.71,"90th_percentile":314.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"106","median_amount":1161.0,"10th_percentile":648.81,"90th_percentile":1489.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"38","median_amount":987.0,"10th_percentile":300.28,"90th_percentile":1627.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"23","median_amount":1063.0,"10th_percentile":563.0,"90th_percentile":1440.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"14","median_amount":283.66,"10th_percentile":163.61,"90th_percentile":292.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"29","median_amount":285.06,"10th_percentile":277.94,"90th_percentile":320.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"22","median_amount":734.6,"10th_percentile":130.42,"90th_percentile":1346.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"86","median_amount":1255.03,"10th_percentile":425.0,"90th_percentile":1573.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"1 through 10","median_amount":2942.63,"10th_percentile":1701.0,"90th_percentile":3998.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"48","median_amount":1441.79,"10th_percentile":306.22,"90th_percentile":3840.32},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"42","median_amount":121.97,"10th_percentile":117.43,"90th_percentile":195.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":281.66,"10th_percentile":281.66,"90th_percentile":281.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":1381.98,"10th_percentile":1381.98,"90th_percentile":1381.98},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":104.95,"10th_percentile":104.95,"90th_percentile":104.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":213.48,"10th_percentile":213.48,"90th_percentile":213.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":282.36,"10th_percentile":282.36,"90th_percentile":287.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"178","median_amount":113.04,"10th_percentile":103.6,"90th_percentile":187.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"134","median_amount":249.59,"10th_percentile":85.88,"90th_percentile":283.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":182.21,"10th_percentile":182.21,"90th_percentile":182.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum HealthCare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":279.36,"10th_percentile":279.36,"90th_percentile":279.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":482.07,"10th_percentile":390.92,"90th_percentile":536.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"36","median_amount":106.45,"10th_percentile":99.75,"90th_percentile":182.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"205","median_amount":116.34,"10th_percentile":106.61,"90th_percentile":200.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":288.73,"10th_percentile":288.73,"90th_percentile":288.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"1 through 10","median_amount":402.62,"10th_percentile":200.0,"90th_percentile":657.43},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"903","median_amount":122.92,"10th_percentile":112.35,"90th_percentile":204.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"63","median_amount":819.4,"10th_percentile":553.1,"90th_percentile":1125.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"98","median_amount":890.0,"10th_percentile":149.71,"90th_percentile":1356.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":182.21,"10th_percentile":182.21,"90th_percentile":182.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"169","median_amount":209.0,"10th_percentile":150.59,"90th_percentile":309.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"1 through 10","median_amount":590.0,"10th_percentile":590.0,"90th_percentile":864.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"1 through 10","median_amount":1091.48,"10th_percentile":1091.48,"90th_percentile":1091.48},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":283.66,"10th_percentile":283.66,"90th_percentile":283.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":164.35,"10th_percentile":164.35,"90th_percentile":308.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Type A ED Visits","code_information":[{"code":"5024","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"1 through 10","median_amount":3271.7,"10th_percentile":3271.7,"90th_percentile":3271.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"31","median_amount":3311.59,"10th_percentile":1822.79,"90th_percentile":7976.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"1 through 10","median_amount":2913.0,"10th_percentile":1768.0,"90th_percentile":3213.0},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":142.04,"10th_percentile":102.13,"90th_percentile":675.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":333.56,"10th_percentile":333.56,"90th_percentile":333.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"130","median_amount":1925.0,"10th_percentile":1239.0,"90th_percentile":2920.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"133","median_amount":552.01,"10th_percentile":426.44,"90th_percentile":797.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"164","median_amount":3115.0,"10th_percentile":1524.78,"90th_percentile":5967.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"102","median_amount":2368.0,"10th_percentile":1088.0,"90th_percentile":6101.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"30","median_amount":2686.0,"10th_percentile":928.23,"90th_percentile":5587.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"19","median_amount":561.95,"10th_percentile":446.62,"90th_percentile":1011.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"62","median_amount":578.81,"10th_percentile":527.86,"90th_percentile":1004.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"38","median_amount":1942.65,"10th_percentile":1018.99,"90th_percentile":5535.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"173","median_amount":3042.81,"10th_percentile":1624.84,"90th_percentile":6545.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"1 through 10","median_amount":4468.0,"10th_percentile":2723.85,"90th_percentile":10146.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"92","median_amount":3898.31,"10th_percentile":773.54,"90th_percentile":14985.69},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"21","median_amount":172.87,"10th_percentile":117.43,"90th_percentile":559.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":553.01,"10th_percentile":553.01,"90th_percentile":553.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":12175.76,"10th_percentile":12175.76,"90th_percentile":12175.76},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":564.73,"10th_percentile":506.49,"90th_percentile":666.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"100","median_amount":212.04,"10th_percentile":109.87,"90th_percentile":604.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"302","median_amount":609.53,"10th_percentile":278.65,"90th_percentile":932.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":134.25,"10th_percentile":134.25,"90th_percentile":134.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum HealthCare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":544.68,"10th_percentile":544.68,"90th_percentile":544.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":997.89,"10th_percentile":655.62,"90th_percentile":1362.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"1 through 10","median_amount":4245.33,"10th_percentile":4245.33,"90th_percentile":4245.33},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"1 through 10","median_amount":17928.24,"10th_percentile":17928.24,"90th_percentile":17928.24},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":109.75,"10th_percentile":99.75,"90th_percentile":275.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"101","median_amount":263.21,"10th_percentile":116.34,"90th_percentile":529.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"1 through 10","median_amount":1556.92,"10th_percentile":834.41,"90th_percentile":4925.38},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"446","median_amount":230.09,"10th_percentile":122.92,"90th_percentile":542.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"86","median_amount":1800.72,"10th_percentile":1081.87,"90th_percentile":3835.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"138","median_amount":1853.01,"10th_percentile":193.56,"90th_percentile":3183.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"1 through 10","median_amount":2180.0,"10th_percentile":2180.0,"90th_percentile":2180.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":478.44,"10th_percentile":261.27,"90th_percentile":480.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"302","median_amount":550.79,"10th_percentile":312.23,"90th_percentile":848.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"1 through 10","median_amount":1680.0,"10th_percentile":1090.0,"90th_percentile":6247.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"1 through 10","median_amount":1272.85,"10th_percentile":1272.85,"90th_percentile":3868.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":428.17,"10th_percentile":193.69,"90th_percentile":831.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Type A ED Visits","code_information":[{"code":"5025","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"1 through 10","median_amount":6550.33,"10th_percentile":6550.33,"90th_percentile":6550.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"32","median_amount":6580.33,"10th_percentile":3364.04,"90th_percentile":9760.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"1 through 10","median_amount":3939.26,"10th_percentile":3939.26,"90th_percentile":3939.26},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":598.01,"10th_percentile":377.2,"90th_percentile":739.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":692.64,"10th_percentile":692.64,"90th_percentile":692.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"85","median_amount":2720.0,"10th_percentile":1675.0,"90th_percentile":4372.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"142","median_amount":1090.83,"10th_percentile":735.74,"90th_percentile":2695.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2757.65,"10th_percentile":2757.65,"90th_percentile":2757.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"1 through 10","median_amount":27792.73,"10th_percentile":27792.73,"90th_percentile":27792.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"109","median_amount":4485.14,"10th_percentile":2105.6,"90th_percentile":9486.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"104","median_amount":4571.03,"10th_percentile":1273.91,"90th_percentile":9878.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"28","median_amount":2786.0,"10th_percentile":1592.0,"90th_percentile":8347.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"19","median_amount":1306.44,"10th_percentile":853.8,"90th_percentile":2904.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"45","median_amount":1106.52,"10th_percentile":748.11,"90th_percentile":2832.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"13","median_amount":3259.4,"10th_percentile":2238.0,"90th_percentile":7449.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"95","median_amount":3315.0,"10th_percentile":1246.92,"90th_percentile":8681.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"1 through 10","median_amount":4468.0,"10th_percentile":4468.0,"90th_percentile":17587.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"43","median_amount":7427.56,"10th_percentile":886.28,"90th_percentile":22043.8},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":223.82,"10th_percentile":173.04,"90th_percentile":689.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":65379.88,"10th_percentile":65379.88,"90th_percentile":65379.88},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":1095.53,"10th_percentile":701.52,"90th_percentile":2692.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"52","median_amount":479.96,"10th_percentile":180.81,"90th_percentile":747.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"365","median_amount":1118.96,"10th_percentile":518.54,"90th_percentile":2759.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":348.85,"10th_percentile":348.85,"90th_percentile":348.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":2151.98,"10th_percentile":1072.47,"90th_percentile":4109.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"1 through 10","median_amount":560.0,"10th_percentile":560.0,"90th_percentile":560.0},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"1 through 10","median_amount":6503.22,"10th_percentile":6503.22,"90th_percentile":6503.22},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":534.16,"10th_percentile":212.47,"90th_percentile":767.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"30","median_amount":509.12,"10th_percentile":173.34,"90th_percentile":781.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"1 through 10","median_amount":2167.51,"10th_percentile":2167.51,"90th_percentile":2167.51},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"198","median_amount":414.8,"10th_percentile":122.92,"90th_percentile":774.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"49","median_amount":3421.13,"10th_percentile":1653.9,"90th_percentile":5674.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"110","median_amount":3050.0,"10th_percentile":840.0,"90th_percentile":8206.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"1 through 10","median_amount":2180.0,"10th_percentile":2180.0,"90th_percentile":2180.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":744.12,"10th_percentile":633.48,"90th_percentile":1041.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"331","median_amount":1133.2,"10th_percentile":697.69,"90th_percentile":2734.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"1 through 10","median_amount":1903.19,"10th_percentile":399.0,"90th_percentile":20955.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"1 through 10","median_amount":1514.58,"10th_percentile":1514.58,"90th_percentile":1514.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":1082.97,"10th_percentile":758.91,"90th_percentile":2770.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Critical Care","code_information":[{"code":"5041","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":278.84,"10th_percentile":278.84,"90th_percentile":278.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"1 through 10","median_amount":3268.75,"10th_percentile":3132.0,"90th_percentile":4910.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"11","median_amount":1841.67,"10th_percentile":1420.92,"90th_percentile":2667.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":12424.13,"10th_percentile":11334.02,"90th_percentile":13580.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":6777.0,"10th_percentile":6777.0,"90th_percentile":6777.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3081.54,"10th_percentile":3081.54,"90th_percentile":3081.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"1 through 10","median_amount":128.46,"10th_percentile":128.46,"90th_percentile":128.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":8681.0,"10th_percentile":7116.68,"90th_percentile":14871.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"1 through 10","median_amount":14186.63,"10th_percentile":14186.63,"90th_percentile":14186.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2711.58,"10th_percentile":2711.58,"90th_percentile":2711.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":715.0,"10th_percentile":546.13,"90th_percentile":747.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":2271.57,"10th_percentile":1285.76,"90th_percentile":2757.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1036.83,"10th_percentile":1036.83,"90th_percentile":1036.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":574.39,"10th_percentile":421.52,"90th_percentile":867.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"1 through 10","median_amount":3221.0,"10th_percentile":2421.0,"90th_percentile":3732.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2506.59,"10th_percentile":1368.85,"90th_percentile":2698.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"1 through 10","median_amount":45973.97,"10th_percentile":45973.97,"90th_percentile":45973.97},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2729.72,"10th_percentile":2729.72,"90th_percentile":2729.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Skin Procedures","code_information":[{"code":"5051","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"1 through 10","median_amount":406.44,"10th_percentile":406.44,"90th_percentile":406.44},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"1 through 10","median_amount":1642.5,"10th_percentile":1492.2,"90th_percentile":2819.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":280.59,"10th_percentile":205.33,"90th_percentile":694.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":2092.15,"10th_percentile":1011.0,"90th_percentile":2806.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":999.23,"10th_percentile":999.23,"90th_percentile":999.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":446.62,"10th_percentile":446.62,"90th_percentile":446.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3720.88,"10th_percentile":3720.88,"90th_percentile":3720.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":2949.91,"10th_percentile":2099.03,"90th_percentile":3290.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"1 through 10","median_amount":4953.53,"10th_percentile":4953.53,"90th_percentile":5811.37},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":270.14,"10th_percentile":270.14,"90th_percentile":270.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":265.01,"10th_percentile":265.01,"90th_percentile":265.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":204.33,"10th_percentile":156.37,"90th_percentile":363.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":272.73,"10th_percentile":272.73,"90th_percentile":272.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":288.16,"10th_percentile":267.32,"90th_percentile":436.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"1 through 10","median_amount":1883.1,"10th_percentile":1883.1,"90th_percentile":1883.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"1 through 10","median_amount":566.52,"10th_percentile":566.52,"90th_percentile":566.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":427.93,"10th_percentile":344.09,"90th_percentile":427.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"1 through 10","median_amount":2086.0,"10th_percentile":2086.0,"90th_percentile":2086.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":253.24,"10th_percentile":253.24,"90th_percentile":253.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Skin Procedures","code_information":[{"code":"5052","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"1 through 10","median_amount":3692.93,"10th_percentile":3692.93,"90th_percentile":4585.94},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"33","median_amount":3692.93,"10th_percentile":3323.64,"90th_percentile":5124.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"78","median_amount":416.03,"10th_percentile":232.68,"90th_percentile":552.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"13","median_amount":652.18,"10th_percentile":652.17,"90th_percentile":3315.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":3492.93,"10th_percentile":630.57,"90th_percentile":5613.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"1 through 10","median_amount":775.82,"10th_percentile":775.82,"90th_percentile":775.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"63","median_amount":435.1,"10th_percentile":422.43,"90th_percentile":524.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":946.3,"10th_percentile":391.59,"90th_percentile":9059.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"1 through 10","median_amount":7954.2,"10th_percentile":7954.2,"90th_percentile":7954.2},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":424.35,"10th_percentile":277.35,"90th_percentile":428.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":713.01,"10th_percentile":713.01,"90th_percentile":713.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"93","median_amount":413.98,"10th_percentile":413.98,"90th_percentile":497.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":269.29,"10th_percentile":269.29,"90th_percentile":284.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":267.32,"10th_percentile":266.75,"90th_percentile":667.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"1 through 10","median_amount":1029.04,"10th_percentile":1029.04,"90th_percentile":1104.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"35","median_amount":1309.0,"10th_percentile":1047.2,"90th_percentile":2290.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"65","median_amount":413.99,"10th_percentile":173.88,"90th_percentile":559.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":361.66,"10th_percentile":361.66,"90th_percentile":361.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Skin Procedures","code_information":[{"code":"5053","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":117.4,"10th_percentile":117.4,"90th_percentile":117.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Skin Procedures","code_information":[{"code":"5054","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2490.26,"10th_percentile":2490.26,"90th_percentile":2490.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3163.65,"10th_percentile":3163.65,"90th_percentile":3163.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2111.1,"10th_percentile":2111.1,"90th_percentile":2111.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Skin Procedures","code_information":[{"code":"5055","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3727.56,"10th_percentile":3727.56,"90th_percentile":3727.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hyperbaric Oxygen","code_information":[{"code":"5061","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"19","median_amount":564.56,"10th_percentile":560.56,"90th_percentile":978.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":1344.49,"10th_percentile":1159.29,"90th_percentile":1344.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"32","median_amount":1458.0,"10th_percentile":1282.55,"90th_percentile":1458.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"30","median_amount":574.8,"10th_percentile":572.0,"90th_percentile":592.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":1496.24,"10th_percentile":1496.24,"90th_percentile":1496.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":565.61,"10th_percentile":565.61,"90th_percentile":983.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"20","median_amount":560.56,"10th_percentile":560.56,"90th_percentile":560.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"174","median_amount":560.56,"10th_percentile":75.46,"90th_percentile":599.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5071","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":815.56,"10th_percentile":815.56,"90th_percentile":815.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":739.49,"10th_percentile":739.49,"90th_percentile":739.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":737.53,"10th_percentile":737.53,"90th_percentile":737.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":813.76,"10th_percentile":813.76,"90th_percentile":813.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":479.28,"10th_percentile":479.28,"90th_percentile":479.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":238.68,"10th_percentile":238.68,"90th_percentile":238.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":998.56,"10th_percentile":998.56,"90th_percentile":998.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":996.08,"10th_percentile":996.08,"90th_percentile":996.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"1 through 10","median_amount":107.0,"10th_percentile":107.0,"90th_percentile":107.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5072","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"1 through 10","median_amount":3456.0,"10th_percentile":3456.0,"90th_percentile":3456.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":2060.32,"10th_percentile":2060.32,"90th_percentile":2060.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":18267.91,"10th_percentile":18267.91,"90th_percentile":18267.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":5085.0,"10th_percentile":1261.0,"90th_percentile":13295.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1681.95,"10th_percentile":1332.2,"90th_percentile":2961.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":818.27,"10th_percentile":818.27,"90th_percentile":818.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"1 through 10","median_amount":6697.32,"10th_percentile":6697.32,"90th_percentile":6697.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"1 through 10","median_amount":10402.0,"10th_percentile":10402.0,"90th_percentile":10402.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1686.85,"10th_percentile":1446.86,"90th_percentile":1686.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5073","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":16940.3,"10th_percentile":16940.3,"90th_percentile":16940.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":8286.0,"10th_percentile":8286.0,"90th_percentile":8286.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3415.84,"10th_percentile":3415.84,"90th_percentile":3415.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"1 through 10","median_amount":69517.15,"10th_percentile":69517.15,"90th_percentile":69517.15},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2966.1,"10th_percentile":2966.1,"90th_percentile":3134.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"1 through 10","median_amount":24104.42,"10th_percentile":24104.42,"90th_percentile":24104.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2824.16,"10th_percentile":2824.16,"90th_percentile":3141.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5091","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":22159.14,"10th_percentile":22159.14,"90th_percentile":22159.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":12820.27,"10th_percentile":12820.27,"90th_percentile":12820.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4362.25,"10th_percentile":4362.25,"90th_percentile":4362.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3193.85,"10th_percentile":3193.85,"90th_percentile":3193.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Strapping and Cast Application","code_information":[{"code":"5101","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"14","median_amount":165.49,"10th_percentile":165.49,"90th_percentile":169.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"21","median_amount":254.54,"10th_percentile":254.54,"90th_percentile":262.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":8116.58,"10th_percentile":8116.58,"90th_percentile":8116.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":172.63,"10th_percentile":22.63,"90th_percentile":172.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":139.35,"10th_percentile":139.35,"90th_percentile":139.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":248.24,"10th_percentile":248.24,"90th_percentile":818.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":204.08,"10th_percentile":204.08,"90th_percentile":204.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"1 through 10","median_amount":160.64,"10th_percentile":160.64,"90th_percentile":160.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"29","median_amount":196.96,"10th_percentile":196.96,"90th_percentile":492.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":248.25,"10th_percentile":248.25,"90th_percentile":248.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Musculoskeletal Procedures","code_information":[{"code":"5111","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"1 through 10","median_amount":1825.0,"10th_percentile":1825.0,"90th_percentile":1825.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":1497.26,"10th_percentile":1497.26,"90th_percentile":1497.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"1 through 10","median_amount":1388.0,"10th_percentile":1388.0,"90th_percentile":1388.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":539.08,"10th_percentile":539.08,"90th_percentile":539.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":569.6,"10th_percentile":569.6,"90th_percentile":569.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Musculoskeletal Procedures","code_information":[{"code":"5112","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":514.89,"10th_percentile":514.89,"90th_percentile":514.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":6891.31,"10th_percentile":6891.31,"90th_percentile":6891.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":1768.65,"10th_percentile":1768.65,"90th_percentile":1768.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1641.04,"10th_percentile":1641.04,"90th_percentile":1641.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":569.6,"10th_percentile":569.6,"90th_percentile":750.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Musculoskeletal Procedures","code_information":[{"code":"5113","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":14588.15,"10th_percentile":14588.15,"90th_percentile":14588.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"1 through 10","median_amount":14034.92,"10th_percentile":14034.92,"90th_percentile":14034.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":3662.23,"10th_percentile":3662.23,"90th_percentile":3662.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":10623.94,"10th_percentile":10623.94,"90th_percentile":10623.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":19474.48,"10th_percentile":19474.48,"90th_percentile":29341.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":22567.81,"10th_percentile":22567.81,"90th_percentile":22567.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3709.98,"10th_percentile":3503.82,"90th_percentile":7589.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"1 through 10","median_amount":4140.0,"10th_percentile":4140.0,"90th_percentile":4140.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2966.52,"10th_percentile":245.0,"90th_percentile":9152.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Musculoskeletal Procedures","code_information":[{"code":"5114","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":51701.71,"10th_percentile":51701.71,"90th_percentile":65193.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"1 through 10","median_amount":10539.62,"10th_percentile":10539.62,"90th_percentile":12638.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":7764.41,"10th_percentile":7573.22,"90th_percentile":7771.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":19273.91,"10th_percentile":19273.91,"90th_percentile":30075.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":27083.98,"10th_percentile":25153.33,"90th_percentile":30818.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7482.89,"10th_percentile":7482.89,"90th_percentile":7482.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7773.02,"10th_percentile":7773.02,"90th_percentile":7968.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":30449.4,"10th_percentile":30449.4,"90th_percentile":40753.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7864.41,"10th_percentile":7864.41,"90th_percentile":13453.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"1 through 10","median_amount":9811.5,"10th_percentile":6708.89,"90th_percentile":41337.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7761.86,"10th_percentile":6080.36,"90th_percentile":13082.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Musculoskeletal Procedures","code_information":[{"code":"5115","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"17","median_amount":13359.63,"10th_percentile":290.0,"90th_percentile":13697.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":29298.58,"10th_percentile":29220.88,"90th_percentile":34874.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":31449.57,"10th_percentile":15869.16,"90th_percentile":43220.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"1 through 10","median_amount":26041.17,"10th_percentile":26041.17,"90th_percentile":26041.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":14060.08,"10th_percentile":14060.08,"90th_percentile":14060.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13896.5,"10th_percentile":11176.59,"90th_percentile":13970.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"1 through 10","median_amount":29283.22,"10th_percentile":29283.22,"90th_percentile":29283.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":25323.17,"10th_percentile":25323.17,"90th_percentile":48987.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"1 through 10","median_amount":23968.25,"10th_percentile":23968.25,"90th_percentile":23968.25},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13938.86,"10th_percentile":13882.26,"90th_percentile":13968.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"35","median_amount":13616.91,"10th_percentile":593.38,"90th_percentile":13654.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"1 through 10","median_amount":23054.5,"10th_percentile":22349.0,"90th_percentile":43960.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":13540.91,"10th_percentile":10838.8,"90th_percentile":14528.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 6 Musculoskeletal Procedures","code_information":[{"code":"5116","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":18327.2,"10th_percentile":18125.99,"90th_percentile":18330.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":46695.54,"10th_percentile":46695.54,"90th_percentile":46695.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":31431.91,"10th_percentile":31431.91,"90th_percentile":31431.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18701.22,"10th_percentile":18701.22,"90th_percentile":18701.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18655.07,"10th_percentile":18655.07,"90th_percentile":18655.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18699.4,"10th_percentile":18699.4,"90th_percentile":18699.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18047.58,"10th_percentile":18043.21,"90th_percentile":18239.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"1 through 10","median_amount":71616.7,"10th_percentile":71616.7,"90th_percentile":71616.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18047.38,"10th_percentile":14438.72,"90th_percentile":19325.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 7 Musculoskeletal Procedures","code_information":[{"code":"5117","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":105975.3,"10th_percentile":105975.3,"90th_percentile":105975.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Airway Endoscopy","code_information":[{"code":"5153","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":1821.54,"10th_percentile":1821.54,"90th_percentile":1821.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":7484.93,"10th_percentile":7484.93,"90th_percentile":7484.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1828.51,"10th_percentile":1828.51,"90th_percentile":1828.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1461.88,"10th_percentile":1461.88,"90th_percentile":1461.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Airway Endoscopy","code_information":[{"code":"5154","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":3802.66,"10th_percentile":3802.66,"90th_percentile":3802.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3812.37,"10th_percentile":3812.37,"90th_percentile":3812.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"1 through 10","median_amount":20580.63,"10th_percentile":20580.63,"90th_percentile":20580.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Airway Endoscopy","code_information":[{"code":"5155","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7200.89,"10th_percentile":7200.89,"90th_percentile":7200.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 ENT Procedures","code_information":[{"code":"5161","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":1523.76,"10th_percentile":1523.76,"90th_percentile":1523.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 ENT Procedures","code_information":[{"code":"5164","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3462.26,"10th_percentile":3462.26,"90th_percentile":3462.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Vascular Procedures","code_information":[{"code":"5181","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":1465.47,"10th_percentile":1465.47,"90th_percentile":1465.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":674.73,"10th_percentile":674.73,"90th_percentile":674.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":742.3,"10th_percentile":742.3,"90th_percentile":742.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":643.74,"10th_percentile":643.74,"90th_percentile":643.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Vascular Procedures","code_information":[{"code":"5182","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":1608.87,"10th_percentile":1608.87,"90th_percentile":1608.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":1741.66,"10th_percentile":1741.66,"90th_percentile":1741.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":5085.0,"10th_percentile":5085.0,"90th_percentile":5085.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1603.08,"10th_percentile":1603.08,"90th_percentile":1603.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1335.92,"10th_percentile":1335.92,"90th_percentile":1335.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"1 through 10","median_amount":1398.56,"10th_percentile":1398.56,"90th_percentile":1398.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1608.08,"10th_percentile":1608.08,"90th_percentile":1713.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"1 through 10","median_amount":2697.2,"10th_percentile":2697.2,"90th_percentile":2697.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Vascular Procedures","code_information":[{"code":"5183","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"1 through 10","median_amount":5925.0,"10th_percentile":5925.0,"90th_percentile":5925.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":3241.0,"10th_percentile":3225.75,"90th_percentile":3590.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":7940.97,"10th_percentile":7940.97,"90th_percentile":7940.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"1 through 10","median_amount":2736.0,"10th_percentile":2736.0,"90th_percentile":2736.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3400.26,"10th_percentile":3400.26,"90th_percentile":3400.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":17395.5,"10th_percentile":17395.5,"90th_percentile":17395.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3218.51,"10th_percentile":1485.25,"90th_percentile":3284.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1749.83,"10th_percentile":1749.83,"90th_percentile":1749.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3242.47,"10th_percentile":3242.47,"90th_percentile":3483.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Vascular Procedures","code_information":[{"code":"5184","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":12762.03,"10th_percentile":12762.03,"90th_percentile":12762.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5955.87,"10th_percentile":5955.87,"90th_percentile":5955.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":15067.19,"10th_percentile":15067.19,"90th_percentile":15067.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5558.27,"10th_percentile":5558.27,"90th_percentile":5796.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5666.75,"10th_percentile":4616.01,"90th_percentile":5678.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Endovascular Procedures","code_information":[{"code":"5191","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"1 through 10","median_amount":15358.0,"10th_percentile":15358.0,"90th_percentile":15358.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"21","median_amount":3307.31,"10th_percentile":3301.51,"90th_percentile":5797.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":5210.54,"10th_percentile":5210.54,"90th_percentile":5210.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":18284.93,"10th_percentile":3918.44,"90th_percentile":23888.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"1 through 10","median_amount":5422.22,"10th_percentile":5422.22,"90th_percentile":5422.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3389.41,"10th_percentile":3389.41,"90th_percentile":3389.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3469.96,"10th_percentile":3469.96,"90th_percentile":3474.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":24844.84,"10th_percentile":24844.84,"90th_percentile":24844.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"1 through 10","median_amount":49004.67,"10th_percentile":49004.67,"90th_percentile":49004.67},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3388.03,"10th_percentile":3322.77,"90th_percentile":5941.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"34","median_amount":3305.51,"10th_percentile":3150.61,"90th_percentile":3317.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum HealthCare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5824.71,"10th_percentile":5824.71,"90th_percentile":5824.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1774.91,"10th_percentile":1774.91,"90th_percentile":1992.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"1 through 10","median_amount":5689.81,"10th_percentile":4207.0,"90th_percentile":9590.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2115.63,"10th_percentile":2115.63,"90th_percentile":2115.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"30","median_amount":3306.42,"10th_percentile":2471.01,"90th_percentile":5796.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"1 through 10","median_amount":8068.5,"10th_percentile":8068.5,"90th_percentile":8068.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Endovascular Procedures","code_information":[{"code":"5192","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":290.0,"10th_percentile":290.0,"90th_percentile":290.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":29710.03,"10th_percentile":29710.03,"90th_percentile":29710.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5727.69,"10th_percentile":5727.69,"90th_percentile":5727.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5802.07,"10th_percentile":175.0,"90th_percentile":27552.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9405.08,"10th_percentile":9405.08,"90th_percentile":11766.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Endovascular Procedures","code_information":[{"code":"5193","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":11760.04,"10th_percentile":11756.34,"90th_percentile":13215.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":25777.08,"10th_percentile":17192.82,"90th_percentile":35204.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":23158.08,"10th_percentile":15125.52,"90th_percentile":44442.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12356.16,"10th_percentile":12356.16,"90th_percentile":12417.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"1 through 10","median_amount":8123.71,"10th_percentile":8123.71,"90th_percentile":8123.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"1 through 10","median_amount":70643.61,"10th_percentile":70643.61,"90th_percentile":115115.32},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12054.43,"10th_percentile":12054.43,"90th_percentile":19139.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"27","median_amount":11759.85,"10th_percentile":175.0,"90th_percentile":18668.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":35433.96,"10th_percentile":35433.96,"90th_percentile":35433.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"1 through 10","median_amount":10087.75,"10th_percentile":10087.75,"90th_percentile":10087.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":11756.36,"10th_percentile":9405.08,"90th_percentile":11765.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Endovascular Procedures","code_information":[{"code":"5194","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"1 through 10","median_amount":200.0,"10th_percentile":200.0,"90th_percentile":200.0},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"1 through 10","median_amount":19222.3,"10th_percentile":19222.3,"90th_percentile":19222.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":18850.74,"10th_percentile":18850.74,"90th_percentile":18850.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":37317.61,"10th_percentile":37317.61,"90th_percentile":37317.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19634.81,"10th_percentile":19634.81,"90th_percentile":19634.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19139.59,"10th_percentile":19139.59,"90th_percentile":19139.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18677.05,"10th_percentile":225.0,"90th_percentile":18793.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"1 through 10","median_amount":24069.7,"10th_percentile":24069.7,"90th_percentile":24069.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17138.59,"10th_percentile":14934.84,"90th_percentile":18691.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Electrophysiologic Procedures","code_information":[{"code":"5212","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7722.51,"10th_percentile":7722.51,"90th_percentile":7722.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Electrophysiologic Procedures","code_information":[{"code":"5213","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":26755.12,"10th_percentile":26755.12,"90th_percentile":26755.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":34727.0,"10th_percentile":34727.0,"90th_percentile":41311.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":32598.21,"10th_percentile":32598.21,"90th_percentile":32598.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"1 through 10","median_amount":39864.16,"10th_percentile":39864.16,"90th_percentile":39864.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":27295.22,"10th_percentile":27295.22,"90th_percentile":27976.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":36350.08,"10th_percentile":26470.91,"90th_percentile":60576.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"1 through 10","median_amount":234957.42,"10th_percentile":234957.42,"90th_percentile":234957.42},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":27284.3,"10th_percentile":27284.3,"90th_percentile":27284.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":26627.04,"10th_percentile":26624.14,"90th_percentile":26637.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"1 through 10","median_amount":31635.5,"10th_percentile":31635.5,"90th_percentile":31635.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":26621.02,"10th_percentile":21294.6,"90th_percentile":28488.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Pacemaker and Similar Procedures","code_information":[{"code":"5222","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":8433.27,"10th_percentile":8433.27,"90th_percentile":8433.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Pacemaker and Similar Procedures","code_information":[{"code":"5223","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":10842.57,"10th_percentile":10842.57,"90th_percentile":10842.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":28378.38,"10th_percentile":28378.38,"90th_percentile":28378.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"1 through 10","median_amount":25744.28,"10th_percentile":25744.28,"90th_percentile":25744.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11187.15,"10th_percentile":11187.15,"90th_percentile":11187.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10283.75,"10th_percentile":10283.75,"90th_percentile":10283.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":12498.39,"10th_percentile":12498.39,"90th_percentile":12498.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10914.34,"10th_percentile":10914.34,"90th_percentile":10914.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10648.09,"10th_percentile":2707.24,"90th_percentile":10836.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10653.99,"10th_percentile":10653.99,"90th_percentile":10653.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12045.63,"10th_percentile":12045.63,"90th_percentile":12045.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Pacemaker and Similar Procedures","code_information":[{"code":"5224","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":19718.09,"10th_percentile":19718.09,"90th_percentile":19718.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19903.61,"10th_percentile":19903.61,"90th_percentile":19903.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19695.76,"10th_percentile":19695.76,"90th_percentile":19695.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19310.49,"10th_percentile":19310.49,"90th_percentile":28281.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 ICD and Similar Procedures","code_information":[{"code":"5231","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":22767.83,"10th_percentile":22767.83,"90th_percentile":22767.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":22708.64,"10th_percentile":22708.64,"90th_percentile":22708.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"1 through 10","median_amount":21993.84,"10th_percentile":21993.84,"90th_percentile":21993.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 ICD and Similar Procedures","code_information":[{"code":"5232","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":47964.07,"10th_percentile":47964.07,"90th_percentile":47964.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":32157.4,"10th_percentile":32157.4,"90th_percentile":32157.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":34171.39,"10th_percentile":34171.39,"90th_percentile":34171.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":35864.55,"10th_percentile":35864.55,"90th_percentile":35864.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Blood Product Exchange and Related Services","code_information":[{"code":"5241","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"1 through 10","median_amount":2967.75,"10th_percentile":2967.75,"90th_percentile":2967.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":809.94,"10th_percentile":629.61,"90th_percentile":2379.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":1096.7,"10th_percentile":1096.7,"90th_percentile":1096.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":877.16,"10th_percentile":877.16,"90th_percentile":877.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"1 through 10","median_amount":180.32,"10th_percentile":180.32,"90th_percentile":180.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2902.86,"10th_percentile":2902.86,"90th_percentile":2902.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":1611.73,"10th_percentile":1611.73,"90th_percentile":1611.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":809.92,"10th_percentile":809.92,"90th_percentile":809.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"1 through 10","median_amount":2472.22,"10th_percentile":2472.22,"90th_percentile":2472.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":809.92,"10th_percentile":647.93,"90th_percentile":1696.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Upper GI Procedures","code_information":[{"code":"5301","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":7065.29,"10th_percentile":7065.29,"90th_percentile":7065.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"1 through 10","median_amount":3570.0,"10th_percentile":3570.0,"90th_percentile":3570.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":933.31,"10th_percentile":875.94,"90th_percentile":2514.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":7659.35,"10th_percentile":7659.35,"90th_percentile":7659.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":2650.0,"10th_percentile":1987.49,"90th_percentile":5385.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"1 through 10","median_amount":2852.0,"10th_percentile":2852.0,"90th_percentile":2852.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":947.15,"10th_percentile":947.15,"90th_percentile":947.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":3393.0,"10th_percentile":3393.0,"90th_percentile":6202.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"1 through 10","median_amount":2572.03,"10th_percentile":2572.03,"90th_percentile":2572.03},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":950.67,"10th_percentile":932.21,"90th_percentile":950.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"23","median_amount":927.43,"10th_percentile":923.66,"90th_percentile":2181.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum HealthCare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":950.67,"10th_percentile":950.67,"90th_percentile":950.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1781.38,"10th_percentile":1781.38,"90th_percentile":1781.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":687.92,"10th_percentile":687.92,"90th_percentile":687.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":681.43,"10th_percentile":681.43,"90th_percentile":681.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"11","median_amount":2592.0,"10th_percentile":2501.62,"90th_percentile":2823.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"31","median_amount":887.59,"10th_percentile":682.18,"90th_percentile":1707.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Upper GI Procedures","code_information":[{"code":"5302","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":10576.01,"10th_percentile":10576.01,"90th_percentile":10576.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"1 through 10","median_amount":5360.0,"10th_percentile":5360.0,"90th_percentile":5360.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":1963.82,"10th_percentile":1959.97,"90th_percentile":2012.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":6879.4,"10th_percentile":6879.4,"90th_percentile":6879.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2003.87,"10th_percentile":2003.87,"90th_percentile":2054.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1967.69,"10th_percentile":1967.69,"90th_percentile":1967.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1960.07,"10th_percentile":1957.67,"90th_percentile":1985.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":668.72,"10th_percentile":668.72,"90th_percentile":668.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":1875.98,"10th_percentile":1563.34,"90th_percentile":1964.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1750.94,"10th_percentile":1750.94,"90th_percentile":1750.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Upper GI Procedures","code_information":[{"code":"5303","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":3934.2,"10th_percentile":3934.2,"90th_percentile":3934.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":10354.73,"10th_percentile":10354.73,"90th_percentile":10354.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":13618.89,"10th_percentile":13618.89,"90th_percentile":13618.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"1 through 10","median_amount":17756.0,"10th_percentile":17756.0,"90th_percentile":17756.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4026.19,"10th_percentile":4026.19,"90th_percentile":4026.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Lower GI Procedures","code_information":[{"code":"5311","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":8441.52,"10th_percentile":8441.52,"90th_percentile":8516.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"1 through 10","median_amount":8640.0,"10th_percentile":8640.0,"90th_percentile":8640.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":947.05,"10th_percentile":947.05,"90th_percentile":951.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":2650.0,"10th_percentile":2650.0,"90th_percentile":6921.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"1 through 10","median_amount":5827.27,"10th_percentile":5827.27,"90th_percentile":5827.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2003.71,"10th_percentile":2003.71,"90th_percentile":2003.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1448.64,"10th_percentile":1448.64,"90th_percentile":1448.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"1 through 10","median_amount":31193.76,"10th_percentile":31193.76,"90th_percentile":31193.76},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":950.89,"10th_percentile":947.04,"90th_percentile":2350.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1833.89,"10th_percentile":1833.89,"90th_percentile":1833.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"1 through 10","median_amount":13311.24,"10th_percentile":13311.24,"90th_percentile":13311.24},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":668.72,"10th_percentile":668.72,"90th_percentile":668.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"1 through 10","median_amount":917.26,"10th_percentile":917.26,"90th_percentile":917.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"1 through 10","median_amount":2592.0,"10th_percentile":2592.0,"90th_percentile":9573.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":950.97,"10th_percentile":947.05,"90th_percentile":2618.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1009.87,"10th_percentile":1009.87,"90th_percentile":1009.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Lower GI Procedures","code_information":[{"code":"5312","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":10008.53,"10th_percentile":8320.19,"90th_percentile":15690.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"1 through 10","median_amount":8640.0,"10th_percentile":8640.0,"90th_percentile":8640.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"12","median_amount":1680.45,"10th_percentile":1218.63,"90th_percentile":2289.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":5049.5,"10th_percentile":5049.5,"90th_percentile":9442.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":3696.0,"10th_percentile":350.0,"90th_percentile":6639.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1666.84,"10th_percentile":1666.84,"90th_percentile":1666.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1284.86,"10th_percentile":1280.81,"90th_percentile":1766.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"1 through 10","median_amount":3696.0,"10th_percentile":3696.0,"90th_percentile":5773.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":7277.71,"10th_percentile":4736.0,"90th_percentile":13979.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"1 through 10","median_amount":19592.53,"10th_percentile":19592.53,"90th_percentile":29527.58},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1680.46,"10th_percentile":1218.63,"90th_percentile":2294.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":675.09,"10th_percentile":675.09,"90th_percentile":675.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":750.5,"10th_percentile":750.5,"90th_percentile":750.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"1 through 10","median_amount":8996.03,"10th_percentile":8996.03,"90th_percentile":8996.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1680.46,"10th_percentile":1218.63,"90th_percentile":2299.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1364.87,"10th_percentile":1364.87,"90th_percentile":1364.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Lower GI Procedures","code_information":[{"code":"5313","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"1 through 10","median_amount":5925.0,"10th_percentile":5925.0,"90th_percentile":5925.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":7037.76,"10th_percentile":7037.76,"90th_percentile":7037.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3201.87,"10th_percentile":3201.87,"90th_percentile":3201.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex GI Procedures","code_information":[{"code":"5331","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6497.9,"10th_percentile":6497.9,"90th_percentile":6497.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5341","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":4026.87,"10th_percentile":4026.87,"90th_percentile":4026.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":18467.1,"10th_percentile":18467.1,"90th_percentile":18467.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"1 through 10","median_amount":21190.91,"10th_percentile":21190.91,"90th_percentile":21190.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":10855.28,"10th_percentile":10855.28,"90th_percentile":10855.28},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3652.11,"10th_percentile":3652.11,"90th_percentile":3652.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5342","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":34641.74,"10th_percentile":34641.74,"90th_percentile":34641.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"1 through 10","median_amount":8624.45,"10th_percentile":8624.45,"90th_percentile":8624.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":6610.45,"10th_percentile":6610.45,"90th_percentile":6610.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":18611.89,"10th_percentile":18611.89,"90th_percentile":19435.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7315.2,"10th_percentile":7315.2,"90th_percentile":7315.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":29470.94,"10th_percentile":29470.94,"90th_percentile":29470.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6926.68,"10th_percentile":6926.68,"90th_percentile":6926.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6526.27,"10th_percentile":6526.27,"90th_percentile":6526.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Laparoscopy and Related Services","code_information":[{"code":"5361","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":35353.85,"10th_percentile":19672.22,"90th_percentile":39859.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"11","median_amount":19257.95,"10th_percentile":18254.72,"90th_percentile":24872.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":6162.75,"10th_percentile":5902.05,"90th_percentile":6576.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":19241.26,"10th_percentile":15594.82,"90th_percentile":27635.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"21","median_amount":16820.0,"10th_percentile":14299.32,"90th_percentile":23860.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"1 through 10","median_amount":19170.37,"10th_percentile":18106.0,"90th_percentile":24063.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6594.87,"10th_percentile":6594.87,"90th_percentile":6594.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6313.82,"10th_percentile":6313.82,"90th_percentile":6313.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"1 through 10","median_amount":18165.89,"10th_percentile":18165.89,"90th_percentile":18165.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"15","median_amount":21548.0,"10th_percentile":15939.39,"90th_percentile":34214.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"1 through 10","median_amount":36969.25,"10th_percentile":21992.68,"90th_percentile":109030.84},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6191.15,"10th_percentile":6191.15,"90th_percentile":6191.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4414.34,"10th_percentile":4414.34,"90th_percentile":4414.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"22","median_amount":6162.54,"10th_percentile":6009.64,"90th_percentile":6361.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7717.96,"10th_percentile":7717.96,"90th_percentile":7717.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3028.61,"10th_percentile":3028.61,"90th_percentile":3028.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3447.34,"10th_percentile":2531.08,"90th_percentile":4585.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"1 through 10","median_amount":28357.22,"10th_percentile":28357.22,"90th_percentile":28357.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"12","median_amount":9106.0,"10th_percentile":8706.0,"90th_percentile":25282.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":6156.65,"10th_percentile":5236.99,"90th_percentile":6536.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Laparoscopy and Related Services","code_information":[{"code":"5362","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":68094.63,"10th_percentile":68094.63,"90th_percentile":68094.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"1 through 10","median_amount":19071.7,"10th_percentile":18748.3,"90th_percentile":30749.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":10831.31,"10th_percentile":10830.19,"90th_percentile":10884.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":31068.59,"10th_percentile":21548.0,"90th_percentile":49042.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":35659.15,"10th_percentile":25475.27,"90th_percentile":52285.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"1 through 10","median_amount":29859.7,"10th_percentile":29859.7,"90th_percentile":32363.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11555.2,"10th_percentile":11555.2,"90th_percentile":11555.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":36353.19,"10th_percentile":34862.11,"90th_percentile":47337.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"1 through 10","median_amount":160777.93,"10th_percentile":160777.93,"90th_percentile":191984.79},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11474.61,"10th_percentile":11474.61,"90th_percentile":11474.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11009.8,"10th_percentile":10930.61,"90th_percentile":11369.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3996.79,"10th_percentile":3996.79,"90th_percentile":3996.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"1 through 10","median_amount":9106.0,"10th_percentile":9106.0,"90th_percentile":41379.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11204.62,"10th_percentile":8818.66,"90th_percentile":11379.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Urology and Related Services","code_information":[{"code":"5372","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":716.0,"10th_percentile":716.0,"90th_percentile":716.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Urology and Related Services","code_information":[{"code":"5373","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"1 through 10","median_amount":6755.0,"10th_percentile":6755.0,"90th_percentile":6755.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":2141.03,"10th_percentile":2141.03,"90th_percentile":2141.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2138.71,"10th_percentile":2138.71,"90th_percentile":2138.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Urology and Related Services","code_information":[{"code":"5374","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":26151.41,"10th_percentile":26151.41,"90th_percentile":26151.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"1 through 10","median_amount":26123.1,"10th_percentile":26123.1,"90th_percentile":26123.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":3617.09,"10th_percentile":3617.09,"90th_percentile":3617.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3772.91,"10th_percentile":3772.91,"90th_percentile":3772.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3611.34,"10th_percentile":3611.34,"90th_percentile":3611.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3593.32,"10th_percentile":3592.76,"90th_percentile":3626.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"1 through 10","median_amount":8867.84,"10th_percentile":8867.84,"90th_percentile":8867.84},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3491.76,"10th_percentile":3491.76,"90th_percentile":3603.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Urology and Related Services","code_information":[{"code":"5375","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":5391.43,"10th_percentile":5391.43,"90th_percentile":5391.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5767.19,"10th_percentile":5767.19,"90th_percentile":5767.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5600.87,"10th_percentile":5600.87,"90th_percentile":5600.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5364.17,"10th_percentile":5364.17,"90th_percentile":5473.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2791.51,"10th_percentile":2791.51,"90th_percentile":2791.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"1 through 10","median_amount":15814.15,"10th_percentile":15814.15,"90th_percentile":15814.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5470.24,"10th_percentile":5470.24,"90th_percentile":5470.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 6 Urology and Related Services","code_information":[{"code":"5376","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":3945.0,"10th_percentile":3945.0,"90th_percentile":3945.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9449.35,"10th_percentile":9449.35,"90th_percentile":9449.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dialysis","code_information":[{"code":"5401","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":2667.17,"10th_percentile":2667.17,"90th_percentile":2667.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2694.38,"10th_percentile":2694.38,"90th_percentile":2694.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2610.66,"10th_percentile":2610.66,"90th_percentile":2610.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Gynecologic Procedures","code_information":[{"code":"5411","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":2262.74,"10th_percentile":2262.74,"90th_percentile":3730.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":188.55,"10th_percentile":188.55,"90th_percentile":188.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"15","median_amount":1263.72,"10th_percentile":501.01,"90th_percentile":3913.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":560.49,"10th_percentile":560.49,"90th_percentile":560.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":1290.87,"10th_percentile":495.15,"90th_percentile":5131.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":2427.8,"10th_percentile":1106.91,"90th_percentile":5251.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"1 through 10","median_amount":196.63,"10th_percentile":196.63,"90th_percentile":196.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"1 through 10","median_amount":314.06,"10th_percentile":220.25,"90th_percentile":314.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"15","median_amount":453.45,"10th_percentile":179.66,"90th_percentile":5131.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"1 through 10","median_amount":1351.02,"10th_percentile":1351.02,"90th_percentile":1351.02},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":367.55,"10th_percentile":367.55,"90th_percentile":371.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":357.95,"10th_percentile":357.95,"90th_percentile":357.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"11","median_amount":313.07,"10th_percentile":178.98,"90th_percentile":345.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"52","median_amount":310.11,"10th_percentile":175.55,"90th_percentile":380.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"11","median_amount":564.96,"10th_percentile":279.98,"90th_percentile":1207.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":330.14,"10th_percentile":330.14,"90th_percentile":330.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Gynecologic Procedures","code_information":[{"code":"5412","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"1 through 10","median_amount":2951.91,"10th_percentile":2951.91,"90th_percentile":2951.91},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":139.23,"10th_percentile":139.23,"90th_percentile":139.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Gynecologic Procedures","code_information":[{"code":"5414","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":16544.44,"10th_percentile":16544.44,"90th_percentile":17810.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"1 through 10","median_amount":10973.55,"10th_percentile":10973.55,"90th_percentile":24394.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":3308.66,"10th_percentile":3302.74,"90th_percentile":3314.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":10892.33,"10th_percentile":8221.54,"90th_percentile":14698.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":6393.09,"10th_percentile":5830.81,"90th_percentile":7944.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3468.48,"10th_percentile":3468.48,"90th_percentile":3473.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"1 through 10","median_amount":9282.31,"10th_percentile":9282.31,"90th_percentile":9282.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":11296.98,"10th_percentile":8994.8,"90th_percentile":14406.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"1 through 10","median_amount":17575.99,"10th_percentile":17575.99,"90th_percentile":17575.99},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1293.85,"10th_percentile":1293.85,"90th_percentile":1293.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1245.49,"10th_percentile":1245.49,"90th_percentile":1245.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3300.71,"10th_percentile":3300.71,"90th_percentile":3312.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6357.9,"10th_percentile":6357.9,"90th_percentile":6357.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1658.24,"10th_percentile":1658.24,"90th_percentile":1753.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1737.12,"10th_percentile":1642.6,"90th_percentile":1799.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"1 through 10","median_amount":12889.18,"10th_percentile":12889.18,"90th_percentile":12889.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2637.55,"10th_percentile":2637.55,"90th_percentile":3301.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Gynecologic Procedures","code_information":[{"code":"5415","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":51055.07,"10th_percentile":51055.07,"90th_percentile":51055.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"1 through 10","median_amount":6626.01,"10th_percentile":5342.21,"90th_percentile":9992.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"1 through 10","median_amount":408.61,"10th_percentile":408.61,"90th_percentile":408.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":5108.67,"10th_percentile":5106.11,"90th_percentile":5459.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":21042.72,"10th_percentile":19242.72,"90th_percentile":21548.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":16820.0,"10th_percentile":16450.45,"90th_percentile":17743.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"1 through 10","median_amount":25816.54,"10th_percentile":25816.54,"90th_percentile":25816.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":31937.71,"10th_percentile":31937.71,"90th_percentile":52566.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"1 through 10","median_amount":124857.53,"10th_percentile":124857.53,"90th_percentile":124857.53},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7555.89,"10th_percentile":7555.89,"90th_percentile":7555.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1642.6,"10th_percentile":1642.6,"90th_percentile":1642.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"1 through 10","median_amount":6348.0,"10th_percentile":6348.0,"90th_percentile":66332.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4850.05,"10th_percentile":4609.95,"90th_percentile":5100.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 6 Gynecologic Procedures","code_information":[{"code":"5416","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":7594.7,"10th_percentile":7594.7,"90th_percentile":7594.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":42128.92,"10th_percentile":42128.92,"90th_percentile":42128.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7559.9,"10th_percentile":7559.9,"90th_percentile":7561.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7284.49,"10th_percentile":7284.49,"90th_percentile":7594.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Procedures","code_information":[{"code":"5431","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":1998.27,"10th_percentile":1998.27,"90th_percentile":1998.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Injections","code_information":[{"code":"5441","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":290.0,"10th_percentile":290.0,"90th_percentile":290.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":472.63,"10th_percentile":472.63,"90th_percentile":472.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"1 through 10","median_amount":1020.1,"10th_percentile":1020.1,"90th_percentile":1020.1},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1053.05,"10th_percentile":1053.05,"90th_percentile":1053.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nerve Injections","code_information":[{"code":"5442","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"1 through 10","median_amount":1425.0,"10th_percentile":1425.0,"90th_percentile":1425.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":724.66,"10th_percentile":724.66,"90th_percentile":724.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":7815.72,"10th_percentile":7815.72,"90th_percentile":7815.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":2650.0,"10th_percentile":2650.0,"90th_percentile":14008.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"1 through 10","median_amount":363.0,"10th_percentile":363.0,"90th_percentile":363.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":755.54,"10th_percentile":755.54,"90th_percentile":755.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"1 through 10","median_amount":2588.0,"10th_percentile":2588.0,"90th_percentile":2588.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":3393.0,"10th_percentile":3393.0,"90th_percentile":3393.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":736.84,"10th_percentile":736.84,"90th_percentile":736.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1416.31,"10th_percentile":1416.31,"90th_percentile":1416.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"1 through 10","median_amount":1873.45,"10th_percentile":1873.45,"90th_percentile":1873.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"1 through 10","median_amount":3050.0,"10th_percentile":3050.0,"90th_percentile":3050.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1774.48,"10th_percentile":575.08,"90th_percentile":2409.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Nerve Injections","code_information":[{"code":"5443","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1289.35,"10th_percentile":1289.35,"90th_percentile":1289.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Neurostimulator and Related Procedures","code_information":[{"code":"5461","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3937.82,"10th_percentile":3937.82,"90th_percentile":3937.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Neurostimulator and Related Procedures","code_information":[{"code":"5462","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5192.1,"10th_percentile":5192.1,"90th_percentile":5192.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Imaging without Contrast","code_information":[{"code":"5521","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":583.11,"10th_percentile":254.51,"90th_percentile":4381.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"1 through 10","median_amount":6192.27,"10th_percentile":6192.27,"90th_percentile":6192.27},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":125.92,"10th_percentile":125.92,"90th_percentile":125.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"1 through 10","median_amount":1667.93,"10th_percentile":702.59,"90th_percentile":1925.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"13","median_amount":90.56,"10th_percentile":88.62,"90th_percentile":729.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"11","median_amount":456.51,"10th_percentile":132.75,"90th_percentile":2266.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":400.0,"10th_percentile":89.57,"90th_percentile":2533.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"1 through 10","median_amount":2209.65,"10th_percentile":194.27,"90th_percentile":2663.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":435.2,"10th_percentile":435.2,"90th_percentile":435.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"21","median_amount":93.14,"10th_percentile":90.88,"90th_percentile":448.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"1 through 10","median_amount":1552.81,"10th_percentile":1552.81,"90th_percentile":1552.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"12","median_amount":512.0,"10th_percentile":148.27,"90th_percentile":2968.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"1 through 10","median_amount":865.36,"10th_percentile":865.36,"90th_percentile":865.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"1 through 10","median_amount":2841.84,"10th_percentile":2841.84,"90th_percentile":4445.9},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":209.96,"10th_percentile":163.97,"90th_percentile":219.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":250.0,"10th_percentile":250.0,"90th_percentile":250.0},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":92.7,"10th_percentile":92.7,"90th_percentile":92.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":133.48,"10th_percentile":54.99,"90th_percentile":211.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"39","median_amount":90.43,"10th_percentile":88.62,"90th_percentile":403.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":142.31,"10th_percentile":116.34,"90th_percentile":217.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"26","median_amount":145.14,"10th_percentile":37.37,"90th_percentile":212.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"1 through 10","median_amount":1752.81,"10th_percentile":1752.81,"90th_percentile":1752.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"12","median_amount":349.0,"10th_percentile":230.0,"90th_percentile":2180.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"33","median_amount":88.72,"10th_percentile":70.89,"90th_percentile":550.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"1 through 10","median_amount":671.11,"10th_percentile":671.11,"90th_percentile":671.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":501.25,"10th_percentile":501.25,"90th_percentile":501.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"19","median_amount":593.64,"10th_percentile":363.46,"90th_percentile":1628.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"1 through 10","median_amount":1394.1,"10th_percentile":1394.1,"90th_percentile":1394.1},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"17","median_amount":761.7,"10th_percentile":168.61,"90th_percentile":1945.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"19","median_amount":112.73,"10th_percentile":106.47,"90th_percentile":656.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"11","median_amount":544.0,"10th_percentile":50.0,"90th_percentile":785.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"21","median_amount":472.0,"10th_percentile":114.2,"90th_percentile":3002.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"1 through 10","median_amount":180.86,"10th_percentile":134.35,"90th_percentile":507.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":109.17,"10th_percentile":109.17,"90th_percentile":109.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":111.9,"10th_percentile":109.17,"90th_percentile":666.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"1 through 10","median_amount":472.0,"10th_percentile":369.89,"90th_percentile":665.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":1174.48,"10th_percentile":203.38,"90th_percentile":1260.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"1 through 10","median_amount":4368.0,"10th_percentile":4368.0,"90th_percentile":4368.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"1 through 10","median_amount":3225.42,"10th_percentile":3225.42,"90th_percentile":3225.42},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":100.85,"10th_percentile":67.23,"90th_percentile":265.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":656.49,"10th_percentile":656.49,"90th_percentile":2871.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"13","median_amount":64.71,"10th_percentile":64.71,"90th_percentile":180.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"30","median_amount":522.87,"10th_percentile":106.57,"90th_percentile":1447.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":203.62,"10th_percentile":185.32,"90th_percentile":863.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"1 through 10","median_amount":225.64,"10th_percentile":225.64,"90th_percentile":225.64},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":111.6,"10th_percentile":66.6,"90th_percentile":349.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"1 through 10","median_amount":6890.2,"10th_percentile":6890.2,"90th_percentile":6890.2},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"71","median_amount":73.33,"10th_percentile":65.97,"90th_percentile":310.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"1 through 10","median_amount":2779.21,"10th_percentile":2779.21,"90th_percentile":9725.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"22","median_amount":285.6,"10th_percentile":52.0,"90th_percentile":1779.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":53.39,"10th_percentile":53.39,"90th_percentile":53.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"33","median_amount":106.9,"10th_percentile":69.84,"90th_percentile":653.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":108.64,"10th_percentile":108.64,"90th_percentile":108.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":119.73,"10th_percentile":119.73,"90th_percentile":448.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Imaging without Contrast","code_information":[{"code":"5523","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":1812.64,"10th_percentile":1120.5,"90th_percentile":4723.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"1 through 10","median_amount":2258.85,"10th_percentile":2258.85,"90th_percentile":2258.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":249.17,"10th_percentile":244.19,"90th_percentile":345.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":1291.83,"10th_percentile":1291.83,"90th_percentile":1315.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":610.93,"10th_percentile":254.05,"90th_percentile":1228.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"1 through 10","median_amount":2186.0,"10th_percentile":2186.0,"90th_percentile":2186.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2799.47,"10th_percentile":2799.47,"90th_percentile":2799.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":357.13,"10th_percentile":250.27,"90th_percentile":698.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":2052.0,"10th_percentile":1743.58,"90th_percentile":2082.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":112.65,"10th_percentile":112.65,"90th_percentile":112.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":82.97,"10th_percentile":82.97,"90th_percentile":82.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":322.74,"10th_percentile":322.74,"90th_percentile":322.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"25","median_amount":332.96,"10th_percentile":242.99,"90th_percentile":668.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":410.57,"10th_percentile":410.57,"90th_percentile":410.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":151.99,"10th_percentile":110.54,"90th_percentile":286.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"1 through 10","median_amount":1456.44,"10th_percentile":1135.0,"90th_percentile":3508.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"28","median_amount":247.6,"10th_percentile":153.12,"90th_percentile":486.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"1 through 10","median_amount":247.95,"10th_percentile":247.95,"90th_percentile":247.95},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":76.15,"10th_percentile":76.15,"90th_percentile":76.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Imaging without Contrast","code_information":[{"code":"5524","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":1581.13,"10th_percentile":1581.13,"90th_percentile":1581.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"1 through 10","median_amount":2159.95,"10th_percentile":2159.95,"90th_percentile":2159.95},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"1 through 10","median_amount":1952.5,"10th_percentile":1952.5,"90th_percentile":1952.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"22","median_amount":561.2,"10th_percentile":556.46,"90th_percentile":670.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":3909.05,"10th_percentile":1522.72,"90th_percentile":3947.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":3080.0,"10th_percentile":1278.61,"90th_percentile":5503.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"1 through 10","median_amount":3316.0,"10th_percentile":3316.0,"90th_percentile":3316.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":584.85,"10th_percentile":584.85,"90th_percentile":584.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":677.99,"10th_percentile":573.15,"90th_percentile":1051.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":2575.26,"10th_percentile":1497.79,"90th_percentile":4095.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":570.38,"10th_percentile":563.1,"90th_percentile":665.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"35","median_amount":565.62,"10th_percentile":556.45,"90th_percentile":1097.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1073.19,"10th_percentile":1073.19,"90th_percentile":1073.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":708.15,"10th_percentile":594.79,"90th_percentile":1816.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"1 through 10","median_amount":1725.09,"10th_percentile":1725.09,"90th_percentile":1725.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"1 through 10","median_amount":1147.0,"10th_percentile":1147.0,"90th_percentile":1810.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"29","median_amount":560.86,"10th_percentile":445.16,"90th_percentile":827.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Imaging with Contrast","code_information":[{"code":"5571","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":1632.51,"10th_percentile":1632.51,"90th_percentile":5227.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"1 through 10","median_amount":2920.0,"10th_percentile":2920.0,"90th_percentile":2920.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"17","median_amount":180.51,"10th_percentile":179.12,"90th_percentile":1146.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":1453.67,"10th_percentile":341.91,"90th_percentile":6446.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":7241.28,"10th_percentile":7241.28,"90th_percentile":7241.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"1 through 10","median_amount":458.0,"10th_percentile":458.0,"90th_percentile":7323.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":187.74,"10th_percentile":178.69,"90th_percentile":1129.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"1 through 10","median_amount":155.58,"10th_percentile":155.58,"90th_percentile":155.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":544.0,"10th_percentile":232.54,"90th_percentile":9594.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"1 through 10","median_amount":1666.47,"10th_percentile":1666.47,"90th_percentile":1666.47},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":185.92,"10th_percentile":185.92,"90th_percentile":185.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"30","median_amount":182.0,"10th_percentile":178.62,"90th_percentile":870.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum HealthCare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":182.27,"10th_percentile":182.27,"90th_percentile":182.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":398.41,"10th_percentile":37.37,"90th_percentile":471.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"11","median_amount":349.0,"10th_percentile":334.0,"90th_percentile":456.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":249.45,"10th_percentile":178.72,"90th_percentile":2565.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"1 through 10","median_amount":23.43,"10th_percentile":23.43,"90th_percentile":23.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1188.17,"10th_percentile":1188.17,"90th_percentile":1188.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Imaging with Contrast","code_information":[{"code":"5572","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":2514.58,"10th_percentile":2248.19,"90th_percentile":8326.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"1 through 10","median_amount":995.0,"10th_percentile":995.0,"90th_percentile":995.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"15","median_amount":450.9,"10th_percentile":355.57,"90th_percentile":780.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":1893.0,"10th_percentile":1779.63,"90th_percentile":1930.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":1479.0,"10th_percentile":1072.68,"90th_percentile":1498.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"1 through 10","median_amount":6594.0,"10th_percentile":6594.0,"90th_percentile":6594.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":561.15,"10th_percentile":561.15,"90th_percentile":561.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":373.41,"10th_percentile":373.41,"90th_percentile":937.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":2250.8,"10th_percentile":2052.0,"90th_percentile":3466.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":551.17,"10th_percentile":549.27,"90th_percentile":1385.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":213.11,"10th_percentile":213.11,"90th_percentile":213.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"30","median_amount":359.23,"10th_percentile":250.0,"90th_percentile":605.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":685.21,"10th_percentile":685.21,"90th_percentile":685.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":269.91,"10th_percentile":269.91,"90th_percentile":269.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":346.15,"10th_percentile":346.15,"90th_percentile":346.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"26","median_amount":360.48,"10th_percentile":355.91,"90th_percentile":782.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nuclear Medicine and Related Services","code_information":[{"code":"5591","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"1 through 10","median_amount":746.36,"10th_percentile":746.36,"90th_percentile":746.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":460.92,"10th_percentile":460.92,"90th_percentile":460.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":417.47,"10th_percentile":417.47,"90th_percentile":417.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":415.43,"10th_percentile":415.43,"90th_percentile":415.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":410.12,"10th_percentile":410.12,"90th_percentile":410.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nuclear Medicine and Related Services","code_information":[{"code":"5592","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":501.95,"10th_percentile":501.95,"90th_percentile":501.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":581.17,"10th_percentile":581.17,"90th_percentile":581.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":559.45,"10th_percentile":559.45,"90th_percentile":559.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Pathology","code_information":[{"code":"5671","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":125.72,"10th_percentile":125.72,"90th_percentile":125.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":53.07,"10th_percentile":53.07,"90th_percentile":53.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Pathology","code_information":[{"code":"5672","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"1 through 10","median_amount":496.6,"10th_percentile":496.6,"90th_percentile":496.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"12","median_amount":137.49,"10th_percentile":135.99,"90th_percentile":173.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":661.98,"10th_percentile":661.98,"90th_percentile":661.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":768.66,"10th_percentile":736.36,"90th_percentile":768.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":142.41,"10th_percentile":142.41,"90th_percentile":142.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":139.89,"10th_percentile":139.89,"90th_percentile":139.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"20","median_amount":173.5,"10th_percentile":135.48,"90th_percentile":173.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"1 through 10","median_amount":564.93,"10th_percentile":564.93,"90th_percentile":564.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":135.49,"10th_percentile":112.25,"90th_percentile":173.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Pathology","code_information":[{"code":"5673","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":6696.97,"10th_percentile":6696.97,"90th_percentile":6696.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"1 through 10","median_amount":717.44,"10th_percentile":717.44,"90th_percentile":717.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"1 through 10","median_amount":5424.78,"10th_percentile":5424.78,"90th_percentile":5424.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":365.03,"10th_percentile":365.03,"90th_percentile":365.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":374.32,"10th_percentile":374.32,"90th_percentile":374.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":767.3,"10th_percentile":767.3,"90th_percentile":767.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":3258.42,"10th_percentile":3258.42,"90th_percentile":3258.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":365.04,"10th_percentile":365.04,"90th_percentile":365.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":106.31,"10th_percentile":106.31,"90th_percentile":106.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":90.03,"10th_percentile":90.03,"90th_percentile":90.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"1 through 10","median_amount":909.06,"10th_percentile":909.06,"90th_percentile":909.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":365.05,"10th_percentile":365.05,"90th_percentile":365.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Pathology","code_information":[{"code":"5674","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":820.49,"10th_percentile":820.49,"90th_percentile":820.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Drug Administration","code_information":[{"code":"5691","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"1 through 10","median_amount":35378.07,"10th_percentile":35378.07,"90th_percentile":35378.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":1259.0,"10th_percentile":1259.0,"90th_percentile":1259.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2665.87,"10th_percentile":2665.87,"90th_percentile":2671.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":988.62,"10th_percentile":988.62,"90th_percentile":988.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":799.46,"10th_percentile":799.46,"90th_percentile":799.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"1 through 10","median_amount":8618.69,"10th_percentile":8618.69,"90th_percentile":8618.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2632.0,"10th_percentile":2632.0,"90th_percentile":2632.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Drug Administration","code_information":[{"code":"5692","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":302.49,"10th_percentile":302.49,"90th_percentile":302.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":126.97,"10th_percentile":126.97,"90th_percentile":126.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"1 through 10","median_amount":1308.0,"10th_percentile":1308.0,"90th_percentile":1308.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":280.66,"10th_percentile":278.49,"90th_percentile":281.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":3315.0,"10th_percentile":3315.0,"90th_percentile":3315.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":2368.0,"10th_percentile":2368.0,"90th_percentile":2478.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"1 through 10","median_amount":1913.46,"10th_percentile":1913.46,"90th_percentile":1913.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":316.62,"10th_percentile":316.62,"90th_percentile":316.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":446.62,"10th_percentile":446.62,"90th_percentile":446.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"1 through 10","median_amount":1388.0,"10th_percentile":1388.0,"90th_percentile":1388.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":2250.86,"10th_percentile":2250.86,"90th_percentile":2250.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"1 through 10","median_amount":7154.51,"10th_percentile":6852.58,"90th_percentile":17761.14},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1055.11,"10th_percentile":1055.11,"90th_percentile":1055.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":288.56,"10th_percentile":288.56,"90th_percentile":288.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":130.0,"10th_percentile":130.0,"90th_percentile":427.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":817.93,"10th_percentile":817.93,"90th_percentile":817.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1064.28,"10th_percentile":1064.28,"90th_percentile":1064.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"1 through 10","median_amount":232.95,"10th_percentile":232.95,"90th_percentile":232.95},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":159.72,"10th_percentile":151.52,"90th_percentile":1122.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"1 through 10","median_amount":1420.31,"10th_percentile":1268.11,"90th_percentile":4572.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"1 through 10","median_amount":547.0,"10th_percentile":547.0,"90th_percentile":2180.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":277.99,"10th_percentile":179.99,"90th_percentile":427.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Drug Administration","code_information":[{"code":"5693","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":412.39,"10th_percentile":287.75,"90th_percentile":2666.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"11","median_amount":1053.34,"10th_percentile":557.55,"90th_percentile":1925.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"1 through 10","median_amount":15007.26,"10th_percentile":15007.26,"90th_percentile":15007.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":1047.36,"10th_percentile":736.83,"90th_percentile":2757.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"13","median_amount":483.19,"10th_percentile":386.55,"90th_percentile":543.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"13","median_amount":542.75,"10th_percentile":380.51,"90th_percentile":3166.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":987.54,"10th_percentile":987.54,"90th_percentile":987.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1045.42,"10th_percentile":1045.42,"90th_percentile":1045.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"1 through 10","median_amount":8136.94,"10th_percentile":8136.94,"90th_percentile":8136.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"1 through 10","median_amount":3284.8,"10th_percentile":3284.8,"90th_percentile":3284.8},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":387.7,"10th_percentile":387.7,"90th_percentile":387.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"12","median_amount":180.81,"10th_percentile":180.81,"90th_percentile":351.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1098.72,"10th_percentile":620.45,"90th_percentile":2833.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":217.77,"10th_percentile":217.77,"90th_percentile":571.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"27","median_amount":196.95,"10th_percentile":122.92,"90th_percentile":474.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"1 through 10","median_amount":872.37,"10th_percentile":7.26,"90th_percentile":1353.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":861.4,"10th_percentile":765.1,"90th_percentile":996.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"1 through 10","median_amount":2883.29,"10th_percentile":2883.29,"90th_percentile":2883.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Diagnostic Tests and Related Services","code_information":[{"code":"5721","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":381.51,"10th_percentile":381.51,"90th_percentile":381.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Diagnostic Tests and Related Services","code_information":[{"code":"5722","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":1159.01,"10th_percentile":1159.01,"90th_percentile":1159.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"1 through 10","median_amount":221.89,"10th_percentile":221.89,"90th_percentile":221.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":221.89,"10th_percentile":219.89,"90th_percentile":222.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":393.03,"10th_percentile":393.03,"90th_percentile":393.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":925.0,"10th_percentile":925.0,"90th_percentile":925.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"1 through 10","median_amount":1665.15,"10th_percentile":1665.15,"90th_percentile":1665.15},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":221.59,"10th_percentile":220.79,"90th_percentile":327.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":245.92,"10th_percentile":245.92,"90th_percentile":245.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"1 through 10","median_amount":905.0,"10th_percentile":905.0,"90th_percentile":905.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":220.79,"10th_percentile":219.99,"90th_percentile":232.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"1 through 10","median_amount":1012.0,"10th_percentile":1012.0,"90th_percentile":1012.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Diagnostic Tests and Related Services","code_information":[{"code":"5723","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":2636.54,"10th_percentile":2636.54,"90th_percentile":2636.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"1 through 10","median_amount":3960.24,"10th_percentile":3960.24,"90th_percentile":3960.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Minor Procedures","code_information":[{"code":"5731","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":30.05,"10th_percentile":30.05,"90th_percentile":30.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":13.76,"10th_percentile":13.76,"90th_percentile":13.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":30.95,"10th_percentile":30.95,"90th_percentile":30.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":105.49,"10th_percentile":105.49,"90th_percentile":105.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":30.06,"10th_percentile":30.06,"90th_percentile":30.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":32.13,"10th_percentile":32.13,"90th_percentile":32.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Minor Procedures","code_information":[{"code":"5732","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":225.94,"10th_percentile":225.94,"90th_percentile":225.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Minor Procedures","code_information":[{"code":"5733","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":211.6,"10th_percentile":211.6,"90th_percentile":211.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"1 through 10","median_amount":953.48,"10th_percentile":953.48,"90th_percentile":953.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"29","median_amount":61.3,"10th_percentile":60.07,"90th_percentile":720.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":110.37,"10th_percentile":110.37,"90th_percentile":512.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"11","median_amount":400.0,"10th_percentile":77.36,"90th_percentile":400.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"1 through 10","median_amount":430.0,"10th_percentile":430.0,"90th_percentile":430.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":61.6,"10th_percentile":61.6,"90th_percentile":61.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":61.6,"10th_percentile":61.6,"90th_percentile":63.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":512.0,"10th_percentile":512.0,"90th_percentile":512.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":62.83,"10th_percentile":62.83,"90th_percentile":62.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"27","median_amount":61.3,"10th_percentile":60.07,"90th_percentile":5796.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":29.47,"10th_percentile":17.71,"90th_percentile":108.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"1 through 10","median_amount":228.11,"10th_percentile":225.15,"90th_percentile":245.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"1 through 10","median_amount":253.16,"10th_percentile":253.16,"90th_percentile":253.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":58.53,"10th_percentile":48.06,"90th_percentile":64.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Minor Procedures","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":435.16,"10th_percentile":399.46,"90th_percentile":622.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"23","median_amount":127.73,"10th_percentile":91.5,"90th_percentile":970.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"39","median_amount":136.99,"10th_percentile":61.99,"90th_percentile":138.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"17","median_amount":305.67,"10th_percentile":240.99,"90th_percentile":474.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"26","median_amount":314.99,"10th_percentile":238.35,"90th_percentile":370.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"1 through 10","median_amount":268.74,"10th_percentile":258.79,"90th_percentile":288.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":138.94,"10th_percentile":138.94,"90th_percentile":142.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"13","median_amount":142.41,"10th_percentile":138.94,"90th_percentile":143.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"1 through 10","median_amount":308.77,"10th_percentile":308.77,"90th_percentile":370.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"25","median_amount":356.6,"10th_percentile":303.96,"90th_percentile":512.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"1 through 10","median_amount":1268.73,"10th_percentile":229.85,"90th_percentile":1981.08},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":44.54,"10th_percentile":44.54,"90th_percentile":44.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":139.89,"10th_percentile":89.89,"90th_percentile":141.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":72.69,"10th_percentile":67.18,"90th_percentile":127.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"78","median_amount":135.48,"10th_percentile":96.28,"90th_percentile":136.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":244.35,"10th_percentile":244.35,"90th_percentile":244.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":15.54,"10th_percentile":14.88,"90th_percentile":16.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"15","median_amount":14.66,"10th_percentile":11.61,"90th_percentile":115.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"29","median_amount":155.37,"10th_percentile":22.84,"90th_percentile":683.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"62","median_amount":135.49,"10th_percentile":126.8,"90th_percentile":138.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Minor Procedures","code_information":[{"code":"5735","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":450.0,"10th_percentile":450.0,"90th_percentile":450.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":4736.0,"10th_percentile":4736.0,"90th_percentile":4736.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":834.3,"10th_percentile":834.3,"90th_percentile":834.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Rehabilitation","code_information":[{"code":"5771","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"1 through 10","median_amount":967.44,"10th_percentile":967.44,"90th_percentile":1209.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"45","median_amount":682.65,"10th_percentile":273.06,"90th_percentile":1575.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":1163.52,"10th_percentile":1163.52,"90th_percentile":1163.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":248.87,"10th_percentile":248.87,"90th_percentile":248.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":689.9,"10th_percentile":275.96,"90th_percentile":1793.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"46","median_amount":788.82,"10th_percentile":131.87,"90th_percentile":1318.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"1 through 10","median_amount":1601.46,"10th_percentile":369.37,"90th_percentile":3860.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"35","median_amount":787.68,"10th_percentile":280.66,"90th_percentile":1706.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Resuscitation and Cardioversion","code_information":[{"code":"5781","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"1 through 10","median_amount":6854.17,"10th_percentile":6854.17,"90th_percentile":6854.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"1 through 10","median_amount":1330.08,"10th_percentile":1323.97,"90th_percentile":1991.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":6205.26,"10th_percentile":6205.26,"90th_percentile":6701.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":3080.0,"10th_percentile":3080.0,"90th_percentile":3080.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1292.28,"10th_percentile":1292.28,"90th_percentile":1292.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1380.42,"10th_percentile":1373.66,"90th_percentile":2736.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":771.89,"10th_percentile":675.84,"90th_percentile":1327.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1054.52,"10th_percentile":682.99,"90th_percentile":1327.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Treatment","code_information":[{"code":"5791","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":2041.04,"10th_percentile":2041.04,"90th_percentile":2041.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":1151.32,"10th_percentile":1151.32,"90th_percentile":1151.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"1 through 10","median_amount":1383.27,"10th_percentile":1383.27,"90th_percentile":1383.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":142.31,"10th_percentile":142.31,"90th_percentile":142.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":122.92,"10th_percentile":122.92,"90th_percentile":150.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"1 through 10","median_amount":790.0,"10th_percentile":790.0,"90th_percentile":790.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":508.47,"10th_percentile":508.47,"90th_percentile":508.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"1 through 10","median_amount":1090.0,"10th_percentile":1090.0,"90th_percentile":1090.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"510K Skin Substitute Products","code_information":[{"code":"6001","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5230.29,"10th_percentile":5230.29,"90th_percentile":5230.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"1 through 10","median_amount":1421.78,"10th_percentile":1421.78,"90th_percentile":1421.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"RBC, l/r, cmv-neg, irrad","code_information":[{"code":"9533","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":902.36,"10th_percentile":902.36,"90th_percentile":941.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"1 through 10","median_amount":1574.33,"10th_percentile":1574.33,"90th_percentile":1574.33},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":935.71,"10th_percentile":935.71,"90th_percentile":935.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"1 through 10","median_amount":668.05,"10th_percentile":668.05,"90th_percentile":668.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Platelets pheresis path redu","code_information":[{"code":"9536","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"1 through 10","median_amount":3217.53,"10th_percentile":3217.53,"90th_percentile":3217.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"1 through 10","median_amount":1729.51,"10th_percentile":1598.19,"90th_percentile":2109.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"1 through 10","median_amount":9337.2,"10th_percentile":9337.2,"90th_percentile":29086.56},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":1634.0,"10th_percentile":1041.64,"90th_percentile":1877.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1634.02,"10th_percentile":1634.02,"90th_percentile":1877.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-OPPS Clinic Services","code_information":[{"code":"N700","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"1 through 10","median_amount":455.0,"10th_percentile":455.0,"90th_percentile":455.0},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"18","median_amount":379.81,"10th_percentile":170.61,"90th_percentile":414.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":218.33,"10th_percentile":182.81,"90th_percentile":984.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"1 through 10","median_amount":1107.88,"10th_percentile":1107.88,"90th_percentile":1107.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":216.76,"10th_percentile":216.75,"90th_percentile":1169.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"33","median_amount":283.59,"10th_percentile":283.59,"90th_percentile":477.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinical Diagnostic Lab Services","code_information":[{"code":"N800","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"154","median_amount":140.03,"10th_percentile":33.24,"90th_percentile":378.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"18","median_amount":84.24,"10th_percentile":19.01,"90th_percentile":558.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"26","median_amount":80.68,"10th_percentile":12.89,"90th_percentile":121.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"19","median_amount":168.61,"10th_percentile":29.42,"90th_percentile":474.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"11","median_amount":99.09,"10th_percentile":15.08,"90th_percentile":370.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"1 through 10","median_amount":173.91,"10th_percentile":173.91,"90th_percentile":228.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"20","median_amount":31.35,"10th_percentile":8.07,"90th_percentile":149.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"11","median_amount":93.11,"10th_percentile":58.12,"90th_percentile":221.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"26","median_amount":137.73,"10th_percentile":33.6,"90th_percentile":474.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"11","median_amount":130.83,"10th_percentile":63.03,"90th_percentile":1138.99},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4.4,"10th_percentile":4.4,"90th_percentile":59.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":50.0,"10th_percentile":50.0,"90th_percentile":50.0},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":27.67,"10th_percentile":27.67,"90th_percentile":27.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"13","median_amount":10.29,"10th_percentile":4.23,"90th_percentile":43.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"49","median_amount":27.67,"10th_percentile":10.35,"90th_percentile":169.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":146.01,"10th_percentile":85.09,"90th_percentile":469.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":10.87,"10th_percentile":4.35,"90th_percentile":52.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"37","median_amount":12.75,"10th_percentile":4.11,"90th_percentile":40.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"28","median_amount":35.03,"10th_percentile":9.69,"90th_percentile":80.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"67","median_amount":37.77,"10th_percentile":12.72,"90th_percentile":129.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":84.18,"10th_percentile":84.18,"90th_percentile":84.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":66.93,"10th_percentile":66.93,"90th_percentile":66.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-covered Services","code_information":[{"code":"N900","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":112.0,"10th_percentile":112.0,"90th_percentile":112.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Packaged Services","code_information":[{"code":"N902","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":87.22,"10th_percentile":87.22,"90th_percentile":87.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4.4,"10th_percentile":4.4,"90th_percentile":4.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4.11,"10th_percentile":4.11,"90th_percentile":4.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Not Recognized by OPPS","code_information":[{"code":"N905","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.2] [Cardiac Cath (%BC): 29.2] [Observation (%BC): 32.8] [Emergency Department (%BC): 32.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 11.3] [Pathology (%BC): 11.3] [Occupational Therapy ($): 157] [Physical Therapy ($): 157] [Speech Therapy ($): 157] [All Other OP (%BC): 29.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 25] [Observation (%BC): 32.5] [Emergency Department (%BC): 32.5] [Occupational Therapy (%BC): 25] [Physical Therapy (%BC): 25] [Respiratory Services/Therapy  (%BC): 25] [Speech Therapy (%BC): 25] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.8] [Cardiac Cath (%BC): 19.8] [Observation (%BC): 33.8] [Emergency Department (%BC): 33.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 19.8] [Occupational Therapy (%BC): 19.8] [Physical Therapy (%BC): 19.8] [Respiratory Services/Therapy  (%BC): 19.8] [Speech Therapy (%BC): 19.8] [All Other OP (%BC): 19.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 5.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 33.4] [Observation (%BC): 42.3] [Emergency Department (%BC): 42.3] [Occupational Therapy (%BC): 33.4] [Physical Therapy (%BC): 33.4] [Respiratory Services/Therapy  (%BC): 33.4] [Speech Therapy (%BC): 33.4] [All Other OP (%BC): 33.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 17.66] [Cardiac Cath (%BC): 17.66] [Lithotripsy (%BC): 17.66] [PTCA (%BC): 17.66] [Observation (%BC): 30.41] [Emergency Department (%BC): 30.41] [Other Cardiac Testing (%BC): 18.67] [EEG (%BC): 18.67] [Chemotherapy (%BC): 18.67] [Nuclear Medicine (%BC): 13.04] [Radiation Therapy  (%BC): 22.96] [CT OP Scan (%BC): 13.04] [MRI OP (%BC): 13.04] [Positron Emission Tomography (%BC): 13.04] [Radiology (%BC): 13.04] [Laboratory (%BC): 18.67] [Occupational Therapy (%BC): 18.67] [Physical Therapy (%BC): 18.67] [Speech Therapy (%BC): 18.67] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 18.67] [All Other OP (%BC): 18.67]","count":"1 through 10","median_amount":1344.49,"10th_percentile":1159.29,"90th_percentile":1344.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.66] [Cardiac Cath (%BC): 13.66] [Lithotripsy (%BC): 13.66] [PTCA (%BC): 13.66] [Observation (%BC): 30.90] [Emergency Department (%BC): 30.90] [Other Cardiac Testing (%BC): 20.94] [EEG (%BC): 20.94] [Chemotherapy (%BC): 20.94] [Nuclear Medicine (%BC): 9.54] [Radiation Therapy  (%BC): 25.75] [CT OP Scan (%BC): 9.54] [MRI OP (%BC): 9.54] [Positron Emission Tomography (%BC): 9.54] [Radiology (%BC): 9.54] [Laboratory (%BC): 20.94] [Occupational Therapy (%BC): 20.94] [Physical Therapy (%BC): 20.94] [Speech Therapy (%BC): 20.94] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.94] [All Other OP (%BC): 20.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 16.37] [Cardiac Cath (%BC): 16.37] [Lithotripsy (%BC): 16.37] [PTCA (%BC): 16.37] [Observation (%BC): 28.71] [Emergency Department (%BC): 28.71] [Other Cardiac Testing (%BC): 17.72] [EEG (%BC): 17.72] [Chemotherapy (%BC): 17.72] [Nuclear Medicine (%BC): 10.42] [Radiation Therapy  (%BC): 21.79] [CT OP Scan (%BC): 10.42] [MRI OP (%BC): 10.42] [Positron Emission Tomography (%BC): 10.42] [Radiology (%BC): 10.42] [Laboratory (%BC): 17.72] [Occupational Therapy (%BC): 17.72] [Physical Therapy (%BC): 17.72] [Speech Therapy (%BC): 17.72] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 17.72] [All Other OP (%BC): 17.72]","count":"32","median_amount":1458.0,"10th_percentile":1282.55,"90th_percentile":1458.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 13.29] [Cardiac Cath (%BC): 13.29] [Lithotripsy (%BC): 13.29] [PTCA (%BC): 13.29] [Observation (%BC): 30.04] [Emergency Department (%BC): 30.04] [Other Cardiac Testing (%BC): 20.36] [EEG (%BC): 20.36] [Chemotherapy (%BC): 20.36] [Nuclear Medicine (%BC): 9.30] [Radiation Therapy  (%BC): 25.04] [CT OP Scan (%BC): 9.30] [MRI OP (%BC): 9.30] [Positron Emission Tomography (%BC): 9.30] [Radiology (%BC): 9.30] [Laboratory (%BC): 20.36] [Occupational Therapy (%BC): 20.36] [Physical Therapy (%BC): 20.36] [Speech Therapy (%BC): 20.36] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 20.36] [All Other OP (%BC): 20.36]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 20.23] [Cardiac Cath (%BC): 20.23] [Lithotripsy (%BC): 20.23] [PTCA (%BC): 20.23] [Observation (%BC): 35.07] [Emergency Department (%BC): 35.07] [Other Cardiac Testing (%BC): 22.01] [EEG (%BC): 22.01] [Chemotherapy (%BC): 22.01] [Nuclear Medicine (%BC): 13.90] [Radiation Therapy  (%BC): 27.07] [CT OP Scan (%BC): 13.90] [MRI OP (%BC): 13.90] [Positron Emission Tomography (%BC): 13.90] [Radiology (%BC): 13.90] [Laboratory (%BC): 22.01] [Occupational Therapy (%BC): 22.01] [Physical Therapy (%BC): 22.01] [Speech Therapy (%BC): 22.01] [Other Outpatient Implant (%BC): 25.66] [IV Therapy (%BC): 22.01] [All Other OP (%BC): 22.01]","count":"1 through 10","median_amount":1496.24,"10th_percentile":1496.24,"90th_percentile":1496.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 42.80] [Observation (%BC): 42.80] [Emergency Department (%BC): 42.80] [Occupational Therapy (%BC): 42.80] [Physical Therapy (%BC): 42.80] [Respiratory Services/Therapy  (%BC): 42.80] [Speech Therapy (%BC): 42.80] [Other Outpatient Implant (%BC): 94.34] [All Other OP (%BC): 42.80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":50.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 62] [Observation (%BC): 62] [Emergency Department (%BC): 65] [Occupational Therapy (%BC): 62] [Physical Therapy (%BC): 62] [Respiratory Services/Therapy  (%BC): 62] [Speech Therapy (%BC): 62] [All Other OP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 19.4] [Observation (%BC): 23] [Emergency Department (%BC): 23] [Occupational Therapy (%BC): 19.4] [Physical Therapy (%BC): 19.4] [Respiratory Services/Therapy  (%BC): 19.4] [Speech Therapy (%BC): 19.4] [All Other OP (%BC): 19.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":17.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 26.6] [Observation (%BC): 31.9] [Emergency Department (%BC): 31.9] [Urgent Care (%BC): 31.9] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 26.6] [Physical Therapy (%BC): 26.6] [Respiratory Services/Therapy  (%BC): 26.6] [Speech Therapy (%BC): 26.6] [All Other OP (%BC): 26.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 44.2] [Observation (%BC): 52.6] [Emergency Department (%BC): 52.6] [Occupational Therapy (%BC): 44.2] [Physical Therapy (%BC): 44.2] [Respiratory Services/Therapy  (%BC): 44.2] [Speech Therapy (%BC): 44.2] [All Other OP (%BC): 44.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 24.8] [Observation (%BC): 29.7] [Emergency Department (%BC): 29.7] [Urgent Care (%BC): 29.7] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 24.8] [Physical Therapy (%BC): 24.8] [Respiratory Services/Therapy  (%BC): 24.8] [Speech Therapy (%BC): 24.8] [All Other OP (%BC): 24.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 11.2] [Observation (%BC): 14.5] [Emergency Department (%BC): 14.5] [Urgent Care (%BC): 14.5] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 11.2] [Physical Therapy (%BC): 11.2] [Respiratory Services/Therapy  (%BC): 11.2] [Speech Therapy (%BC): 11.2] [All Other OP (%BC): 11.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Principal Diagnosis Invalid As Discharge Diagnosis","code_information":[{"code":"998","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3182.84,"10th_percentile":3182.84,"90th_percentile":3182.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2025.46,"10th_percentile":2025.46,"90th_percentile":2025.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ungroupable","code_information":[{"code":"999","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"AdventHealth","plan_name":"AMPS PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 243101 | Total % of Charge: 30.8] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14461 Days: 3 Additional Days: 1562] [Normal vag. Del. 2 day stay-Case Rate: 9833 Days: 2 Additional Days: 1562] [Nursery  Level 1- Boarder-Per Diem: 982] [Nursery  Level 2-Per Diem: 2025] [Nursery  Level 3-Per Diem: 3644] [Nursery  Level 4-NICU-Per Diem: 5287]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 223729 | Total % of Charge: 32.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"ASA PPO","methodology":"percent of total billed charges","standard_charge_percentage":63.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 229711 | Total % of Charge: 41.0] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17597 Days: 3 Additional Days: 2264] [Normal vag. Del. 2 day stay-Case Rate: 12570 Days: 2 Additional Days: 2264] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2264] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5697] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 15000 (%BC): 18.0]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"International PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allegiance","plan_name":"Employee HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 205532 | Total % of Charge: 35.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 3347]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 34.46] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 21.22] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 397209 | Total % of Charge: 32.99] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 272369 | Total % of Charge: 19.70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPC PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 317764 | Total % of Charge: 46.38] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 125533 | Total % of Charge: 54.90] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 25.66]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Community Care Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 18103]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Global Medical Management International","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Health First Health Plans","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 350175 | Total % of Charge: 35.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 11825 Days: 3 Additional Days: 1721] [Normal vag. Del. 2 day stay-Case Rate: 7256 Days: 2 Additional Days: 1721] [Nursery  Level 1- Boarder-Per Diem: 694]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Plotkin Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Wellpoint Exchange","methodology":"percent of total billed charges","standard_charge_percentage":29.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 29.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15620 Days: 4 Additional Days: 2233] [Normal vag. Del. 2 day stay-Case Rate: 11716 Days: 2 Additional Days: 2233] [Nursery  Level 1- Boarder-Per Diem: 1170] [Nursery  Level 2-Per Diem: 1874] [Nursery  Level 3-Per Diem: 5156] [Nursery  Level 4-NICU-Per Diem: 5780] [Rehab-Per Diem: 1842] [SNF-Per Diem: 1004] [Hospice-Per Diem: 745] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 14.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":46.3,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 245220 | Total % of Charge: 27.1] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14531 Days: 4 Additional Days: 2075] [Normal vag. Del. 2 day stay-Case Rate: 10896 Days: 2 Additional Days: 2075] [Nursery  Level 1- Boarder-Per Diem: 1089] [Nursery  Level 2-Per Diem: 1744] [Nursery  Level 3-Per Diem: 4794] [Nursery  Level 4-NICU-Per Diem: 5375] [Rehab-Per Diem: 1714] [SNF-Per Diem: 935] [Hospice-Per Diem: 692] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 55874 (%BC): 13.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 274891 | Total % of Charge: 21.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 11033 Days: 4 Additional Days: 1574] [Normal vag. Del. 2 day stay-Case Rate: 8274 Days: 2 Additional Days: 1574] [Nursery  Level 1- Boarder-Per Diem: 827] [Nursery  Level 2-Per Diem: 1325] [Nursery  Level 3-Per Diem: 3640] [Nursery  Level 4-NICU-Per Diem: 4082] [Rehab-Per Diem: 1302] [SNF-Per Diem: 954] [Hospice-Per Diem: 708] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 53338 (%BC): 13.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, bupivacaine liposome","code_information":[{"code":"J0666","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1.45,"maximum":2.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1.56,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1.55,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1.63,"additional_payer_notes":"APC"}]}]},{"description":"Ketorolac tromethamine inj","code_information":[{"code":"J1885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":0.29,"maximum":0.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":0.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":0.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":0.29,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":0.31,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":0.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":0.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":0.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":0.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":0.32,"additional_payer_notes":"APC"}]}]},{"description":"Rem mlt day uroflow setup","code_information":[{"code":"0811T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.03,"maximum":253.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.72,"additional_payer_notes":"APC"}]}]},{"description":"Rem mntr impl ivc snr set-up","code_information":[{"code":"0982T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.03,"maximum":253.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.72,"additional_payer_notes":"APC"}]}]},{"description":"Rem mntr s-scl eeg sys setup","code_information":[{"code":"1008T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.03,"maximum":253.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.72,"additional_payer_notes":"APC"}]}]},{"description":"Eye exam new patient","code_information":[{"code":"92002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.03,"maximum":253.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.72,"additional_payer_notes":"APC"}]}]},{"description":"Eye exam new patient","code_information":[{"code":"92004","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.03,"maximum":253.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.72,"additional_payer_notes":"APC"}]}]},{"description":"Eye exam establish patient","code_information":[{"code":"92012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.03,"maximum":253.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.72,"additional_payer_notes":"APC"}]}]},{"description":"Eye exam&tx estab pt 1/>vst","code_information":[{"code":"92014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.03,"maximum":253.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.72,"additional_payer_notes":"APC"}]}]},{"description":"Glucose monitoring cont","code_information":[{"code":"95250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.03,"maximum":253.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.72,"additional_payer_notes":"APC"}]}]},{"description":"Rem ther mntr 1st setup&edu","code_information":[{"code":"98975","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.03,"maximum":253.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.72,"additional_payer_notes":"APC"}]}]},{"description":"Rem mntr physiol param setup","code_information":[{"code":"99453","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.03,"maximum":253.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.72,"additional_payer_notes":"APC"}]}]},{"description":"Init nb em per day hosp","code_information":[{"code":"99460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.03,"maximum":253.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.72,"additional_payer_notes":"APC"}]}]},{"description":"Same day nb discharge","code_information":[{"code":"99463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.03,"maximum":253.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.72,"additional_payer_notes":"APC"}]}]},{"description":"Trans care mgmt 14 day disch","code_information":[{"code":"99495","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.03,"maximum":253.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.72,"additional_payer_notes":"APC"}]}]},{"description":"Trans care mgmt 7 day disch","code_information":[{"code":"99496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.03,"maximum":253.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.72,"additional_payer_notes":"APC"}]}]},{"description":"Periodic oral evaluation","code_information":[{"code":"D0120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.03,"maximum":253.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.72,"additional_payer_notes":"APC"}]}]},{"description":"Limit oral eval problm focus","code_information":[{"code":"D0140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.03,"maximum":253.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.72,"additional_payer_notes":"APC"}]}]},{"description":"Comprehensve oral evaluation","code_information":[{"code":"D0150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.03,"maximum":253.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.72,"additional_payer_notes":"APC"}]}]},{"description":"Extensv oral eval prob focus","code_information":[{"code":"D0160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.03,"maximum":253.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.72,"additional_payer_notes":"APC"}]}]},{"description":"Re-eval,est pt,problem focus","code_information":[{"code":"D0170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.03,"maximum":253.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.72,"additional_payer_notes":"APC"}]}]},{"description":"Re-eval post-op visit","code_information":[{"code":"D0171","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.03,"maximum":253.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.72,"additional_payer_notes":"APC"}]}]},{"description":"Comp periodontal evaluation","code_information":[{"code":"D0180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.03,"maximum":253.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.72,"additional_payer_notes":"APC"}]}]},{"description":"Assessment of a patient","code_information":[{"code":"D0191","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.03,"maximum":253.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.72,"additional_payer_notes":"APC"}]}]},{"description":"Dental prophylaxis adult","code_information":[{"code":"D1110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.03,"maximum":253.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.72,"additional_payer_notes":"APC"}]}]},{"description":"Gingival irrigation per quad","code_information":[{"code":"D4921","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.03,"maximum":253.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.72,"additional_payer_notes":"APC"}]}]},{"description":"Initial foot exam pt lops","code_information":[{"code":"G0245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.03,"maximum":253.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.72,"additional_payer_notes":"APC"}]}]},{"description":"Followup eval of foot pt lop","code_information":[{"code":"G0246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.03,"maximum":253.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.72,"additional_payer_notes":"APC"}]}]},{"description":"Demonstrate use home inr mon","code_information":[{"code":"G0248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.03,"maximum":253.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.72,"additional_payer_notes":"APC"}]}]},{"description":"Provide INR test mater/equip","code_information":[{"code":"G0249","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.03,"maximum":253.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.72,"additional_payer_notes":"APC"}]}]},{"description":"Initial preventive exam","code_information":[{"code":"G0402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.03,"maximum":253.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.72,"additional_payer_notes":"APC"}]}]},{"description":"Hospital outpt clinic visit","code_information":[{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.03,"maximum":253.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.72,"additional_payer_notes":"APC"}]}]},{"description":"Supply of digital device","code_information":[{"code":"G0552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.03,"maximum":253.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.72,"additional_payer_notes":"APC"}]}]},{"description":"Monthly tx for dmht 20mins","code_information":[{"code":"G0553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":139.03,"maximum":253.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.72,"additional_payer_notes":"APC"}]}]},{"description":"Emergency dept visit","code_information":[{"code":"99281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":88.06,"maximum":160.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":91.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":90.7,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.22,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":89.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":160.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.13,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":98.62,"additional_payer_notes":"APC"}]}]},{"description":"Emergency dept visit","code_information":[{"code":"99282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":160.34,"maximum":292.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":166.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":160.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":165.15,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":171.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":163.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":292.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":169.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":171.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":179.58,"additional_payer_notes":"APC"}]}]},{"description":"Emergency dept visit","code_information":[{"code":"99283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":285.06,"maximum":520.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":296.47,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":285.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":293.62,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":305.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":290.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":520.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":302.17,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":304.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":319.27,"additional_payer_notes":"APC"}]}]},{"description":"Dialysis one evaluation","code_information":[{"code":"90945","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.74,"maximum":795.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.74,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":448.81,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":466.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":444.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":795.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":461.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":465.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":488.03,"additional_payer_notes":"APC"}]}]},{"description":"Emergency dept visit","code_information":[{"code":"99284","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.74,"maximum":795.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.74,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":448.81,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":466.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":444.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":795.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":461.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":465.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":488.03,"additional_payer_notes":"APC"}]}]},{"description":"Opps service,sched team conf","code_information":[{"code":"G0175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.74,"maximum":795.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.74,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":448.81,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":466.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":444.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":795.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":461.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":465.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":488.03,"additional_payer_notes":"APC"}]}]},{"description":"Emergency dept visit","code_information":[{"code":"99285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":621.9,"maximum":1135.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":646.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":621.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":640.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":665.43,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":634.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1135.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":659.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":664.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":696.53,"additional_payer_notes":"APC"}]}]},{"description":"Direct refer hospital observ","code_information":[{"code":"G0379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":621.9,"maximum":1135.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":646.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":621.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":640.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":665.43,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":634.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1135.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":659.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":664.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":696.53,"additional_payer_notes":"APC"}]}]},{"description":"Critical care first hour","code_information":[{"code":"99291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":862.6,"maximum":1575.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":897.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":862.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":888.48,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":922.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":879.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1575.12,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":914.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":922.12,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":966.12,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl impltbl glucose sensor","code_information":[{"code":"0447T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Esw integ wnd hlg 1st wnd","code_information":[{"code":"0512T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Coms ther 1st appl<=50 sq cm","code_information":[{"code":"0906T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Acne surgery","code_information":[{"code":"10040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of skin abscess","code_information":[{"code":"10060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Trim skin lesion","code_information":[{"code":"11055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Trim skin lesions 2 to 4","code_information":[{"code":"11056","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Trim skin lesions over 4","code_information":[{"code":"11057","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Removal of skin tags <w/15","code_information":[{"code":"11200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion 0.6-1.0 cm","code_information":[{"code":"11301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion 1.1-2.0 cm","code_information":[{"code":"11302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion 0.5 cm/<","code_information":[{"code":"11305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion 0.6-1.0 cm","code_information":[{"code":"11306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion 1.1-2.0 cm","code_information":[{"code":"11307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion 0.5 cm/<","code_information":[{"code":"11310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion 0.6-1.0 cm","code_information":[{"code":"11311","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Removal of nail plate","code_information":[{"code":"11730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Inject skin lesions <=w 7","code_information":[{"code":"11900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Inject skin lesions >7","code_information":[{"code":"11901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Tx contour defects 1 cc/<","code_information":[{"code":"11950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Rpr s/n/ax/gen/trnk 2.5cm/<","code_information":[{"code":"12001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Rpr s/n/ax/gen/trnk2.6-7.5cm","code_information":[{"code":"12002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Rpr s/n/ax/gen/trk7.6-12.5cm","code_information":[{"code":"12004","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Rpr s/n/ax/gen/trnk >30.0 cm","code_information":[{"code":"12007","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Rpr f/e/e/n/l/m 2.5 cm/<","code_information":[{"code":"12011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Rpr f/e/e/n/l/m 2.6-5.0 cm","code_information":[{"code":"12013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Rpr f/e/e/n/l/m 5.1-7.5 cm","code_information":[{"code":"12014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Rpr f/e/e/n/l/m 7.6-12.5 cm","code_information":[{"code":"12015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Rpr f/e/e/n/l/m >30.0 cm","code_information":[{"code":"12018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Abrasion lesion single","code_information":[{"code":"15786","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Initial treatment of burn(s)","code_information":[{"code":"16000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Dress/debrid p-thick burn s","code_information":[{"code":"16020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Dress/debrid p-thick burn m","code_information":[{"code":"16025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Destruct premalg lesion","code_information":[{"code":"17000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Destruct b9 lesion 1-14","code_information":[{"code":"17110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Destruct lesion 15 or more","code_information":[{"code":"17111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Chemical cautery tissue","code_information":[{"code":"17250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Skin peel therapy","code_information":[{"code":"17360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Skin tissue procedure","code_information":[{"code":"17999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of finger abscess","code_information":[{"code":"26010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Cryosurgery anal lesion(s)","code_information":[{"code":"46916","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Cryosurgery penis lesion(s)","code_information":[{"code":"54056","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Clean out mastoid cavity","code_information":[{"code":"69220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Photodynamic tx skin","code_information":[{"code":"96567","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Pdt dstr prmlg les phys/qhp","code_information":[{"code":"96573","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Dbrdmt prmlg les w/pdt","code_information":[{"code":"96574","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Laser tx skin < 250 sq cm","code_information":[{"code":"96920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Laser tx skin 250-500 sq cm","code_information":[{"code":"96921","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Dermatological procedure","code_information":[{"code":"96999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl devital tis 20 cm/<","code_information":[{"code":"97597","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Wound(s) care non-selective","code_information":[{"code":"97602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Neg press wound tx <=50 cm","code_information":[{"code":"97605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Low frequency non-thermal us","code_information":[{"code":"97610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Routine footcare pt w lops","code_information":[{"code":"G0247","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.52,"maximum":382.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"}]}]},{"description":"Slctv nzmtc dbrdmt t/a/l 1st","code_information":[{"code":"0973T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Slctv nzmtc dbrdmt s/n/hf 1","code_information":[{"code":"0975T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Fna w/o image","code_information":[{"code":"10021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of skin abscess","code_information":[{"code":"10061","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Remove foreign body","code_information":[{"code":"10120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Puncture drainage of lesion","code_information":[{"code":"10160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Debride infected skin","code_information":[{"code":"11000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Deb subq tissue 20 sq cm/<","code_information":[{"code":"11042","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Tangntl bx skin single les","code_information":[{"code":"11102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Punch bx skin single lesion","code_information":[{"code":"11104","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion 0.5 cm/<","code_information":[{"code":"11300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion >2.0 cm","code_information":[{"code":"11303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion >2.0 cm","code_information":[{"code":"11308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion 1.1-2.0 cm","code_information":[{"code":"11312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion >2.0 cm","code_information":[{"code":"11313","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext b9+marg 0.6-1 cm","code_information":[{"code":"11401","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext mal+marg 1.1-2 cm","code_information":[{"code":"11602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Removal of nail bed","code_information":[{"code":"11750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Excision of nail fold toe","code_information":[{"code":"11765","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Rpr s/n/a/gen/trk12.6-20.0cm","code_information":[{"code":"12005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Rpr s/n/a/gen/trk20.1-30.0cm","code_information":[{"code":"12006","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Rpr fe/e/en/l/m 12.6-20.0 cm","code_information":[{"code":"12016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Rpr fe/e/en/l/m 20.1-30.0 cm","code_information":[{"code":"12017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Closure of split wound","code_information":[{"code":"12021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr s/a/t/ext 2.5 cm/<","code_information":[{"code":"12031","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr s/a/t/ext 2.6-7.5","code_information":[{"code":"12032","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr s/tr/ext 7.6-12.5","code_information":[{"code":"12034","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr s/a/t/ext 12.6-20","code_information":[{"code":"12035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr n-hf/genit 2.5cm/<","code_information":[{"code":"12041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr n-hf/genit2.6-7.5","code_information":[{"code":"12042","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr face/mm 2.5 cm/<","code_information":[{"code":"12051","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr face/mm 2.6-5.0 cm","code_information":[{"code":"12052","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr face/mm 5.1-7.5 cm","code_information":[{"code":"12053","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr face/mm 7.6-12.5cm","code_information":[{"code":"12054","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr face/mm 12.6-20 cm","code_information":[{"code":"12055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr face/mm 20.1-30.0","code_information":[{"code":"12056","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr face/mm >30.0 cm","code_information":[{"code":"12057","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Cmplx rpr s/a/l 1.1-2.5 cm","code_information":[{"code":"13120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Cmplx rpr s/a/l 2.6-7.5 cm","code_information":[{"code":"13121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Cmplx rpr f/c/c/m/n/ax/g/h/f","code_information":[{"code":"13131","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Cmplx rpr f/c/c/m/n/ax/g/h/f","code_information":[{"code":"13132","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Wound prep f/n/hf/g","code_information":[{"code":"15004","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Hair trnspl 1-15 punch grfts","code_information":[{"code":"15775","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Hair trnspl >15 punch grafts","code_information":[{"code":"15776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Dermabrasion suprfl any site","code_information":[{"code":"15783","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Chemical peel face epiderm","code_information":[{"code":"15788","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Chemical peel nonfacial","code_information":[{"code":"15793","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Dress/debrid p-thick burn l","code_information":[{"code":"16030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Incision of burn scab initi","code_information":[{"code":"16035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Destroy premal lesions 15/>","code_information":[{"code":"17004","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17266","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Injection(s) spider veins","code_information":[{"code":"36468","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Injection therapy of vein","code_information":[{"code":"36470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Injection therapy of veins","code_information":[{"code":"36471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Destruction anal lesion(s)","code_information":[{"code":"46900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Destruction penis lesion(s)","code_information":[{"code":"54050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Photochemotherapy uv-a or b","code_information":[{"code":"96913","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Laser tx skin >500 sq cm","code_information":[{"code":"96922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Neg press wound tx >50 cm","code_information":[{"code":"97606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Neg press wnd tx <=50 sq cm","code_information":[{"code":"97607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Neg press wound tx >50 cm","code_information":[{"code":"97608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":424.52,"maximum":775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":433.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":775.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.46,"additional_payer_notes":"APC"}]}]},{"description":"Dstrj neurofibroma xtnsv","code_information":[{"code":"0419T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.8,"maximum":1409.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":794.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":787.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1409.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":818.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":864.41,"additional_payer_notes":"APC"}]}]},{"description":"Dstrj neurofibroma xtnsv","code_information":[{"code":"0420T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.8,"maximum":1409.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":794.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":787.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1409.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":818.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":864.41,"additional_payer_notes":"APC"}]}]},{"description":"Fxjl abl lsr 1st 100 sq cm","code_information":[{"code":"0479T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.8,"maximum":1409.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":794.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":787.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1409.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":818.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":864.41,"additional_payer_notes":"APC"}]}]},{"description":"Deb musc/fascia 20 sq cm/<","code_information":[{"code":"11043","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.8,"maximum":1409.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":794.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":787.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1409.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":818.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":864.41,"additional_payer_notes":"APC"}]}]},{"description":"Incal bx skn single les","code_information":[{"code":"11106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.8,"maximum":1409.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":794.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":787.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1409.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":818.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":864.41,"additional_payer_notes":"APC"}]}]},{"description":"Repair of nail bed","code_information":[{"code":"11760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.8,"maximum":1409.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":794.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":787.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1409.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":818.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":864.41,"additional_payer_notes":"APC"}]}]},{"description":"Correct skin color 6.0 cm/<","code_information":[{"code":"11920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.8,"maximum":1409.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":794.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":787.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1409.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":818.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":864.41,"additional_payer_notes":"APC"}]}]},{"description":"Correct skn color 6.1-20.0cm","code_information":[{"code":"11921","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.8,"maximum":1409.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":794.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":787.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1409.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":818.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":864.41,"additional_payer_notes":"APC"}]}]},{"description":"Tx contour defects 1.1-5.0cc","code_information":[{"code":"11951","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.8,"maximum":1409.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":794.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":787.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1409.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":818.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":864.41,"additional_payer_notes":"APC"}]}]},{"description":"Tx contour defects 5.1-10cc","code_information":[{"code":"11952","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.8,"maximum":1409.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":794.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":787.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1409.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":818.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":864.41,"additional_payer_notes":"APC"}]}]},{"description":"Tx contour defects >10.0 cc","code_information":[{"code":"11954","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.8,"maximum":1409.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":794.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":787.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1409.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":818.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":864.41,"additional_payer_notes":"APC"}]}]},{"description":"Closure of split wound","code_information":[{"code":"12020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.8,"maximum":1409.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":794.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":787.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1409.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":818.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":864.41,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr s/a/t/ext 20.1-30","code_information":[{"code":"12036","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.8,"maximum":1409.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":794.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":787.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1409.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":818.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":864.41,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr n-hf/genit7.6-12.5","code_information":[{"code":"12044","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.8,"maximum":1409.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":794.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":787.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1409.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":818.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":864.41,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr n-hf/genit12.6-20","code_information":[{"code":"12045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.8,"maximum":1409.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":794.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":787.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1409.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":818.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":864.41,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr n-hf/genit20.1-30","code_information":[{"code":"12046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.8,"maximum":1409.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":794.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":787.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1409.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":818.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":864.41,"additional_payer_notes":"APC"}]}]},{"description":"Cmplx rpr trunk 1.1-2.5 cm","code_information":[{"code":"13100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.8,"maximum":1409.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":794.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":787.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1409.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":818.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":864.41,"additional_payer_notes":"APC"}]}]},{"description":"Cmplx rpr trunk 2.6-7.5 cm","code_information":[{"code":"13101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.8,"maximum":1409.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":794.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":787.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1409.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":818.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":864.41,"additional_payer_notes":"APC"}]}]},{"description":"Cmplx rpr e/n/e/l 1.1-2.5 cm","code_information":[{"code":"13151","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.8,"maximum":1409.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":794.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":787.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1409.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":818.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":864.41,"additional_payer_notes":"APC"}]}]},{"description":"Cmplx rpr e/n/e/l 2.6-7.5 cm","code_information":[{"code":"13152","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.8,"maximum":1409.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":794.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":787.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1409.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":818.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":864.41,"additional_payer_notes":"APC"}]}]},{"description":"Wound prep trk/arm/leg","code_information":[{"code":"15002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.8,"maximum":1409.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":794.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":787.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1409.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":818.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":864.41,"additional_payer_notes":"APC"}]}]},{"description":"Skin pinch graft","code_information":[{"code":"15050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.8,"maximum":1409.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":794.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":787.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1409.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":818.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":864.41,"additional_payer_notes":"APC"}]}]},{"description":"Skin sub graft trnk/arm/leg","code_information":[{"code":"15271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.8,"maximum":1409.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":794.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":787.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1409.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":818.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":864.41,"additional_payer_notes":"APC"}]}]},{"description":"Skin sub graft face/nk/hf/g","code_information":[{"code":"15275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.8,"maximum":1409.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":794.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":787.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1409.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":818.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":864.41,"additional_payer_notes":"APC"}]}]},{"description":"Chemical peel face dermal","code_information":[{"code":"15789","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.8,"maximum":1409.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":794.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":787.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1409.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":818.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":864.41,"additional_payer_notes":"APC"}]}]},{"description":"Chemical peel nonfacial","code_information":[{"code":"15792","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.8,"maximum":1409.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":794.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":787.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1409.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":818.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":864.41,"additional_payer_notes":"APC"}]}]},{"description":"Dressing change not for burn","code_information":[{"code":"15852","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.8,"maximum":1409.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":794.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":787.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1409.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":818.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":864.41,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.8,"maximum":1409.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":794.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":787.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1409.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":818.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":864.41,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17284","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.8,"maximum":1409.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":794.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":787.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1409.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":818.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":864.41,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.8,"maximum":1409.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":794.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":787.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1409.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":818.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":864.41,"additional_payer_notes":"APC"}]}]},{"description":"Mohs 1 stage h/n/hf/g","code_information":[{"code":"17311","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.8,"maximum":1409.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":794.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":787.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1409.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":818.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":864.41,"additional_payer_notes":"APC"}]}]},{"description":"Mohs 1 stage t/a/l","code_information":[{"code":"17313","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.8,"maximum":1409.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":794.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":787.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1409.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":818.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":864.41,"additional_payer_notes":"APC"}]}]},{"description":"Hair removal by electrolysis","code_information":[{"code":"17380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.8,"maximum":1409.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":794.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":787.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1409.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":818.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":864.41,"additional_payer_notes":"APC"}]}]},{"description":"Remove cartilage for graft","code_information":[{"code":"20910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.8,"maximum":1409.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":794.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":787.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1409.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":818.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":864.41,"additional_payer_notes":"APC"}]}]},{"description":"Reloc skin pocket pls gen","code_information":[{"code":"0416T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Autolog prp diab wound ulcer","code_information":[{"code":"0465?","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Rlcj pg wcs lv battery only","code_information":[{"code":"0862T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Rlcj pg wcs lv trnsmtr only","code_information":[{"code":"0863T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Rlcj skin pocket ccm-d pg","code_information":[{"code":"0925T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of nail bed","code_information":[{"code":"11762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr s/tr/ext >30.0 cm","code_information":[{"code":"12037","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr n-hf/genit >30.0cm","code_information":[{"code":"12047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Tis trnfr trunk 10 sq cm/<","code_information":[{"code":"14000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Tis trnfr trunk 10.1-30sqcm","code_information":[{"code":"14001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Tis trnfr s/a/l 10 sq cm/<","code_information":[{"code":"14020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Tis trnfr s/a/l 10.1-30 sqcm","code_information":[{"code":"14021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Tis trnfr f/c/c/m/n/a/g/h/f","code_information":[{"code":"14040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Tis trnfr f/c/c/m/n/a/g/h/f","code_information":[{"code":"14041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Tis trnfr e/n/e/l 10 sq cm/<","code_information":[{"code":"14060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Tis trnfr e/n/e/l10.1-30sqcm","code_information":[{"code":"14061","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Filleted finger/toe flap","code_information":[{"code":"14350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Hrv skn cll ssp agrft 1st 25","code_information":[{"code":"15011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"App skn cl ssp agrft t/a/l 1","code_information":[{"code":"15015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"App skn cll ssp f/n/g/hf 1st","code_information":[{"code":"15017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Harvest cultured skin graft","code_information":[{"code":"15040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Skin splt grft trnk/arm/leg","code_information":[{"code":"15100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Epidrm autogrft trnk/arm/leg","code_information":[{"code":"15110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Epidrm a-grft face/nck/hf/g","code_information":[{"code":"15115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Derm autograft trnk/arm/leg","code_information":[{"code":"15130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Cult skin grft t/arm/leg","code_information":[{"code":"15150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Skin full graft trunk","code_information":[{"code":"15200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Skin full graft sclp/arm/leg","code_information":[{"code":"15220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Skin full grft face/genit/hf","code_information":[{"code":"15240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Skin full graft een & lips","code_information":[{"code":"15260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Skin sub grft t/arm/lg child","code_information":[{"code":"15273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Skn sub grft f/n/hf/g child","code_information":[{"code":"15277","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Skin pedicle flap trunk","code_information":[{"code":"15570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Pedcle fh/ch/ch/m/n/ax/g/h/f","code_information":[{"code":"15574","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Pedicle e/n/e/l/ntroral","code_information":[{"code":"15576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Delay flap arms/legs","code_information":[{"code":"15610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Delay flap f/c/c/n/ax/g/h/f","code_information":[{"code":"15620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Delay flap eye/nos/ear/lip","code_information":[{"code":"15630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Transfer skin pedicle flap","code_information":[{"code":"15650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Muscle-skin graft arm","code_information":[{"code":"15736","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Island pedicle flap graft","code_information":[{"code":"15740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Composite skin graft","code_information":[{"code":"15760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Grfg autol fat lipo 25 cc/<","code_information":[{"code":"15773","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Revision of lower eyelid","code_information":[{"code":"15820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Revision of lower eyelid","code_information":[{"code":"15821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Revision of upper eyelid","code_information":[{"code":"15822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Revision of upper eyelid","code_information":[{"code":"15823","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Removal of forehead wrinkles","code_information":[{"code":"15824","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Nerve palsy microsurg graft","code_information":[{"code":"15842","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Remove sutures diff surgeon","code_information":[{"code":"15851","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Suction lipectomy upr extrem","code_information":[{"code":"15878","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Remove sacrum pressure sore","code_information":[{"code":"15936","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Remove sacrum pressure sore","code_information":[{"code":"15937","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Remove hip pressure sore","code_information":[{"code":"15945","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Remove hip pressure sore","code_information":[{"code":"15946","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Remove thigh pressure sore","code_information":[{"code":"15952","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Remove thigh pressure sore","code_information":[{"code":"15956","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Explore wound chest","code_information":[{"code":"20101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Explore wound abdomen","code_information":[{"code":"20102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Removal of fascia for graft","code_information":[{"code":"20920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Removal of fascia for graft","code_information":[{"code":"20922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"23921","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"25929","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Relocation pocket pacemaker","code_information":[{"code":"33222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Relocate pocket for defib","code_information":[{"code":"33223","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Njx noncmpnd sclrsnt 1 vein","code_information":[{"code":"36465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Njx noncmpnd sclrsnt mlt vn","code_information":[{"code":"36466","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Remove gastric port open","code_information":[{"code":"43887","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Destruction anal lesion(s)","code_information":[{"code":"46910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Destruction penis lesion(s)","code_information":[{"code":"54055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Laser surg penis lesion(s)","code_information":[{"code":"54057","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Excision of penis lesion(s)","code_information":[{"code":"54060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Destruction penis lesion(s)","code_information":[{"code":"54065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Destroy vulva lesions sim","code_information":[{"code":"56501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Destroy vulva lesion/s compl","code_information":[{"code":"56515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Dermal filler injection(s)","code_information":[{"code":"G0429","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Autologous PRP for ulcers","code_information":[{"code":"G0460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2154.64,"maximum":3934.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2154.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2219.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2305.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2197.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3934.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2283.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2303.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2413.2,"additional_payer_notes":"APC"}]}]},{"description":"Adrc ther prtl rc tear","code_information":[{"code":"0717T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Adrc ther prtl rc tear njx","code_information":[{"code":"0718T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Insert tissue expander(s)","code_information":[{"code":"11960","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Late closure of wound","code_information":[{"code":"13160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Tis trnfr any 30.1-60 sq cm","code_information":[{"code":"14301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Skn splt a-grft fac/nck/hf/g","code_information":[{"code":"15120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Derm autograft face/nck/hf/g","code_information":[{"code":"15135","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Cult skin graft f/n/hf/g","code_information":[{"code":"15155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Skin pedicle flap arms/legs","code_information":[{"code":"15572","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Delay flap trunk","code_information":[{"code":"15600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Mdfc flap w/prsrv vasc pedcl","code_information":[{"code":"15730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Forehead Flap w/Vasc Pedicle","code_information":[{"code":"15731","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Musc myoq/fscq flp h&n pedcl","code_information":[{"code":"15733","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Muscle-skin graft trunk","code_information":[{"code":"15734","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Muscle-skin graft leg","code_information":[{"code":"15738","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Neurovascular pedicle flap","code_information":[{"code":"15750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Grfg autol soft tiss dir exc","code_information":[{"code":"15769","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Derma-fat-fascia graft","code_information":[{"code":"15770","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Grfg autol fat lipo 50 cc/<","code_information":[{"code":"15771","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Removal of neck wrinkles","code_information":[{"code":"15825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Removal of brow wrinkles","code_information":[{"code":"15826","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Removal of face wrinkles","code_information":[{"code":"15828","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Removal of skin wrinkles","code_information":[{"code":"15829","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Nerve palsy fascial graft","code_information":[{"code":"15840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Nerve palsy muscle graft","code_information":[{"code":"15841","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Skin and muscle repair face","code_information":[{"code":"15845","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Suction lipectomy head&neck","code_information":[{"code":"15876","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Suction lipectomy trunk","code_information":[{"code":"15877","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Suction lipectomy lwr extrem","code_information":[{"code":"15879","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Removal of tail bone ulcer","code_information":[{"code":"15922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Remove sacrum pressure sore","code_information":[{"code":"15934","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Remove sacrum pressure sore","code_information":[{"code":"15935","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Remove hip pressure sore","code_information":[{"code":"15944","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Remove thigh pressure sore","code_information":[{"code":"15953","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Remove thigh pressure sore","code_information":[{"code":"15958","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Remove cartilage for graft","code_information":[{"code":"20912","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Revise gastric port open","code_information":[{"code":"43886","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Change gastric port open","code_information":[{"code":"43888","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Revision of ileostomy","code_information":[{"code":"44312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Revision of ileostomy","code_information":[{"code":"44314","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Revision of colostomy","code_information":[{"code":"44340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Revision of colostomy","code_information":[{"code":"44345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Revision of colostomy","code_information":[{"code":"44346","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3700.64,"maximum":6757.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3700.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3811.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3959.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3774.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6757.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3922.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3955.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.71,"additional_payer_notes":"APC"}]}]},{"description":"Hbot, full body chamber, 30m","code_information":[{"code":"G0277","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.7,"maximum":262.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":149.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":148.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":153.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":146.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":262.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":152.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":153.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":160.95,"additional_payer_notes":"APC"}]}]},{"description":"Fna bx w/us gdn 1st les","code_information":[{"code":"10005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Fna bx w/fluor gdn 1st les","code_information":[{"code":"10007","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Fna bx w/ct gdn 1st les","code_information":[{"code":"10009","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Fna bx w/mr gdn 1st les","code_information":[{"code":"10011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Guide cathet fluid drainage","code_information":[{"code":"10030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Perq dev soft tiss 1st imag","code_information":[{"code":"10035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of pilonidal cyst","code_information":[{"code":"10080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of pilonidal cyst","code_information":[{"code":"10081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Debride skin at fx site","code_information":[{"code":"11010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Debride skin musc at fx site","code_information":[{"code":"11011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext b9+marg 0.5 cm<","code_information":[{"code":"11400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext b9+marg 1.1-2 cm","code_information":[{"code":"11402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext b9+marg 2.1-3cm/<","code_information":[{"code":"11403","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Exc h-f-nk-sp b9+marg 0.6-1","code_information":[{"code":"11421","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Exc face-mm b9+marg 0.5 cm/<","code_information":[{"code":"11440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Exc face-mm b9+marg 0.6-1 cm","code_information":[{"code":"11441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Exc face-mm b9+marg 1.1-2 cm","code_information":[{"code":"11442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext mal+marg 0.5 cm/<","code_information":[{"code":"11600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext mal+marg 0.6-1 cm","code_information":[{"code":"11601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext mal+marg 2.1-3 cm","code_information":[{"code":"11603","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext mal+marg 3.1-4 cm","code_information":[{"code":"11604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Exc s/n/h/f/g mal+mrg 0.6-1","code_information":[{"code":"11621","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Exc s/n/h/f/g mal+mrg 1.1-2","code_information":[{"code":"11622","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Exc f/e/e/n/l mal+mrg 0.5cm<","code_information":[{"code":"11640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Exc f/e/e/n/l mal+mrg 0.6-1","code_information":[{"code":"11641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Exc f/e/e/n/l mal+mrg 1.1-2","code_information":[{"code":"11642","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy nail unit","code_information":[{"code":"11755","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Remove contraceptive capsule","code_information":[{"code":"11976","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Dermabrasion segmental face","code_information":[{"code":"15781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Removal of pressure sore","code_information":[{"code":"15999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of breast lesion","code_information":[{"code":"19000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Perq dev breast 1st strtctc","code_information":[{"code":"19283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Perq dev breast 1st us imag","code_information":[{"code":"19285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Perq dev breast 1st mr guide","code_information":[{"code":"19287","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of bone cyst","code_information":[{"code":"20615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Fluid pressure muscle","code_information":[{"code":"20950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Revision of neck muscle","code_information":[{"code":"21725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foot foreign body","code_information":[{"code":"28190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl subq car rhythm mntr","code_information":[{"code":"33286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"40800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of salivary gland","code_information":[{"code":"42400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Liver surgery procedure","code_information":[{"code":"47399","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Pancreas surgery procedure","code_information":[{"code":"48999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of kidney lesion","code_information":[{"code":"50390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of hydrocele","code_information":[{"code":"55000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of thyroid","code_information":[{"code":"60100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Aspir/inj thyroid cyst","code_information":[{"code":"60300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Interdiscal perq aspir dx","code_information":[{"code":"62267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Drain external ear lesion","code_information":[{"code":"69000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Drain outer ear canal lesion","code_information":[{"code":"69020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"I&d absc intraoral soft tiss","code_information":[{"code":"D7510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Incision/drain abscess intra","code_information":[{"code":"D7511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"I&d abscess extraoral","code_information":[{"code":"D7520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Incision/drain abscess extra","code_information":[{"code":"D7521","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":739.49,"maximum":1350.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":754.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1350.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":828.23,"additional_payer_notes":"APC"}]}]},{"description":"Abltj b9 thyr ndul perq lasr","code_information":[{"code":"0673T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Rmv/rplc magnet coil assem","code_information":[{"code":"0959T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Remove foreign body","code_information":[{"code":"10121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of hematoma/fluid","code_information":[{"code":"10140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Deb bone 20 sq cm/<","code_information":[{"code":"11044","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext b9+marg 3.1-4 cm","code_information":[{"code":"11404","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext b9+marg >4.0 cm","code_information":[{"code":"11406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Exc h-f-nk-sp b9+marg 0.5/<","code_information":[{"code":"11420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Exc h-f-nk-sp b9+marg 1.1-2","code_information":[{"code":"11422","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Exc h-f-nk-sp b9+marg 2.1-3","code_information":[{"code":"11423","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Exc h-f-nk-sp b9+marg 3.1-4","code_information":[{"code":"11424","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Exc face-mm b9+marg 2.1-3 cm","code_information":[{"code":"11443","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Exc face-mm b9+marg 3.1-4 cm","code_information":[{"code":"11444","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext mal+marg >4 cm","code_information":[{"code":"11606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Exc h-f-nk-sp mal+marg 0.5/<","code_information":[{"code":"11620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Exc s/n/h/f/g mal+mrg 2.1-3","code_information":[{"code":"11623","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Exc s/n/h/f/g mal+mrg 3.1-4","code_information":[{"code":"11624","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Exc f/e/e/n/l mal+mrg 2.1-3","code_information":[{"code":"11643","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Exc f/e/e/n/l mal+mrg 3.1-4","code_information":[{"code":"11644","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Remove thigh pressure sore","code_information":[{"code":"15950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Incision of breast lesion","code_information":[{"code":"19020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Bx breast 1st lesion strtctc","code_information":[{"code":"19081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Bx breast 1st lesion us imag","code_information":[{"code":"19083","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Bx breast 1st lesion mr imag","code_information":[{"code":"19085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Bx breast percut w/o image","code_information":[{"code":"19100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Perq device breast 1st imag","code_information":[{"code":"19281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Explore wound extremity","code_information":[{"code":"20103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Muscle biopsy","code_information":[{"code":"20200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Needle biopsy muscle","code_information":[{"code":"20206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Bone biopsy trocar/needle","code_information":[{"code":"20220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Bone biopsy trocar/needle","code_information":[{"code":"20225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foreign body","code_information":[{"code":"20520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Removal of support implant","code_information":[{"code":"20670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Exc face les sc <2 cm","code_information":[{"code":"21011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Exc face les sbq 2 cm/>","code_information":[{"code":"21012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Exc face tum deep < 2 cm","code_information":[{"code":"21013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of neck/chest","code_information":[{"code":"21550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Exc neck les sc < 3 cm","code_information":[{"code":"21555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy soft tissue of back","code_information":[{"code":"21920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy soft tissue of back","code_information":[{"code":"21925","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Exc back les sc < 3 cm","code_information":[{"code":"21930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Exc back les sc 3 cm/>","code_information":[{"code":"21931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Exc abd les sc < 3 cm","code_information":[{"code":"22902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy shoulder tissues","code_information":[{"code":"23065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Exc shoulder les sc 3 cm/>","code_information":[{"code":"23071","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Exc shoulder les sc < 3 cm","code_information":[{"code":"23075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Remove shoulder foreign body","code_information":[{"code":"23330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of arm bursa","code_information":[{"code":"23931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy arm/elbow soft tissue","code_information":[{"code":"24065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Exc arm/elbow les sc < 3 cm","code_information":[{"code":"24075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Removal of arm foreign body","code_information":[{"code":"24200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy forearm soft tissues","code_information":[{"code":"25065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Exc forearm les sc 3 cm/>","code_information":[{"code":"25071","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Exc forearm les sc < 3 cm","code_information":[{"code":"25075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Exc forearm tum deep < 3 cm","code_information":[{"code":"25076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of finger abscess","code_information":[{"code":"26011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Exc hand les sc 1.5 cm/>","code_information":[{"code":"26111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Exc hand tum deep 1.5 cm/>","code_information":[{"code":"26113","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Exc hand les sc < 1.5 cm","code_information":[{"code":"26115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Exc hand tum deep < 1.5 cm","code_information":[{"code":"26116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Removal of implant from hand","code_information":[{"code":"26320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of soft tissues","code_information":[{"code":"27040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of soft tissues","code_information":[{"code":"27041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy thigh soft tissues","code_information":[{"code":"27323","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Exc thigh/knee les sc < 3 cm","code_information":[{"code":"27327","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy lower leg soft tissue","code_information":[{"code":"27613","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Exc leg/ankle tum < 3 cm","code_information":[{"code":"27618","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of bursa of foot","code_information":[{"code":"28001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Exc foot/toe tum sc < 1.5 cm","code_information":[{"code":"28043","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foot foreign body","code_information":[{"code":"28192","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foot foreign body","code_information":[{"code":"28193","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Needle biopsy chest lining","code_information":[{"code":"32400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Core ndl bx lng/med perq","code_information":[{"code":"32408","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Temporal artery procedure","code_information":[{"code":"37609","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Bone marrow aspiration","code_information":[{"code":"38220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Bone marrow biopsy","code_information":[{"code":"38221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Needle biopsy lymph nodes","code_information":[{"code":"38505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of floor of mouth","code_information":[{"code":"41108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Needle biopsy of liver","code_information":[{"code":"47000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Needle biopsy pancreas","code_information":[{"code":"48102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy abdominal mass","code_information":[{"code":"49180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Sclerotx fluid collection","code_information":[{"code":"49185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Image cath fluid colxn visc","code_information":[{"code":"49405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Image cath fluid peri/retro","code_information":[{"code":"49406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Image cath fluid trns/vgnl","code_information":[{"code":"49407","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Renal biopsy perq","code_information":[{"code":"50200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Drain penis lesion","code_information":[{"code":"54015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of penis","code_information":[{"code":"54100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of epididymis","code_information":[{"code":"54800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of scrotum abscess","code_information":[{"code":"55100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Abltj 1/+thyr ndul 1lobe prq","code_information":[{"code":"60660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Needle biopsy spinal cord","code_information":[{"code":"62269","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Drain external ear lesion","code_information":[{"code":"69005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Clear outer ear canal","code_information":[{"code":"69205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1724.73,"maximum":3149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1759.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3149.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1843.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1931.7,"additional_payer_notes":"APC"}]}]},{"description":"Complex drainage wound","code_information":[{"code":"10180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Deb skin bone at fx site","code_information":[{"code":"11012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc h-f-nk-sp b9+marg >4 cm","code_information":[{"code":"11426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc face-mm b9+marg >4 cm","code_information":[{"code":"11446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Removal sweat gland lesion","code_information":[{"code":"11450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Removal sweat gland lesion","code_information":[{"code":"11451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Removal sweat gland lesion","code_information":[{"code":"11462","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Removal sweat gland lesion","code_information":[{"code":"11463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Removal sweat gland lesion","code_information":[{"code":"11470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Removal sweat gland lesion","code_information":[{"code":"11471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc s/n/h/f/g mal+mrg >4 cm","code_information":[{"code":"11626","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc f/e/e/n/l mal+mrg >4 cm","code_information":[{"code":"11646","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Remove pilonidal cyst simple","code_information":[{"code":"11770","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Remove pilonidal cyst exten","code_information":[{"code":"11771","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Remove pilonidal cyst compl","code_information":[{"code":"11772","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Remove tissue expander(s)","code_information":[{"code":"11971","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Dermabrasion total face","code_information":[{"code":"15780","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Dermabrasion other than face","code_information":[{"code":"15782","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Excise excessive skin thigh","code_information":[{"code":"15832","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Excise excessive skin leg","code_information":[{"code":"15833","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Excise excessive skin hip","code_information":[{"code":"15834","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Excise excessive skin buttck","code_information":[{"code":"15835","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Excise excessive skin arm","code_information":[{"code":"15836","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Excise excess skin arm/hand","code_information":[{"code":"15837","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Excise excess skin fat pad","code_information":[{"code":"15838","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Excise excess skin & tissue","code_information":[{"code":"15839","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Removal of tail bone ulcer","code_information":[{"code":"15920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Remove sacrum pressure sore","code_information":[{"code":"15931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Remove sacrum pressure sore","code_information":[{"code":"15933","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Remove hip pressure sore","code_information":[{"code":"15940","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Remove hip pressure sore","code_information":[{"code":"15941","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Remove thigh pressure sore","code_information":[{"code":"15951","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Deep muscle biopsy","code_information":[{"code":"20205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Bone biopsy open superficial","code_information":[{"code":"20240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Bone biopsy open deep","code_information":[{"code":"20245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foreign body","code_information":[{"code":"20525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Removal of support implant","code_information":[{"code":"20680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc face tum deep 2 cm/>","code_information":[{"code":"21014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Resect face/scalp tum < 2 cm","code_information":[{"code":"21015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Resect face/scalp tum 2 cm/>","code_information":[{"code":"21016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Drain neck/chest lesion","code_information":[{"code":"21501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc neck les sc 3 cm/>","code_information":[{"code":"21552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc neck tum deep 5 cm/>","code_information":[{"code":"21554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc neck tum deep < 5 cm","code_information":[{"code":"21556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Resect neck thorax tumor<5cm","code_information":[{"code":"21557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Resect neck tumor 5 cm/>","code_information":[{"code":"21558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc chest wall tumor w/ribs","code_information":[{"code":"21601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc back tum deep < 5 cm","code_information":[{"code":"21932","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc back tum deep 5 cm/>","code_information":[{"code":"21933","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Resect back tum < 5 cm","code_information":[{"code":"21935","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Resect back tum 5 cm/>","code_information":[{"code":"21936","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc abdl tum deep < 5 cm","code_information":[{"code":"22900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc abdl tum deep 5 cm/>","code_information":[{"code":"22901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc abd les sc 3 cm/>","code_information":[{"code":"22903","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Radical resect abd tumor<5cm","code_information":[{"code":"22904","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Rad resect abd tumor 5 cm/>","code_information":[{"code":"22905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Removal of calcium deposits","code_information":[{"code":"23000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Drain shoulder lesion","code_information":[{"code":"23030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Drain shoulder bursa","code_information":[{"code":"23031","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy shoulder tissues","code_information":[{"code":"23066","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc shoulder tum deep 5 cm/>","code_information":[{"code":"23073","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc shoulder tum deep < 5 cm","code_information":[{"code":"23076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Resect shoulder tumor < 5 cm","code_information":[{"code":"23077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Resect shoulder tumor 5 cm/>","code_information":[{"code":"23078","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Remove shoulder fb deep","code_information":[{"code":"23333","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of arm lesion","code_information":[{"code":"23930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy arm/elbow soft tissue","code_information":[{"code":"24066","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc arm/elbow les sc 3 cm/>","code_information":[{"code":"24071","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Ex arm/elbow tum deep 5 cm/>","code_information":[{"code":"24073","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Ex arm/elbow tum deep < 5 cm","code_information":[{"code":"24076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Resect arm/elbow tum < 5 cm","code_information":[{"code":"24077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Resect arm/elbow tum 5 cm/>","code_information":[{"code":"24079","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Removal of arm foreign body","code_information":[{"code":"24201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy forearm soft tissues","code_information":[{"code":"25066","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc forearm tum deep 3 cm/>","code_information":[{"code":"25073","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Resect forearm/wrist tum<3cm","code_information":[{"code":"25077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Resect forarm/wrist tum 3cm>","code_information":[{"code":"25078","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Rad resect hand tumor < 3 cm","code_information":[{"code":"26117","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Rad resect hand tumor 3 cm/>","code_information":[{"code":"26118","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc hip pelvis les sc 3 cm/>","code_information":[{"code":"27043","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc hip/pelv tum deep 5 cm/>","code_information":[{"code":"27045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc hip/pelvis les sc < 3 cm","code_information":[{"code":"27047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc hip/pelv tum deep < 5 cm","code_information":[{"code":"27048","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Resect hip/pelv tum < 5 cm","code_information":[{"code":"27049","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Resect hip/pelv tum 5 cm/>","code_information":[{"code":"27059","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Remove hip foreign body","code_information":[{"code":"27086","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Drain thigh/knee lesion","code_information":[{"code":"27301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy thigh soft tissues","code_information":[{"code":"27324","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc thigh/knee tum deep <5cm","code_information":[{"code":"27328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Resect thigh/knee tum < 5 cm","code_information":[{"code":"27329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc thigh/knee les sc 3 cm/>","code_information":[{"code":"27337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc thigh/knee tum dep 5cm/>","code_information":[{"code":"27339","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Resect thigh/knee tum 5 cm/>","code_information":[{"code":"27364","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foreign body","code_information":[{"code":"27372","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Drain lower leg lesion","code_information":[{"code":"27603","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy lower leg soft tissue","code_information":[{"code":"27614","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Resect leg/ankle tum < 5 cm","code_information":[{"code":"27615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Resect leg/ankle tum 5 cm/>","code_information":[{"code":"27616","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc leg/ankle tum deep <5 cm","code_information":[{"code":"27619","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc leg/ankle les sc 3 cm/>","code_information":[{"code":"27632","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc leg/ankle tum dep 5 cm/>","code_information":[{"code":"27634","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc foot/toe tum sc 1.5 cm/>","code_information":[{"code":"28039","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc foot/toe tum dep 1.5cm/>","code_information":[{"code":"28041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Exc foot/toe tum deep <1.5cm","code_information":[{"code":"28045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Resect foot/toe tumor < 3 cm","code_information":[{"code":"28046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Resect foot/toe tumor 3 cm/>","code_information":[{"code":"28047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Dx bone marrow bx & aspir","code_information":[{"code":"38222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Drainage lymph node lesion","code_information":[{"code":"38300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Drainage lymph node lesion","code_information":[{"code":"38305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of bladder abscess","code_information":[{"code":"51080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of penis","code_information":[{"code":"54105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of penis lesion","code_information":[{"code":"54115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of testis","code_information":[{"code":"54500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"I & d vaginal hematoma pp","code_information":[{"code":"57022","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"I & d vag hematoma non-ob","code_information":[{"code":"57023","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Remove external ear partial","code_information":[{"code":"69110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Remove ear canal lesion(s)","code_information":[{"code":"69145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.33,"maximum":5538.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5538.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.33,"additional_payer_notes":"APC"}]}]},{"description":"Abltj mal brst tum perq crtx","code_information":[{"code":"0581T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4088.81,"maximum":7466.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4170.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7466.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4370.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4579.46,"additional_payer_notes":"APC"}]}]},{"description":"Ablt b9 brst tum perq lsr ea","code_information":[{"code":"0970T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4088.81,"maximum":7466.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4170.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7466.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4370.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4579.46,"additional_payer_notes":"APC"}]}]},{"description":"Ablt mal brst tum pq lsr uni","code_information":[{"code":"0971T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4088.81,"maximum":7466.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4170.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7466.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4370.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4579.46,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of breast open","code_information":[{"code":"19101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4088.81,"maximum":7466.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4170.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7466.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4370.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4579.46,"additional_payer_notes":"APC"}]}]},{"description":"Cryosurg ablate fa each","code_information":[{"code":"19105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4088.81,"maximum":7466.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4170.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7466.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4370.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4579.46,"additional_payer_notes":"APC"}]}]},{"description":"Nipple exploration","code_information":[{"code":"19110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4088.81,"maximum":7466.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4170.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7466.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4370.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4579.46,"additional_payer_notes":"APC"}]}]},{"description":"Excise breast duct fistula","code_information":[{"code":"19112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4088.81,"maximum":7466.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4170.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7466.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4370.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4579.46,"additional_payer_notes":"APC"}]}]},{"description":"Removal of breast lesion","code_information":[{"code":"19120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4088.81,"maximum":7466.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4170.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7466.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4370.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4579.46,"additional_payer_notes":"APC"}]}]},{"description":"Excision breast lesion","code_information":[{"code":"19125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4088.81,"maximum":7466.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4170.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7466.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4370.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4579.46,"additional_payer_notes":"APC"}]}]},{"description":"Removal of Breast Tissue","code_information":[{"code":"19300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4088.81,"maximum":7466.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4170.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7466.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4370.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4579.46,"additional_payer_notes":"APC"}]}]},{"description":"Partial Mastectomy","code_information":[{"code":"19301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4088.81,"maximum":7466.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4170.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7466.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4370.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4579.46,"additional_payer_notes":"APC"}]}]},{"description":"Removal of breast implant","code_information":[{"code":"19328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4088.81,"maximum":7466.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4170.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7466.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4370.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4579.46,"additional_payer_notes":"APC"}]}]},{"description":"Removal of implant material","code_information":[{"code":"19330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4088.81,"maximum":7466.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4170.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7466.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4370.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4579.46,"additional_payer_notes":"APC"}]}]},{"description":"Breast reconstruction","code_information":[{"code":"19350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4088.81,"maximum":7466.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4170.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7466.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4370.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4579.46,"additional_payer_notes":"APC"}]}]},{"description":"Correct inverted nipple(s)","code_information":[{"code":"19355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4088.81,"maximum":7466.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4170.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7466.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4370.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4579.46,"additional_payer_notes":"APC"}]}]},{"description":"Surgery of breast capsule","code_information":[{"code":"19370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4088.81,"maximum":7466.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4170.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7466.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4370.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4579.46,"additional_payer_notes":"APC"}]}]},{"description":"Removal of breast capsule","code_information":[{"code":"19371","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4088.81,"maximum":7466.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4170.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7466.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4370.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4579.46,"additional_payer_notes":"APC"}]}]},{"description":"Design custom breast implant","code_information":[{"code":"19396","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4088.81,"maximum":7466.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4170.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7466.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4370.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4579.46,"additional_payer_notes":"APC"}]}]},{"description":"Breast surgery procedure","code_information":[{"code":"19499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4088.81,"maximum":7466.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4170.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7466.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4370.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4579.46,"additional_payer_notes":"APC"}]}]},{"description":"Incision of lymph channels","code_information":[{"code":"38308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4088.81,"maximum":7466.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4170.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7466.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4370.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4579.46,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy/removal lymph nodes","code_information":[{"code":"38500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4088.81,"maximum":7466.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4170.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7466.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4370.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4579.46,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy/removal lymph nodes","code_information":[{"code":"38510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4088.81,"maximum":7466.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4170.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7466.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4370.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4579.46,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy/removal lymph nodes","code_information":[{"code":"38520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4088.81,"maximum":7466.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4170.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7466.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4370.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4579.46,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy/removal lymph nodes","code_information":[{"code":"38525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4088.81,"maximum":7466.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4170.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7466.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4370.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4579.46,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy/removal lymph nodes","code_information":[{"code":"38530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4088.81,"maximum":7466.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4170.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7466.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4370.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4579.46,"additional_payer_notes":"APC"}]}]},{"description":"Open bx/exc inguinofem nodes","code_information":[{"code":"38531","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4088.81,"maximum":7466.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4170.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7466.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4370.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4579.46,"additional_payer_notes":"APC"}]}]},{"description":"Removal neck/armpit lesion","code_information":[{"code":"38550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4088.81,"maximum":7466.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4170.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7466.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4370.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4579.46,"additional_payer_notes":"APC"}]}]},{"description":"Application of body cast","code_information":[{"code":"29044","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.7,"maximum":309.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":176.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":169.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":174.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":173.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":309.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":179.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.06,"additional_payer_notes":"APC"}]}]},{"description":"Apply hand/wrist cast","code_information":[{"code":"29085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.7,"maximum":309.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":176.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":169.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":174.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":173.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":309.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":179.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.06,"additional_payer_notes":"APC"}]}]},{"description":"Apply finger cast","code_information":[{"code":"29086","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.7,"maximum":309.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":176.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":169.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":174.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":173.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":309.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":179.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.06,"additional_payer_notes":"APC"}]}]},{"description":"Apply long arm splint","code_information":[{"code":"29105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.7,"maximum":309.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":176.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":169.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":174.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":173.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":309.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":179.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.06,"additional_payer_notes":"APC"}]}]},{"description":"Strapping of chest","code_information":[{"code":"29200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.7,"maximum":309.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":176.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":169.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":174.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":173.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":309.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":179.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.06,"additional_payer_notes":"APC"}]}]},{"description":"Addition of walker to cast","code_information":[{"code":"29440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.7,"maximum":309.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":176.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":169.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":174.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":173.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":309.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":179.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.06,"additional_payer_notes":"APC"}]}]},{"description":"Application of leg cast","code_information":[{"code":"29450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.7,"maximum":309.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":176.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":169.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":174.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":173.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":309.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":179.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.06,"additional_payer_notes":"APC"}]}]},{"description":"Application long leg splint","code_information":[{"code":"29505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.7,"maximum":309.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":176.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":169.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":174.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":173.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":309.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":179.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.06,"additional_payer_notes":"APC"}]}]},{"description":"Application lower leg splint","code_information":[{"code":"29515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.7,"maximum":309.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":176.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":169.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":174.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":173.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":309.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":179.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.06,"additional_payer_notes":"APC"}]}]},{"description":"Strapping of ankle and/or ft","code_information":[{"code":"29540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.7,"maximum":309.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":176.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":169.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":174.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":173.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":309.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":179.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.06,"additional_payer_notes":"APC"}]}]},{"description":"Application of paste boot","code_information":[{"code":"29580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.7,"maximum":309.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":176.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":169.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":174.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":173.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":309.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":179.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.06,"additional_payer_notes":"APC"}]}]},{"description":"Apply multlay comprs lwr leg","code_information":[{"code":"29581","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.7,"maximum":309.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":176.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":169.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":174.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":173.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":309.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":179.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.06,"additional_payer_notes":"APC"}]}]},{"description":"Appl multlay comprs arm/hand","code_information":[{"code":"29584","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.7,"maximum":309.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":176.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":169.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":174.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":173.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":309.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":179.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.06,"additional_payer_notes":"APC"}]}]},{"description":"Repair of body cast","code_information":[{"code":"29720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.7,"maximum":309.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":176.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":169.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":174.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":173.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":309.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":179.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.06,"additional_payer_notes":"APC"}]}]},{"description":"Windowing of cast","code_information":[{"code":"29730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.7,"maximum":309.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":176.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":169.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":174.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":173.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":309.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":179.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.06,"additional_payer_notes":"APC"}]}]},{"description":"Casting/strapping procedure","code_information":[{"code":"29799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.7,"maximum":309.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":176.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":169.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":174.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":173.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":309.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":179.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.06,"additional_payer_notes":"APC"}]}]},{"description":"Extracorp shockwv tx hi enrg","code_information":[{"code":"0101T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Musculoskeletal surgery","code_information":[{"code":"20999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Reset dislocated jaw","code_information":[{"code":"21480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat sternum fracture","code_information":[{"code":"21820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Closed tx vert fx w/o manj","code_information":[{"code":"22310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Spine surgery procedure","code_information":[{"code":"22899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Abdomen surgery procedure","code_information":[{"code":"22999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat clavicle fracture","code_information":[{"code":"23500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat shoulder blade fx","code_information":[{"code":"23570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"23600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"23620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat shoulder dislocation","code_information":[{"code":"23650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder surgery procedure","code_information":[{"code":"23929","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat elbow dislocation","code_information":[{"code":"24600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat elbow dislocation","code_information":[{"code":"24640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat radius fracture","code_information":[{"code":"24650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat ulnar fracture","code_information":[{"code":"24670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Upper arm/elbow surgery","code_information":[{"code":"24999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture of radius","code_information":[{"code":"25500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture of ulna","code_information":[{"code":"25530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture of ulna","code_information":[{"code":"25535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture radius & ulna","code_information":[{"code":"25560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture radius/ulna","code_information":[{"code":"25600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist bone fracture","code_information":[{"code":"25622","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist bone fracture","code_information":[{"code":"25630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist bone fracture","code_information":[{"code":"25650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist dislocation","code_information":[{"code":"25660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist dislocation","code_information":[{"code":"25675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist fracture","code_information":[{"code":"25680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Forearm or wrist surgery","code_information":[{"code":"25999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Manipulat palm cord post inj","code_information":[{"code":"26341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat metacarpal fracture","code_information":[{"code":"26600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat metacarpal fracture","code_information":[{"code":"26605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat thumb dislocation","code_information":[{"code":"26641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat hand dislocation","code_information":[{"code":"26670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat knuckle dislocation","code_information":[{"code":"26700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26755","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat finger dislocation","code_information":[{"code":"26770","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Hand/finger surgery","code_information":[{"code":"26989","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Clsd tx pelvic ring fx","code_information":[{"code":"27197","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Clsd tx pelvic ring fx","code_information":[{"code":"27198","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat tail bone fracture","code_information":[{"code":"27200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip socket fracture","code_information":[{"code":"27220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip socket fracture","code_information":[{"code":"27222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27256","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Pelvis/hip joint surgery","code_information":[{"code":"27299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27508","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fx growth plate","code_information":[{"code":"27516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat kneecap fracture","code_information":[{"code":"27520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat knee fracture","code_information":[{"code":"27530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat knee fracture(s)","code_information":[{"code":"27538","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat knee dislocation","code_information":[{"code":"27550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat kneecap dislocation","code_information":[{"code":"27560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat kneecap dislocation","code_information":[{"code":"27562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Leg surgery procedure","code_information":[{"code":"27599","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of tibia fracture","code_information":[{"code":"27750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Cltx medial ankle fx","code_information":[{"code":"27760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Cltx post ankle fx","code_information":[{"code":"27767","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of fibula fracture","code_information":[{"code":"27780","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27786","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27788","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27808","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27816","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower leg fracture","code_information":[{"code":"27824","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower leg dislocation","code_information":[{"code":"27830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat ankle dislocation","code_information":[{"code":"27840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Leg/ankle surgery procedure","code_information":[{"code":"27899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of heel fracture","code_information":[{"code":"28400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of heel fracture","code_information":[{"code":"28405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"28430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat midfoot fracture each","code_information":[{"code":"28450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat metatarsal fracture","code_information":[{"code":"28470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat metatarsal fracture","code_information":[{"code":"28475","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat big toe fracture","code_information":[{"code":"28490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat big toe fracture","code_information":[{"code":"28495","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of toe fracture","code_information":[{"code":"28510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of toe fracture","code_information":[{"code":"28515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat sesamoid bone fracture","code_information":[{"code":"28530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat toe dislocation","code_information":[{"code":"28630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Treat toe dislocation","code_information":[{"code":"28660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Foot/toes surgery procedure","code_information":[{"code":"28899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Arthroscopy of joint","code_information":[{"code":"29999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.59,"maximum":470.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":273.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.5,"additional_payer_notes":"APC"}]}]},{"description":"Rev s-sclp eltr ra rcvr&tlmt","code_information":[{"code":"0957T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Apply rem fixation device","code_information":[{"code":"20660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Application of head brace","code_information":[{"code":"20661","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Application of pelvis brace","code_information":[{"code":"20662","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Application of halo","code_information":[{"code":"20664","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Remove bone fixation device","code_information":[{"code":"20694","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Comp ext fixate strut change","code_information":[{"code":"20697","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Replantation digit complete","code_information":[{"code":"20816","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Replantation digit complete","code_information":[{"code":"20822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Replantation thumb complete","code_information":[{"code":"20824","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Replantation thumb complete","code_information":[{"code":"20827","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of rib fracture","code_information":[{"code":"21813","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Manipulation of spine","code_information":[{"code":"22505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Drain shoulder bone lesion","code_information":[{"code":"23035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat clavicle fracture","code_information":[{"code":"23505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat shoulder blade fx","code_information":[{"code":"23575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"23605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"23625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat shoulder dislocation","code_information":[{"code":"23655","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat dislocation/fracture","code_information":[{"code":"23665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat dislocation/fracture","code_information":[{"code":"23675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Fixation of shoulder","code_information":[{"code":"23700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Manipulate elbow w/anesth","code_information":[{"code":"24300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24566","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24577","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat elbow dislocation","code_information":[{"code":"24605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat elbow fracture","code_information":[{"code":"24620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat radius fracture","code_information":[{"code":"24655","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat ulnar fracture","code_information":[{"code":"24675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Incision of tendon sheath","code_information":[{"code":"25000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Decompress forearm 1 space","code_information":[{"code":"25020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Decompress forearm 2 spaces","code_information":[{"code":"25025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of forearm bursa","code_information":[{"code":"25031","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Remove wrist tendon lesion","code_information":[{"code":"25110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Remove wrist tendon lesion","code_information":[{"code":"25111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Reremove wrist tendon lesion","code_information":[{"code":"25112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Remove wrist/forearm lesion","code_information":[{"code":"25115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Excise wrist tendon sheath","code_information":[{"code":"25118","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft forearm lesion","code_information":[{"code":"25125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Remove forearm foreign body","code_information":[{"code":"25248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Removal of wrist prosthesis","code_information":[{"code":"25250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Manipulate wrist w/anesthes","code_information":[{"code":"25259","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture of radius","code_information":[{"code":"25505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture of radius","code_information":[{"code":"25520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture radius & ulna","code_information":[{"code":"25565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture radius/ulna","code_information":[{"code":"25605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist bone fracture","code_information":[{"code":"25624","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist bone fracture","code_information":[{"code":"25635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist dislocation","code_information":[{"code":"25690","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Amputate hand at wrist","code_information":[{"code":"25922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat hand bone lesion","code_information":[{"code":"26034","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Release palm contracture","code_information":[{"code":"26040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Incise finger tendon sheath","code_information":[{"code":"26055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Incision of finger tendon","code_information":[{"code":"26060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat hand joint","code_information":[{"code":"26070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat finger joint","code_information":[{"code":"26080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy finger joint lining","code_information":[{"code":"26110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Revise finger joint each","code_information":[{"code":"26140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Tendon excision palm/finger","code_information":[{"code":"26145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Remove tendon sheath lesion","code_information":[{"code":"26160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Removal of palm tendon each","code_information":[{"code":"26170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Removal of finger tendon","code_information":[{"code":"26180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Remove finger bone","code_information":[{"code":"26185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Remove hand bone lesion","code_information":[{"code":"26200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Removal of finger lesion","code_information":[{"code":"26210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal finger bone","code_information":[{"code":"26235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal finger bone","code_information":[{"code":"26236","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Resect distal finger tumor","code_information":[{"code":"26262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Manipulate finger w/anesth","code_information":[{"code":"26340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Repair hand tendon","code_information":[{"code":"26410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger tendon","code_information":[{"code":"26418","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger tendon","code_information":[{"code":"26432","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Release palm/finger tendon","code_information":[{"code":"26440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Incision of finger tendon","code_information":[{"code":"26455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Incise hand/finger tendon","code_information":[{"code":"26460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of finger tendons","code_information":[{"code":"26474","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Release finger contracture","code_information":[{"code":"26525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Repair of web finger","code_information":[{"code":"26560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger deformity","code_information":[{"code":"26590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat thumb fracture","code_information":[{"code":"26645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat hand dislocation","code_information":[{"code":"26675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat knuckle dislocation","code_information":[{"code":"26705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26742","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of pelvis bursa","code_information":[{"code":"26991","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Incision of hip tendon","code_information":[{"code":"27000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of sacroiliac joint","code_information":[{"code":"27050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of hip joint","code_information":[{"code":"27052","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Buttock fasciotomy w/dbrdmt","code_information":[{"code":"27057","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27232","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27257","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27266","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Cltx thigh fx w/mnpj","code_information":[{"code":"27268","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Manipulation of hip joint","code_information":[{"code":"27275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of thigh/knee","code_information":[{"code":"27498","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27503","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fx growth plate","code_information":[{"code":"27517","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat knee dislocation","code_information":[{"code":"27552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Fixation of knee joint","code_information":[{"code":"27570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Incision of achilles tendon","code_information":[{"code":"27605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of tibia fracture","code_information":[{"code":"27752","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Cltx med ankle fx w/mnpj","code_information":[{"code":"27762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Cltx post ankle fx w/mnpj","code_information":[{"code":"27768","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of fibula fracture","code_information":[{"code":"27781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27818","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower leg fracture","code_information":[{"code":"27825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat ankle dislocation","code_information":[{"code":"27842","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of foot infection","code_information":[{"code":"28002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Incision of toe tendon","code_information":[{"code":"28010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Incision of toe tendons","code_information":[{"code":"28011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of toe joint","code_information":[{"code":"28024","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foot lesion","code_information":[{"code":"28080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foot lesion","code_information":[{"code":"28090","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Removal of toe lesions","code_information":[{"code":"28092","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Removal of toe lesions","code_information":[{"code":"28108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Resect phalanx of toe tumor","code_information":[{"code":"28175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Release of foot tendon","code_information":[{"code":"28220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Incision of foot tendon(s)","code_information":[{"code":"28230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Incision of toe tendon","code_information":[{"code":"28232","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Incision of foot tendon","code_information":[{"code":"28234","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Revision of foot tendon","code_information":[{"code":"28261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Release of midfoot joint","code_information":[{"code":"28264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Release of toe joint each","code_information":[{"code":"28272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Repair webbed toe(s)","code_information":[{"code":"28345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"28435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat midfoot fracture each","code_information":[{"code":"28455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28546","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Treat toe dislocation","code_information":[{"code":"28635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Hi enrgy eswt plantar fascia","code_information":[{"code":"28890","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Wrist endoscopy/surgery","code_information":[{"code":"29848","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29851","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Mcp joint arthroscopy surg","code_information":[{"code":"29902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1679.19,"maximum":3066.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1712.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3066.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1795.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1880.7,"additional_payer_notes":"APC"}]}]},{"description":"Extracorp shockwv tx anesth","code_information":[{"code":"0102T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl sinus tarsi implant","code_information":[{"code":"0510T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Njx b1 sub mtrl sbchdrl dfct","code_information":[{"code":"0707T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Njx b1 sub mtrl hw fixj aug","code_information":[{"code":"0869T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Rmv s-sclp eltr ra rcvr&tlmt","code_information":[{"code":"0958T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Excise epiphyseal bar","code_information":[{"code":"20150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Open bone biopsy","code_information":[{"code":"20250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Place ndl musc/tis for rt","code_information":[{"code":"20555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Insert and remove bone pin","code_information":[{"code":"20650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Application of thigh brace","code_information":[{"code":"20663","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Open tx septal fx w/wo stabj","code_information":[{"code":"21336","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Drain chest lesion","code_information":[{"code":"21502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of bone lesion","code_information":[{"code":"21510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of rib","code_information":[{"code":"21610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of sternum","code_information":[{"code":"21620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Sternal debridement","code_information":[{"code":"21627","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Revision of neck muscle","code_information":[{"code":"21720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair stern/nuss w/o scope","code_information":[{"code":"21742","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair sternum/nuss w/scope","code_information":[{"code":"21743","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Closed tx vert fx w/manj","code_information":[{"code":"22315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Perq cervicothoracic inject","code_information":[{"code":"22510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Perq lumbosacral injection","code_information":[{"code":"22511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Release shoulder joint","code_information":[{"code":"23020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Exploratory shoulder surgery","code_information":[{"code":"23040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Exploratory shoulder surgery","code_information":[{"code":"23044","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of shoulder joint","code_information":[{"code":"23100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder joint surgery","code_information":[{"code":"23101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Incision of collarbone joint","code_information":[{"code":"23106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal collar bone","code_information":[{"code":"23120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Removal of collar bone","code_information":[{"code":"23125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Remove shoulder bone part","code_information":[{"code":"23130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Removal of bone lesion","code_information":[{"code":"23140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Removal of bone lesion","code_information":[{"code":"23145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Removal of humerus lesion","code_information":[{"code":"23150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Remove collar bone lesion","code_information":[{"code":"23170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Remove shoulder blade lesion","code_information":[{"code":"23172","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of scapula","code_information":[{"code":"23190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Drain arm/elbow bone lesion","code_information":[{"code":"23935","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Exploratory elbow surgery","code_information":[{"code":"24000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Release elbow joint","code_information":[{"code":"24006","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy elbow joint lining","code_information":[{"code":"24100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat elbow joint","code_information":[{"code":"24101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Remove elbow joint lining","code_information":[{"code":"24102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Removal of elbow bursa","code_information":[{"code":"24105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Remove humerus lesion","code_information":[{"code":"24110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Remove elbow lesion","code_information":[{"code":"24120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft bone lesion","code_information":[{"code":"24125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Removal of head of radius","code_information":[{"code":"24130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Remove radius bone lesion","code_information":[{"code":"24136","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of arm bone","code_information":[{"code":"24140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of elbow","code_information":[{"code":"24147","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Removal of elbow joint","code_information":[{"code":"24155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Remove elbow joint implant","code_information":[{"code":"24160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Remove radius head implant","code_information":[{"code":"24164","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Arm tendon lengthening","code_information":[{"code":"24305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Revision of arm tendon","code_information":[{"code":"24310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Tenolysis triceps","code_information":[{"code":"24332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repr elbow lat ligmnt w/tiss","code_information":[{"code":"24343","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair elbow perc","code_information":[{"code":"24357","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair elbow w/deb open","code_information":[{"code":"24358","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair elbow deb/attch open","code_information":[{"code":"24359","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Revision of elbow joint","code_information":[{"code":"24470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"24925","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Incise flexor carpi radialis","code_information":[{"code":"25001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Decompress forearm 1 space","code_information":[{"code":"25023","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Decompress forearm 2 spaces","code_information":[{"code":"25024","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of forearm lesion","code_information":[{"code":"25028","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat wrist joint","code_information":[{"code":"25040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Incision of wrist capsule","code_information":[{"code":"25085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of wrist joint","code_information":[{"code":"25100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat wrist joint","code_information":[{"code":"25101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Remove wrist joint lining","code_information":[{"code":"25105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Remove wrist joint cartilage","code_information":[{"code":"25107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Excise tendon forearm/wrist","code_information":[{"code":"25109","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Remove wrist/forearm lesion","code_information":[{"code":"25116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of ulna","code_information":[{"code":"25119","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Removal of forearm lesion","code_information":[{"code":"25120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft forearm lesion","code_information":[{"code":"25126","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Removal of wrist lesion","code_information":[{"code":"25130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Remove forearm bone lesion","code_information":[{"code":"25145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of ulna","code_information":[{"code":"25150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of radius","code_information":[{"code":"25151","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Removal of wrist bone","code_information":[{"code":"25210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Removal of wrist bones","code_information":[{"code":"25215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of radius","code_information":[{"code":"25230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of ulna","code_information":[{"code":"25240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Removal of wrist prosthesis","code_information":[{"code":"25251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair forearm tendon/muscle","code_information":[{"code":"25260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair forearm tendon/muscle","code_information":[{"code":"25265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair forearm tendon/muscle","code_information":[{"code":"25270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair forearm tendon/muscle","code_information":[{"code":"25272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair forearm tendon/muscle","code_information":[{"code":"25274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair forearm tendon sheath","code_information":[{"code":"25275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Revise wrist/forearm tendon","code_information":[{"code":"25280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Incise wrist/forearm tendon","code_information":[{"code":"25290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Release wrist/forearm tendon","code_information":[{"code":"25295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of tendons at wrist","code_information":[{"code":"25300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of tendons at wrist","code_information":[{"code":"25301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Transplant forearm tendon","code_information":[{"code":"25310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Transplant forearm tendon","code_information":[{"code":"25312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Revise wrist joint","code_information":[{"code":"25332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Realignment of hand","code_information":[{"code":"25335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Revision of radius","code_information":[{"code":"25355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Revise radius or ulna","code_information":[{"code":"25370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Revise radius & ulna","code_information":[{"code":"25375","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair carpal bone shorten","code_information":[{"code":"25394","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft radius & ulna","code_information":[{"code":"25426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Vasc graft into carpal bone","code_information":[{"code":"25430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair wrist joints","code_information":[{"code":"25447","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Arthrp ntrcrpl/crp/mtcrp ssp","code_information":[{"code":"25448","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Revision of wrist joint","code_information":[{"code":"25450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Revision of wrist joint","code_information":[{"code":"25455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Reinforce radius and ulna","code_information":[{"code":"25492","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Treat Fx Distal Radial","code_information":[{"code":"25606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist bone fracture","code_information":[{"code":"25645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Pin ulnar styloid fracture","code_information":[{"code":"25651","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Pin radioulnar dislocation","code_information":[{"code":"25671","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"25907","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Amputate hand at wrist","code_information":[{"code":"25920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"25924","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of hand","code_information":[{"code":"25927","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"25931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Drain hand tendon sheath","code_information":[{"code":"26020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of palm bursa","code_information":[{"code":"26025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of palm bursas","code_information":[{"code":"26030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Decompress fingers/hand","code_information":[{"code":"26035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Decompress fingers/hand","code_information":[{"code":"26037","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Release palm contracture","code_information":[{"code":"26045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat finger joint","code_information":[{"code":"26075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy hand joint lining","code_information":[{"code":"26100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy finger joint lining","code_information":[{"code":"26105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Release palm contracture","code_information":[{"code":"26121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Release palm contracture","code_information":[{"code":"26123","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Remove wrist joint lining","code_information":[{"code":"26130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Revise finger joint each","code_information":[{"code":"26135","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft finger lesion","code_information":[{"code":"26215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of hand bone","code_information":[{"code":"26230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Extensive hand surgery","code_information":[{"code":"26250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Resect prox finger tumor","code_information":[{"code":"26260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger/hand tendon","code_information":[{"code":"26350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger/hand tendon","code_information":[{"code":"26356","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger/hand tendon","code_information":[{"code":"26357","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger/hand tendon","code_information":[{"code":"26370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger/hand tendon","code_information":[{"code":"26373","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft hand tendon","code_information":[{"code":"26412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Excision hand/finger tendon","code_information":[{"code":"26415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Graft hand or finger tendon","code_information":[{"code":"26416","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft finger tendon","code_information":[{"code":"26420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger/hand tendon","code_information":[{"code":"26426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft finger tendon","code_information":[{"code":"26428","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger tendon","code_information":[{"code":"26433","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft finger tendon","code_information":[{"code":"26434","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Realignment of tendons","code_information":[{"code":"26437","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Release palm & finger tendon","code_information":[{"code":"26442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Release hand/finger tendon","code_information":[{"code":"26445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Release forearm/hand tendon","code_information":[{"code":"26449","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Incision of palm tendon","code_information":[{"code":"26450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of finger tendons","code_information":[{"code":"26471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Tendon lengthening","code_information":[{"code":"26476","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Tendon shortening","code_information":[{"code":"26477","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Lengthening of hand tendon","code_information":[{"code":"26478","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Shortening of hand tendon","code_information":[{"code":"26479","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Transplant hand tendon","code_information":[{"code":"26480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Transplant/graft hand tendon","code_information":[{"code":"26483","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Transplant palm tendon","code_information":[{"code":"26485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Transplant/graft palm tendon","code_information":[{"code":"26489","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Revise thumb tendon","code_information":[{"code":"26490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Tendon transfer with graft","code_information":[{"code":"26492","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Hand tendon/muscle transfer","code_information":[{"code":"26494","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Revise thumb tendon","code_information":[{"code":"26496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Finger tendon transfer","code_information":[{"code":"26497","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Finger tendon transfer","code_information":[{"code":"26498","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Revision of finger","code_information":[{"code":"26499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Hand tendon reconstruction","code_information":[{"code":"26502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Release thumb contracture","code_information":[{"code":"26508","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Thumb tendon transfer","code_information":[{"code":"26510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of knuckle joint","code_information":[{"code":"26516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of knuckle joints","code_information":[{"code":"26517","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Release knuckle contracture","code_information":[{"code":"26520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Revise finger joint","code_information":[{"code":"26535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair hand joint","code_information":[{"code":"26540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair hand joint with graft","code_information":[{"code":"26541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair hand joint with graft","code_information":[{"code":"26542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct finger joint","code_information":[{"code":"26545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct finger joint","code_information":[{"code":"26548","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Construct thumb replacement","code_information":[{"code":"26550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair of web finger","code_information":[{"code":"26561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair of web finger","code_information":[{"code":"26562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Correct metacarpal flaw","code_information":[{"code":"26565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Correct finger deformity","code_information":[{"code":"26567","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair hand deformity","code_information":[{"code":"26580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct extra finger","code_information":[{"code":"26587","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair muscles of hand","code_information":[{"code":"26591","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Release muscles of hand","code_information":[{"code":"26593","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Excision constricting tissue","code_information":[{"code":"26596","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Treat metacarpal fracture","code_information":[{"code":"26607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Treat metacarpal fracture","code_information":[{"code":"26608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Treat metacarpal fracture","code_information":[{"code":"26615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Treat thumb fracture","code_information":[{"code":"26650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Treat thumb fracture","code_information":[{"code":"26665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Pin hand dislocation","code_information":[{"code":"26676","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Treat hand dislocation","code_information":[{"code":"26685","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Treat hand dislocation","code_information":[{"code":"26686","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Pin knuckle dislocation","code_information":[{"code":"26706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Treat knuckle dislocation","code_information":[{"code":"26715","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26735","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26746","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Pin finger fracture each","code_information":[{"code":"26756","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26765","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Pin finger dislocation","code_information":[{"code":"26776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Treat finger dislocation","code_information":[{"code":"26785","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of finger joint","code_information":[{"code":"26860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Fusion/graft of finger joint","code_information":[{"code":"26862","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Amputate metacarpal bone","code_information":[{"code":"26910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of finger/thumb","code_information":[{"code":"26951","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of finger/thumb","code_information":[{"code":"26952","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of pelvis lesion","code_information":[{"code":"26990","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of bone lesion","code_information":[{"code":"26992","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Incision of hip tendon","code_information":[{"code":"27001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Incision of hip tendon","code_information":[{"code":"27005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Incision of hip tendons","code_information":[{"code":"27006","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Incision of hip/thigh fascia","code_information":[{"code":"27025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Denervation of hip joint","code_information":[{"code":"27035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Removal of hip joint lining","code_information":[{"code":"27054","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Remove femur lesion/bursa","code_information":[{"code":"27062","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Remove hip bone les deep","code_information":[{"code":"27066","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Part remove hip bone super","code_information":[{"code":"27070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Part removal hip bone deep","code_information":[{"code":"27071","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Removal of tail bone","code_information":[{"code":"27080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Remove hip foreign body","code_information":[{"code":"27087","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Revision of hip tendon","code_information":[{"code":"27097","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Transfer tendon to pelvis","code_information":[{"code":"27098","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Transfer of spinal muscle","code_information":[{"code":"27105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Transfer of iliopsoas muscle","code_information":[{"code":"27111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Treat slipped epiphysis","code_information":[{"code":"27175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Treat slipped epiphysis","code_information":[{"code":"27176","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Treat slipped epiphysis","code_information":[{"code":"27177","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Treat slipped epiphysis","code_information":[{"code":"27178","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Revision of femur epiphysis","code_information":[{"code":"27185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Treat tail bone fracture","code_information":[{"code":"27202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27253","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27258","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27259","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Cltx thigh fx","code_information":[{"code":"27267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of pubic bones","code_information":[{"code":"27282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of bone lesion","code_information":[{"code":"27303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Incise thigh tendon & fascia","code_information":[{"code":"27305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Incision of thigh tendon","code_information":[{"code":"27306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Incision of thigh tendons","code_information":[{"code":"27307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of knee joint","code_information":[{"code":"27310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy knee joint lining","code_information":[{"code":"27330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat knee joint","code_information":[{"code":"27331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Removal of knee cartilage","code_information":[{"code":"27332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Removal of knee cartilage","code_information":[{"code":"27333","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Remove knee joint lining","code_information":[{"code":"27334","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Removal of kneecap bursa","code_information":[{"code":"27340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Removal of knee cyst","code_information":[{"code":"27345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Remove knee cyst","code_information":[{"code":"27347","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Remove femur lesion","code_information":[{"code":"27355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal leg bone(s)","code_information":[{"code":"27360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Resect femur/knee tumor","code_information":[{"code":"27365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Incision of thigh tendon","code_information":[{"code":"27390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Incision of thigh tendons","code_information":[{"code":"27391","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Incision of thigh tendons","code_information":[{"code":"27392","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Lengthening of thigh tendons","code_information":[{"code":"27395","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Lat retinacular release open","code_information":[{"code":"27425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Incision of knee joint","code_information":[{"code":"27435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of thigh/knee","code_information":[{"code":"27496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of thigh/knee","code_information":[{"code":"27497","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Treat knee fracture","code_information":[{"code":"27532","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Amputate leg at thigh","code_information":[{"code":"27590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Amputate leg at thigh","code_information":[{"code":"27591","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Amputate leg at thigh","code_information":[{"code":"27592","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"27594","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"27596","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Amputate lower leg at knee","code_information":[{"code":"27598","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of lower leg","code_information":[{"code":"27600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of lower leg","code_information":[{"code":"27601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of lower leg","code_information":[{"code":"27602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Drain lower leg bursa","code_information":[{"code":"27604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Incision of achilles tendon","code_information":[{"code":"27606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower leg bone lesion","code_information":[{"code":"27607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat ankle joint","code_information":[{"code":"27610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of ankle joint","code_information":[{"code":"27612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat ankle joint","code_information":[{"code":"27620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Remove ankle joint lining","code_information":[{"code":"27625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Remove ankle joint lining","code_information":[{"code":"27626","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Removal of tendon lesion","code_information":[{"code":"27630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Remove lower leg bone lesion","code_information":[{"code":"27635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of tibia","code_information":[{"code":"27640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of fibula","code_information":[{"code":"27641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Resect tibia tumor","code_information":[{"code":"27645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Resect fibula tumor","code_information":[{"code":"27646","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Resect talus/calcaneus tum","code_information":[{"code":"27647","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair leg fascia defect","code_information":[{"code":"27656","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair of leg tendon each","code_information":[{"code":"27658","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair lower leg tendons","code_information":[{"code":"27675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Release of lower leg tendon","code_information":[{"code":"27680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Release of lower leg tendons","code_information":[{"code":"27681","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Revision of lower leg tendon","code_information":[{"code":"27685","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Revise lower leg tendons","code_information":[{"code":"27686","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Revision of calf tendon","code_information":[{"code":"27687","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Removal of ankle implant","code_information":[{"code":"27704","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Incision of fibula","code_information":[{"code":"27707","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair of lower leg","code_information":[{"code":"27727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair of tibia epiphysis","code_information":[{"code":"27730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair of fibula epiphysis","code_information":[{"code":"27732","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair lower leg epiphyses","code_information":[{"code":"27734","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair of leg epiphyses","code_information":[{"code":"27740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair of leg epiphyses","code_information":[{"code":"27742","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower leg dislocation","code_information":[{"code":"27831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Fixation of ankle joint","code_information":[{"code":"27860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of lower leg","code_information":[{"code":"27881","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of lower leg","code_information":[{"code":"27882","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"27884","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"27886","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of foot at ankle","code_information":[{"code":"27888","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of leg","code_information":[{"code":"27892","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of leg","code_information":[{"code":"27894","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of foot infection","code_information":[{"code":"28003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Treat foot bone lesion","code_information":[{"code":"28005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Incision of foot fascia","code_information":[{"code":"28008","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of foot joint","code_information":[{"code":"28020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of foot joint","code_information":[{"code":"28022","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of foot joint lining","code_information":[{"code":"28050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of foot joint lining","code_information":[{"code":"28052","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of toe joint lining","code_information":[{"code":"28054","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal foot fascia","code_information":[{"code":"28060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foot fascia","code_information":[{"code":"28062","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foot joint lining","code_information":[{"code":"28072","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Excise foot tendon sheath","code_information":[{"code":"28086","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Excise foot tendon sheath","code_information":[{"code":"28088","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Removal of ankle/heel lesion","code_information":[{"code":"28100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foot lesion","code_information":[{"code":"28104","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Part removal of metatarsal","code_information":[{"code":"28110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Part removal of metatarsal","code_information":[{"code":"28111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Part removal of metatarsal","code_information":[{"code":"28112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Part removal of metatarsal","code_information":[{"code":"28113","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Removal of metatarsal heads","code_information":[{"code":"28114","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Revision of foot","code_information":[{"code":"28116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Removal of heel bone","code_information":[{"code":"28118","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Removal of heel spur","code_information":[{"code":"28119","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Part removal of ankle/heel","code_information":[{"code":"28120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of foot bone","code_information":[{"code":"28122","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of toe","code_information":[{"code":"28124","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of toe","code_information":[{"code":"28126","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Removal of metatarsal","code_information":[{"code":"28140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Removal of toe","code_information":[{"code":"28150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of toe","code_information":[{"code":"28153","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of toe","code_information":[{"code":"28160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Resect tarsal tumor","code_information":[{"code":"28171","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Resect metatarsal tumor","code_information":[{"code":"28173","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair of foot tendon","code_information":[{"code":"28200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair of foot tendon","code_information":[{"code":"28208","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Release of foot tendons","code_information":[{"code":"28222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Release of foot tendon","code_information":[{"code":"28225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Release of foot tendons","code_information":[{"code":"28226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Release of big toe","code_information":[{"code":"28240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Revision of foot fascia","code_information":[{"code":"28250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Release of midfoot joint","code_information":[{"code":"28260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Release of foot contracture","code_information":[{"code":"28270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of toes","code_information":[{"code":"28280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair of hammertoe","code_information":[{"code":"28285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair of hammertoe","code_information":[{"code":"28286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of foot bone","code_information":[{"code":"28288","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Corrj halux rigdus w/o implt","code_information":[{"code":"28289","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Correction hallux valgus","code_information":[{"code":"28292","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Correction hallux valgus","code_information":[{"code":"28295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Correction hallux valgus","code_information":[{"code":"28296","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Incision of metatarsal","code_information":[{"code":"28308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Revision of toe","code_information":[{"code":"28312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair deformity of toe","code_information":[{"code":"28313","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Removal of sesamoid bone","code_information":[{"code":"28315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Resect enlarged toe tissue","code_information":[{"code":"28340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Resect enlarged toe","code_information":[{"code":"28341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair extra toe(s)","code_information":[{"code":"28344","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Treat metatarsal fracture","code_information":[{"code":"28476","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Treat big toe fracture","code_information":[{"code":"28496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Treat big toe fracture","code_information":[{"code":"28505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Treat toe fracture","code_information":[{"code":"28525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Treat toe dislocation","code_information":[{"code":"28636","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair toe dislocation","code_information":[{"code":"28645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Treat toe dislocation","code_information":[{"code":"28666","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Repair of toe dislocation","code_information":[{"code":"28675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of midfoot","code_information":[{"code":"28800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Amputation thru metatarsal","code_information":[{"code":"28805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Amputation toe & metatarsal","code_information":[{"code":"28810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of toe","code_information":[{"code":"28820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Partial amputation of toe","code_information":[{"code":"28825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Jaw arthroscopy/surgery","code_information":[{"code":"29800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Jaw arthroscopy/surgery","code_information":[{"code":"29804","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy dx","code_information":[{"code":"29805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29819","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29823","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29824","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Elbow arthroscopy","code_information":[{"code":"29830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Elbow arthroscopy/surgery","code_information":[{"code":"29834","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Elbow arthroscopy/surgery","code_information":[{"code":"29835","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Elbow arthroscopy/surgery","code_information":[{"code":"29837","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Elbow arthroscopy/surgery","code_information":[{"code":"29838","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Wrist arthroscopy","code_information":[{"code":"29840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Wrist arthroscopy/surgery","code_information":[{"code":"29843","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Wrist arthroscopy/surgery","code_information":[{"code":"29844","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Wrist arthroscopy/surgery","code_information":[{"code":"29845","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Wrist arthroscopy/surgery","code_information":[{"code":"29846","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Hip arthr0 w/synovectomy","code_information":[{"code":"29863","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy dx","code_information":[{"code":"29870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/drainage","code_information":[{"code":"29871","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29873","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29874","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29875","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29876","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29877","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29879","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29881","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29882","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29883","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29884","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29886","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Ankle arthroscopy/surgery","code_information":[{"code":"29891","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Scope plantar fasciotomy","code_information":[{"code":"29893","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Ankle arthroscopy/surgery","code_information":[{"code":"29894","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Ankle arthroscopy/surgery","code_information":[{"code":"29895","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Ankle arthroscopy/surgery","code_information":[{"code":"29897","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Ankle arthroscopy/surgery","code_information":[{"code":"29898","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Mcp joint arthroscopy dx","code_information":[{"code":"29900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Mcp joint arthroscopy surg","code_information":[{"code":"29901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Subtalar arthro w/fb rmvl","code_information":[{"code":"29904","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Subtalar arthro w/deb","code_information":[{"code":"29906","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Rmv sk-mnt crnl nstm pg/rcvr","code_information":[{"code":"61892","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Remove sympathetic nerves","code_information":[{"code":"64821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Remove sympathetic nerves","code_information":[{"code":"64822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Sympathectomy supfc palmar","code_information":[{"code":"64823","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl oi implt skl perq esp","code_information":[{"code":"69726","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl oi implt skl tc esp","code_information":[{"code":"69727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Rmv ntr oi imp sktc esp>=100","code_information":[{"code":"69728","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Tmj arthroscopy disc reposit","code_information":[{"code":"D7874","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Open tx post pelvic fxcture","code_information":[{"code":"G0415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3416.88,"maximum":6239.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6239.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3652.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3826.91,"additional_payer_notes":"APC"}]}]},{"description":"Perq sacral augmt unilat inj","code_information":[{"code":"0200T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Perq sacral augmt bilat inj","code_information":[{"code":"0201T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Plmt post facet implt lumb","code_information":[{"code":"0221T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Perq lamot/lam crv/thrc","code_information":[{"code":"0274T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Extraosseous joint stblztion","code_information":[{"code":"0335T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl&rinsj sinus tarsi implt","code_information":[{"code":"0511T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Osteot hum xtrnl lngth dev","code_information":[{"code":"0594T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Replace tissue expander","code_information":[{"code":"11970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Open bone biopsy","code_information":[{"code":"20251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Apply bone fixation device","code_information":[{"code":"20690","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Adjust bone fixation device","code_information":[{"code":"20693","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Removal of bone for graft","code_information":[{"code":"20900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Removal of bone for graft","code_information":[{"code":"20902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Removal of tendon for graft","code_information":[{"code":"20924","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Fibula bone graft microvasc","code_information":[{"code":"20955","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Iliac bone graft microvasc","code_information":[{"code":"20956","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Mt bone graft microvasc","code_information":[{"code":"20957","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Other bone graft microvasc","code_information":[{"code":"20962","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Bone/skin graft microvasc","code_information":[{"code":"20969","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Bone/skin graft iliac crest","code_information":[{"code":"20970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Bone/skin graft metatarsal","code_information":[{"code":"20972","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Bone/skin graft great toe","code_information":[{"code":"20973","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Ablate bone tumor(s) perq","code_information":[{"code":"20983","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of rib","code_information":[{"code":"21600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Exc ch wal tum w/o lymphadec","code_information":[{"code":"21602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Exc ch wal tum w/lymphadec","code_information":[{"code":"21603","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Removal of rib","code_information":[{"code":"21615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Removal of rib and nerves","code_information":[{"code":"21616","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Extensive sternum surgery","code_information":[{"code":"21630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Revision of neck muscle","code_information":[{"code":"21700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Revision of neck muscle/rib","code_information":[{"code":"21705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of sternum","code_information":[{"code":"21740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair of sternum separation","code_information":[{"code":"21750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Optx of rib fx w/fixj scope","code_information":[{"code":"21811","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of rib fracture","code_information":[{"code":"21812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat sternum fracture","code_information":[{"code":"21825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"I&d p-spine c/t/cerv-thor","code_information":[{"code":"22010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"I&d abscess p-spine l/s/ls","code_information":[{"code":"22015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove part of neck vertebra","code_information":[{"code":"22100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove part thorax vertebra","code_information":[{"code":"22101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove part lumbar vertebra","code_information":[{"code":"22102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove part of neck vertebra","code_information":[{"code":"22110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove part thorax vertebra","code_information":[{"code":"22112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove part lumbar vertebra","code_information":[{"code":"22114","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Incis spine 3 column thorac","code_information":[{"code":"22206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Incis spine 3 column lumbar","code_information":[{"code":"22207","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Incis 1 vertebral seg cerv","code_information":[{"code":"22210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Incis 1 vertebral seg thorac","code_information":[{"code":"22212","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Incis 1 vertebral seg lumbar","code_information":[{"code":"22214","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Incis w/discectomy cervical","code_information":[{"code":"22220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Incis w/discectomy thoracic","code_information":[{"code":"22222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Incis w/discectomy lumbar","code_information":[{"code":"22224","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Perq vertebral augmentation","code_information":[{"code":"22513","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Perq vertebral augmentation","code_information":[{"code":"22514","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of spinal fusion","code_information":[{"code":"22830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine fixation device","code_information":[{"code":"22850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine fixation device","code_information":[{"code":"22852","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine fixation device","code_information":[{"code":"22855","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove cerv artif disc","code_information":[{"code":"22864","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove Lumb Artif Disc","code_information":[{"code":"22865","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove shoulder joint lining","code_information":[{"code":"23105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Explore treat shoulder joint","code_information":[{"code":"23107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Removal of bone lesion","code_information":[{"code":"23146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Removal of humerus lesion","code_information":[{"code":"23155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Removal of humerus lesion","code_information":[{"code":"23156","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove humerus lesion","code_information":[{"code":"23174","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove collar bone lesion","code_information":[{"code":"23180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove shoulder blade lesion","code_information":[{"code":"23182","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove humerus lesion","code_information":[{"code":"23184","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Removal of head of humerus","code_information":[{"code":"23195","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Resect clavicle tumor","code_information":[{"code":"23200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Resect scapula tumor","code_information":[{"code":"23210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Resect prox humerus tumor","code_information":[{"code":"23220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder prosthesis removal","code_information":[{"code":"23334","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder prosthesis removal","code_information":[{"code":"23335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Muscle transfer shoulder/arm","code_information":[{"code":"23395","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Muscle transfers","code_information":[{"code":"23397","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Fixation of shoulder blade","code_information":[{"code":"23400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Incision of tendon & muscle","code_information":[{"code":"23405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Incise tendon(s) & muscle(s)","code_information":[{"code":"23406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair rotator cuff acute","code_information":[{"code":"23410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair rotator cuff chronic","code_information":[{"code":"23412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Release of shoulder ligament","code_information":[{"code":"23415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair of shoulder","code_information":[{"code":"23420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair biceps tendon","code_information":[{"code":"23430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove/transplant tendon","code_information":[{"code":"23440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair shoulder capsule","code_information":[{"code":"23450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair shoulder capsule","code_information":[{"code":"23455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair shoulder capsule","code_information":[{"code":"23460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair shoulder capsule","code_information":[{"code":"23462","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair shoulder capsule","code_information":[{"code":"23465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair shoulder capsule","code_information":[{"code":"23466","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Revision of collar bone","code_information":[{"code":"23480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Reinforce clavicle","code_information":[{"code":"23490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat clavicle fracture","code_information":[{"code":"23515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23532","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat scapula fracture","code_information":[{"code":"23585","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"23630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat shoulder dislocation","code_information":[{"code":"23660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat dislocation/fracture","code_information":[{"code":"23670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of shoulder joint","code_information":[{"code":"23800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft bone lesion","code_information":[{"code":"24115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft bone lesion","code_information":[{"code":"24116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft bone lesion","code_information":[{"code":"24126","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Removal of arm bone lesion","code_information":[{"code":"24134","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove elbow bone lesion","code_information":[{"code":"24138","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of radius","code_information":[{"code":"24145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Radical resection of elbow","code_information":[{"code":"24149","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Resect distal humerus tumor","code_information":[{"code":"24150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Resect radius tumor","code_information":[{"code":"24152","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Muscle/tendon transfer","code_information":[{"code":"24301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair of arm tendon","code_information":[{"code":"24320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Revision of arm muscles","code_information":[{"code":"24330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Revision of arm muscles","code_information":[{"code":"24331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair of biceps tendon","code_information":[{"code":"24340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair arm tendon/muscle","code_information":[{"code":"24341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair of ruptured tendon","code_information":[{"code":"24342","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct elbow lat ligmnt","code_information":[{"code":"24344","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repr elbw med ligmnt w/tissu","code_information":[{"code":"24345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct elbow joint","code_information":[{"code":"24360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Revision of humerus","code_information":[{"code":"24400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Revision of humerus","code_information":[{"code":"24420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of forearm","code_information":[{"code":"24495","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24538","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24582","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat elbow dislocation","code_information":[{"code":"24615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat elbow fracture","code_information":[{"code":"24635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat radius fracture","code_information":[{"code":"24665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat ulnar fracture","code_information":[{"code":"24685","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of elbow joint","code_information":[{"code":"24800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"24930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Revision of amputation","code_information":[{"code":"24935","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat forearm bone lesion","code_information":[{"code":"25035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove & graft wrist lesion","code_information":[{"code":"25135","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove & graft wrist lesion","code_information":[{"code":"25136","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Resect radius/ulnar tumor","code_information":[{"code":"25170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair forearm tendon/muscle","code_information":[{"code":"25263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Revise palsy hand tendon(s)","code_information":[{"code":"25315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Revise palsy hand tendon(s)","code_information":[{"code":"25316","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair/revise wrist joint","code_information":[{"code":"25320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct ulna/radioulnar","code_information":[{"code":"25337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Revision of radius","code_information":[{"code":"25350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Revision of ulna","code_information":[{"code":"25360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Shorten radius or ulna","code_information":[{"code":"25390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Shorten radius & ulna","code_information":[{"code":"25392","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Lengthen radius & ulna","code_information":[{"code":"25393","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair radius or ulna","code_information":[{"code":"25400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft radius or ulna","code_information":[{"code":"25405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair radius & ulna","code_information":[{"code":"25415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft radius & ulna","code_information":[{"code":"25420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft radius or ulna","code_information":[{"code":"25425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair nonunion carpal bone","code_information":[{"code":"25431","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft wrist bone","code_information":[{"code":"25440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct wrist joint","code_information":[{"code":"25443","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct wrist joint","code_information":[{"code":"25445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove wrist joint implant","code_information":[{"code":"25449","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Reinforce radius","code_information":[{"code":"25490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture of radius","code_information":[{"code":"25515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture of radius","code_information":[{"code":"25525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture of radius","code_information":[{"code":"25526","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture of ulna","code_information":[{"code":"25545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture radius & ulna","code_information":[{"code":"25574","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture radius/ulna","code_information":[{"code":"25575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat Fx Rad Extra-Articul","code_information":[{"code":"25607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat Fx Rad Intra-Articul","code_information":[{"code":"25608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat Fx Radial 3+ Frag","code_information":[{"code":"25609","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist bone fracture","code_information":[{"code":"25628","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture ulnar styloid","code_information":[{"code":"25652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist dislocation","code_information":[{"code":"25670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist dislocation","code_information":[{"code":"25676","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist fracture","code_information":[{"code":"25685","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist dislocation","code_information":[{"code":"25695","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of wrist joint","code_information":[{"code":"25800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Fusion/graft of wrist joint","code_information":[{"code":"25805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of hand bones","code_information":[{"code":"25820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Fuse hand bones with graft","code_information":[{"code":"25825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Fusion radioulnar jnt/ulna","code_information":[{"code":"25830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of forearm","code_information":[{"code":"25900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of forearm","code_information":[{"code":"25905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"25909","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of forearm","code_information":[{"code":"25915","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft bone lesion","code_information":[{"code":"26205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft hand tendon","code_information":[{"code":"26352","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft hand tendon","code_information":[{"code":"26358","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft hand tendon","code_information":[{"code":"26372","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Revise hand/finger tendon","code_information":[{"code":"26390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft hand tendon","code_information":[{"code":"26392","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Hand tendon reconstruction","code_information":[{"code":"26500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of knuckle joints","code_information":[{"code":"26518","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Revise knuckle joint","code_information":[{"code":"26530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Revise knuckle with implant","code_information":[{"code":"26531","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Revise/implant finger joint","code_information":[{"code":"26536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair nonunion hand","code_information":[{"code":"26546","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Great toe-hand transfer","code_information":[{"code":"26551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Single transfer toe-hand","code_information":[{"code":"26553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Double transfer toe-hand","code_information":[{"code":"26554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Positional change of finger","code_information":[{"code":"26555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Toe joint transfer","code_information":[{"code":"26556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Lengthen metacarpal/finger","code_information":[{"code":"26568","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Thumb fusion with graft","code_information":[{"code":"26820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of thumb","code_information":[{"code":"26841","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Thumb fusion with graft","code_information":[{"code":"26842","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of hand joint","code_information":[{"code":"26843","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Fusion/graft of hand joint","code_information":[{"code":"26844","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of knuckle","code_information":[{"code":"26850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of knuckle with graft","code_information":[{"code":"26852","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Incision of hip tendon","code_information":[{"code":"27003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Buttock fasciotomy","code_information":[{"code":"27027","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of hip joint","code_information":[{"code":"27030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of hip joint","code_information":[{"code":"27033","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Excision of hip joint/muscle","code_information":[{"code":"27036","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Removal of ischial bursa","code_information":[{"code":"27060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove hip bone les super","code_information":[{"code":"27065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft hip bone lesion","code_information":[{"code":"27067","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Resect hip tumor","code_information":[{"code":"27075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Resect hip tum incl acetabul","code_information":[{"code":"27076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Resect hip tum w/innom bone","code_information":[{"code":"27077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Rsect hip tum incl femur","code_information":[{"code":"27078","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Removal of hip prosthesis","code_information":[{"code":"27090","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Transfer of abdominal muscle","code_information":[{"code":"27100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Transfer of iliopsoas muscle","code_information":[{"code":"27110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of hip socket","code_information":[{"code":"27122","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Transplant femur ridge","code_information":[{"code":"27140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Incision of hip bone","code_information":[{"code":"27146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Revision of hip bone","code_information":[{"code":"27147","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Incision of hip bones","code_information":[{"code":"27151","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Revision of hip bones","code_information":[{"code":"27156","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Revision of pelvis","code_information":[{"code":"27158","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Incision of neck of femur","code_information":[{"code":"27161","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Incision/fixation of femur","code_information":[{"code":"27165","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft femur head/neck","code_information":[{"code":"27170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Revise head/neck of femur","code_information":[{"code":"27179","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat slipped epiphysis","code_information":[{"code":"27181","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Reinforce hip bones","code_information":[{"code":"27187","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip wall fracture","code_information":[{"code":"27226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip fracture(s)","code_information":[{"code":"27227","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip fracture(s)","code_information":[{"code":"27228","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27236","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27244","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27254","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Optx thigh fx","code_information":[{"code":"27269","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove knee joint lining","code_information":[{"code":"27335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Removal of kneecap","code_information":[{"code":"27350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove femur lesion/graft","code_information":[{"code":"27357","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair of kneecap tendon","code_information":[{"code":"27380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft kneecap tendon","code_information":[{"code":"27381","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair of thigh muscle","code_information":[{"code":"27385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft of thigh muscle","code_information":[{"code":"27386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Lengthening of thigh tendon","code_information":[{"code":"27393","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Lengthening of thigh tendons","code_information":[{"code":"27394","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Transplant of thigh tendon","code_information":[{"code":"27396","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Transplants of thigh tendons","code_information":[{"code":"27397","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Revise thigh muscles/tendons","code_information":[{"code":"27400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair of knee cartilage","code_information":[{"code":"27403","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair of knee ligament","code_information":[{"code":"27405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair of knee ligament","code_information":[{"code":"27407","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair of knee ligaments","code_information":[{"code":"27409","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Autochondrocyte implant knee","code_information":[{"code":"27412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Osteochondral knee autograft","code_information":[{"code":"27416","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair degenerated kneecap","code_information":[{"code":"27418","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Revision of unstable kneecap","code_information":[{"code":"27420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Revision of unstable kneecap","code_information":[{"code":"27422","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Revision/removal of kneecap","code_information":[{"code":"27424","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction knee","code_information":[{"code":"27427","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Revision of thigh muscles","code_information":[{"code":"27430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Revise kneecap","code_information":[{"code":"27437","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Incision of thigh","code_information":[{"code":"27448","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Incision of thigh","code_information":[{"code":"27450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Realignment of thigh bone","code_information":[{"code":"27454","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Realignment of knee","code_information":[{"code":"27455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Realignment of knee","code_information":[{"code":"27457","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Osteot femur imed lngth dev","code_information":[{"code":"27458","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Shortening of thigh bone","code_information":[{"code":"27465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Lengthening of thigh bone","code_information":[{"code":"27466","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair of thigh","code_information":[{"code":"27470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft of thigh","code_information":[{"code":"27472","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Surgery to stop leg growth","code_information":[{"code":"27475","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Surgery to stop leg growth","code_information":[{"code":"27477","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Surgery to stop leg growth","code_information":[{"code":"27479","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Surgery to stop leg growth","code_information":[{"code":"27485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Reinforce thigh","code_information":[{"code":"27495","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of thigh/knee","code_information":[{"code":"27499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27506","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27507","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27509","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fx growth plate","code_information":[{"code":"27519","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat kneecap fracture","code_information":[{"code":"27524","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat knee fracture","code_information":[{"code":"27535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat knee fracture","code_information":[{"code":"27536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat knee fracture","code_information":[{"code":"27540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat knee dislocation","code_information":[{"code":"27556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat knee dislocation","code_information":[{"code":"27557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat knee dislocation","code_information":[{"code":"27558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat kneecap dislocation","code_information":[{"code":"27566","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft leg bone lesion","code_information":[{"code":"27637","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft leg bone lesion","code_information":[{"code":"27638","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair achilles tendon","code_information":[{"code":"27650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft achilles tendon","code_information":[{"code":"27652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair of achilles tendon","code_information":[{"code":"27654","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair of leg tendon each","code_information":[{"code":"27659","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair of leg tendon each","code_information":[{"code":"27664","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair of leg tendon each","code_information":[{"code":"27665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair lower leg tendons","code_information":[{"code":"27676","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Revise lower leg tendon","code_information":[{"code":"27690","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Revise lower leg tendon","code_information":[{"code":"27691","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair of ankle ligament","code_information":[{"code":"27695","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair of ankle ligaments","code_information":[{"code":"27696","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair of ankle ligament","code_information":[{"code":"27698","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Revision of ankle joint","code_information":[{"code":"27700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Incision of tibia","code_information":[{"code":"27705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Osteot tibia imed lngth dev","code_information":[{"code":"27713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair of tibia","code_information":[{"code":"27720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft of tibia","code_information":[{"code":"27722","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft of tibia","code_information":[{"code":"27724","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair of lower leg","code_information":[{"code":"27725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair fibula nonunion","code_information":[{"code":"27726","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Reinforce tibia","code_information":[{"code":"27745","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of tibia fracture","code_information":[{"code":"27756","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Optx medial ankle fx","code_information":[{"code":"27766","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Optx post ankle fx","code_information":[{"code":"27769","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of fibula fracture","code_information":[{"code":"27784","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27792","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27814","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27823","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower leg fracture","code_information":[{"code":"27826","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower leg joint","code_information":[{"code":"27829","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower leg dislocation","code_information":[{"code":"27832","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat ankle dislocation","code_information":[{"code":"27846","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat ankle dislocation","code_information":[{"code":"27848","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of lower leg","code_information":[{"code":"27880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of foot at ankle","code_information":[{"code":"27889","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of leg","code_information":[{"code":"27893","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foot joint lining","code_information":[{"code":"28070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft foot lesion","code_information":[{"code":"28102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft foot lesion","code_information":[{"code":"28103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft foot lesion","code_information":[{"code":"28106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft foot lesion","code_information":[{"code":"28107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Removal of ankle bone","code_information":[{"code":"28130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft of foot tendon","code_information":[{"code":"28202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft of foot tendon","code_information":[{"code":"28210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Revision of foot tendon","code_information":[{"code":"28238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Revision of foot and ankle","code_information":[{"code":"28262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Corrj halux rigdus w/implt","code_information":[{"code":"28291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Correction hallux valgus","code_information":[{"code":"28298","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Correction hallux valgus","code_information":[{"code":"28299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Incision of heel bone","code_information":[{"code":"28300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Incision of ankle bone","code_information":[{"code":"28302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Incision of midfoot bones","code_information":[{"code":"28304","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Incise/graft midfoot bones","code_information":[{"code":"28305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Incision of metatarsal","code_information":[{"code":"28306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Incision of metatarsal","code_information":[{"code":"28307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Incision of metatarsals","code_information":[{"code":"28309","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Revision of big toe","code_information":[{"code":"28310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair of metatarsals","code_information":[{"code":"28322","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct cleft foot","code_information":[{"code":"28360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of heel fracture","code_information":[{"code":"28406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat heel fracture","code_information":[{"code":"28415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"28436","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat ankle fracture","code_information":[{"code":"28445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Osteochondral talus autogrft","code_information":[{"code":"28446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat midfoot fracture","code_information":[{"code":"28456","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat midfoot fracture each","code_information":[{"code":"28465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat metatarsal fracture","code_information":[{"code":"28485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat sesamoid bone fracture","code_information":[{"code":"28531","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair foot dislocation","code_information":[{"code":"28555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair foot dislocation","code_information":[{"code":"28585","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Repair foot dislocation","code_information":[{"code":"28615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of foot bones","code_information":[{"code":"28740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of big toe joint","code_information":[{"code":"28750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of big toe joint","code_information":[{"code":"28755","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of big toe joint","code_information":[{"code":"28760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29806","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29807","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Arthroscop rotator cuff repr","code_information":[{"code":"29827","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Arthroscopy biceps tenodesis","code_information":[{"code":"29828","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Elbow arthroscopy/surgery","code_information":[{"code":"29836","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Wrist arthroscopy/surgery","code_information":[{"code":"29847","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Tibial arthroscopy/surgery","code_information":[{"code":"29855","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Hip arthroscopy dx","code_information":[{"code":"29860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Hip arthro w/fb removal","code_information":[{"code":"29861","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Hip arthr0 w/debridement","code_information":[{"code":"29862","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Autgrft implnt knee w/scope","code_information":[{"code":"29866","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Meniscal trnspl knee w/scpe","code_information":[{"code":"29868","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29887","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29888","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Ankle arthroscopy/surgery","code_information":[{"code":"29892","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Ankle arthroscopy/surgery","code_information":[{"code":"29899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Subtalar arthro w/exc","code_information":[{"code":"29905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Hip arthro w/femoroplasty","code_information":[{"code":"29914","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Hip arthro acetabuloplasty","code_information":[{"code":"29915","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Hip arthro w/labral repair","code_information":[{"code":"29916","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Dcmprn prq rmv lig flv 1lmbr","code_information":[{"code":"62330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Implant spinal canal cath","code_information":[{"code":"62351","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Ndsc dcmprn 1 ntrspc lumbar","code_information":[{"code":"62380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina 1/2 crvl","code_information":[{"code":"63001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina 1/2 thrc","code_information":[{"code":"63003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina 1/2 lmbr","code_information":[{"code":"63005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina 1/2 scrl","code_information":[{"code":"63011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove lamina/facets lumbar","code_information":[{"code":"63012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina >2 crvcl","code_information":[{"code":"63015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina >2 thrc","code_information":[{"code":"63016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina >2 lmbr","code_information":[{"code":"63017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Neck spine disk surgery","code_information":[{"code":"63020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Low back disk surgery","code_information":[{"code":"63030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Laminotomy single cervical","code_information":[{"code":"63040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Laminotomy single lumbar","code_information":[{"code":"63042","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina 1 crvl","code_information":[{"code":"63045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina 1 thrc","code_information":[{"code":"63046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina 1 lmbr","code_information":[{"code":"63047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Decompress spinal cord thrc","code_information":[{"code":"63055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Decompress spinal cord lmbr","code_information":[{"code":"63056","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Decompress spinal cord thrc","code_information":[{"code":"63064","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Neck spine disk surgery","code_information":[{"code":"63075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Excise intraspinl lesion crv","code_information":[{"code":"63265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Excise intrspinl lesion thrc","code_information":[{"code":"63266","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Excise intrspinl lesion lmbr","code_information":[{"code":"63267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Excise intrspinl lesion scrl","code_information":[{"code":"63268","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Temple Bone Implant Revision","code_information":[{"code":"69717","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Pild/placebo control clin tr","code_information":[{"code":"G0276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Open tx iliac spine uni/bil","code_information":[{"code":"G0412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Pelvic ring fracture uni/bil","code_information":[{"code":"G0413","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Pelvic ring fx treat int fix","code_information":[{"code":"G0414","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7577.51,"maximum":13836.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7729.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13836.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8100.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8486.81,"additional_payer_notes":"APC"}]}]},{"description":"Post vert arthrplst 1 lumbar","code_information":[{"code":"0202T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Plmt post facet implt cerv","code_information":[{"code":"0219T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Plmt post facet implt thor","code_information":[{"code":"0220T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Perq njx algc fluor lmbr 1st","code_information":[{"code":"0627T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Perq njx algc ct lmbr 1st","code_information":[{"code":"0629T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Xenograft impltj artclr surf","code_information":[{"code":"0737T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Arthrp 1st crp/mtcrpl prostc","code_information":[{"code":"1003T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Apply bone fixation device","code_information":[{"code":"20692","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Treat odontoid fx w/o graft","code_information":[{"code":"22318","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Treat odontoid fx w/graft","code_information":[{"code":"22319","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Treat spine fracture","code_information":[{"code":"22325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Treat neck spine fracture","code_information":[{"code":"22326","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Treat thorax spine fracture","code_information":[{"code":"22327","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Lat thorax spine fusion","code_information":[{"code":"22532","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Neck spine fusion","code_information":[{"code":"22548","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Neck spine fuse&remov bel c2","code_information":[{"code":"22551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Neck spine fusion","code_information":[{"code":"22554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Spine & skull spinal fusion","code_information":[{"code":"22590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Neck spinal fusion","code_information":[{"code":"22595","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Reinsert spinal fixation","code_information":[{"code":"22849","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Insj stablj dev w/o dcmprn","code_information":[{"code":"22869","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct shoulder joint","code_information":[{"code":"23470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Revis reconst shoulder joint","code_information":[{"code":"23473","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Revis reconst shoulder joint","code_information":[{"code":"23474","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Revision of collar bone","code_information":[{"code":"23485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Reinforce shoulder bones","code_information":[{"code":"23491","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"23615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Treat dislocation/fracture","code_information":[{"code":"23680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of shoulder joint","code_information":[{"code":"23802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of arm & girdle","code_information":[{"code":"23900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Amputation at shoulder joint","code_information":[{"code":"23920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct elbow med ligmnt","code_information":[{"code":"24346","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct elbow joint","code_information":[{"code":"24362","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct head of radius","code_information":[{"code":"24365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct head of radius","code_information":[{"code":"24366","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Revise reconst elbow joint","code_information":[{"code":"24370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Revision of humerus","code_information":[{"code":"24410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Repair of humerus","code_information":[{"code":"24430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Repair humerus with graft","code_information":[{"code":"24435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Reinforce humerus","code_information":[{"code":"24498","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24546","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24579","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Treat elbow fracture","code_information":[{"code":"24586","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Treat elbow fracture","code_information":[{"code":"24587","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Treat radius fracture","code_information":[{"code":"24666","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Fusion/graft of elbow joint","code_information":[{"code":"24802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of upper arm","code_information":[{"code":"24900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of upper arm","code_information":[{"code":"24920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Amputate upper arm & implant","code_information":[{"code":"24931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Revision of upper arm","code_information":[{"code":"24940","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Revise radius & ulna","code_information":[{"code":"25365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Lengthen radius or ulna","code_information":[{"code":"25391","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct wrist joint","code_information":[{"code":"25441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct wrist joint","code_information":[{"code":"25444","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Reinforce ulna","code_information":[{"code":"25491","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Fusion/graft of wrist joint","code_information":[{"code":"25810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Removal of hip prosthesis","code_information":[{"code":"27091","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of hip socket","code_information":[{"code":"27120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Partial hip replacement","code_information":[{"code":"27125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Total hip arthroplasty","code_information":[{"code":"27130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Total hip arthroplasty","code_information":[{"code":"27132","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Revise hip joint replacement","code_information":[{"code":"27134","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Revise hip joint replacement","code_information":[{"code":"27137","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Revise hip joint replacement","code_information":[{"code":"27138","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of hip joint","code_information":[{"code":"27284","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of hip joint","code_information":[{"code":"27286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Remove femur lesion/graft","code_information":[{"code":"27356","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Osteochondral knee allograft","code_information":[{"code":"27415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction knee","code_information":[{"code":"27428","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction knee","code_information":[{"code":"27429","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Revise kneecap with implant","code_information":[{"code":"27438","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Revision of knee joint","code_information":[{"code":"27440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Revision of knee joint","code_information":[{"code":"27441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Revision of knee joint","code_information":[{"code":"27442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Revision of knee joint","code_information":[{"code":"27443","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Revision of knee joint","code_information":[{"code":"27446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Total knee arthroplasty","code_information":[{"code":"27447","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Revise/replace knee joint","code_information":[{"code":"27486","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Removal of knee prosthesis","code_information":[{"code":"27488","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27513","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27514","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of knee","code_information":[{"code":"27580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Incision of tibia & fibula","code_information":[{"code":"27709","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Realignment of lower leg","code_information":[{"code":"27712","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Revision of lower leg","code_information":[{"code":"27715","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of tibia fracture","code_information":[{"code":"27758","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of tibia fracture","code_information":[{"code":"27759","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower leg fracture","code_information":[{"code":"27827","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower leg fracture","code_information":[{"code":"27828","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of ankle joint open","code_information":[{"code":"27870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of tibiofibular joint","code_information":[{"code":"27871","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Correction hallux valgus","code_information":[{"code":"28297","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Repair of foot bones","code_information":[{"code":"28320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Treat/graft heel fracture","code_information":[{"code":"28420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of foot bones","code_information":[{"code":"28715","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of foot bones","code_information":[{"code":"28725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of foot bones","code_information":[{"code":"28730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of foot bones","code_information":[{"code":"28735","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Revision of foot bones","code_information":[{"code":"28737","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Tibial arthroscopy/surgery","code_information":[{"code":"29856","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Allgrft implnt knee w/scope","code_information":[{"code":"29867","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29889","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Subtalar arthro w/fusion","code_information":[{"code":"29907","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Trml dstrj ios bvn 1st 2 l/s","code_information":[{"code":"64628","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Implant Temple Bone W/Stimul","code_information":[{"code":"69714","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Impltj oi implt skl tc esp","code_information":[{"code":"69716","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Revj/rplcmt oi implt tc esp","code_information":[{"code":"69719","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Impl oi implt sk tc esp>=100","code_information":[{"code":"69729","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Rplc oi implt sk tc esp>=100","code_information":[{"code":"69730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"U/s trtmt, not leiomyomata","code_information":[{"code":"C9734","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Spine/lumbar disk surgery","code_information":[{"code":"C9757","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Arthro/shoul surg; w/spacer","code_information":[{"code":"C9781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13407.17,"maximum":24481.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13675.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24481.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14332.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15016.02,"additional_payer_notes":"APC"}]}]},{"description":"Vrt bdy tethering ant","code_information":[{"code":"0656T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Vrt bdy tethering ant 8+ seg","code_information":[{"code":"0657T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Revj rplcmt/rmvl vrt tethrg","code_information":[{"code":"0790T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Replantation arm complete","code_information":[{"code":"20802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Replant forearm complete","code_information":[{"code":"20805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Replantation hand complete","code_information":[{"code":"20808","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Replantation foot complete","code_information":[{"code":"20838","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Ablate bone tumor(s) perq","code_information":[{"code":"20982","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Lat lumbar spine fusion","code_information":[{"code":"22533","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Thorax spine fusion","code_information":[{"code":"22556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Prescrl fuse w/ instr l5-s1","code_information":[{"code":"22586","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Neck spine fusion","code_information":[{"code":"22600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Thorax spine fusion","code_information":[{"code":"22610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Lumbar spine fusion","code_information":[{"code":"22612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Post fusion <=6 vert seg","code_information":[{"code":"22800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Post fusion 7-12 vert seg","code_information":[{"code":"22802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Post fusion 13/> vert seg","code_information":[{"code":"22804","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Ant fusion 2-3 vert seg","code_information":[{"code":"22808","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Ant fusion 4-7 vert seg","code_information":[{"code":"22810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Ant fusion 8/> vert seg","code_information":[{"code":"22812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Kyphectomy 1-2 segments","code_information":[{"code":"22818","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Kyphectomy 3 or more","code_information":[{"code":"22819","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Ant thrc vrt body tethrg <7","code_information":[{"code":"22836","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Ant thrc vrt body tethrg 8+","code_information":[{"code":"22837","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Rev rplc/rmv thrc vrt tethrg","code_information":[{"code":"22838","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Cerv artific diskectomy","code_information":[{"code":"22856","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Lumbar Artif Diskectomy","code_information":[{"code":"22857","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Revise cerv artific disc","code_information":[{"code":"22861","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Revise Lumbar Artif Disc","code_information":[{"code":"22862","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Insj stablj dev w/dcmprn","code_information":[{"code":"22867","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct shoulder joint","code_information":[{"code":"23472","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"23616","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct elbow joint","code_information":[{"code":"24361","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Replace elbow joint","code_information":[{"code":"24363","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Revise reconst elbow joint","code_information":[{"code":"24371","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct wrist joint","code_information":[{"code":"25442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Wrist replacement","code_information":[{"code":"25446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Arthrd si jt prq wo tfxj dev","code_information":[{"code":"27278","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Arthrodesis sacroiliac joint","code_information":[{"code":"27279","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of sacroiliac joint","code_information":[{"code":"27280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of leg at hip","code_information":[{"code":"27290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of leg at hip","code_information":[{"code":"27295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Revise/replace knee joint","code_information":[{"code":"27487","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction ankle joint","code_information":[{"code":"27703","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of foot bones","code_information":[{"code":"28705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Imp extar knee shck absrb","code_information":[{"code":"C8003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18310.2,"maximum":33434.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18676.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33434.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19573.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20507.42,"additional_payer_notes":"APC"}]}]},{"description":"Prt crn ch cr&tun elt s-sclp","code_information":[{"code":"0956T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28335.49,"maximum":51740.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29468.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28335.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29185.55,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30318.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28902.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":51740.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30035.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30290.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31735.75,"additional_payer_notes":"APC"}]}]},{"description":"Rpl s-sclp eltr ra rcvr&tlmt","code_information":[{"code":"0960T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28335.49,"maximum":51740.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29468.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28335.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29185.55,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30318.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28902.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":51740.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30035.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30290.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31735.75,"additional_payer_notes":"APC"}]}]},{"description":"Comp multiplane ext fixation","code_information":[{"code":"20696","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28335.49,"maximum":51740.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29468.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28335.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29185.55,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30318.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28902.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":51740.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30035.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30290.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31735.75,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of jaw joint","code_information":[{"code":"21243","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28335.49,"maximum":51740.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29468.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28335.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29185.55,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30318.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28902.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":51740.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30035.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30290.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31735.75,"additional_payer_notes":"APC"}]}]},{"description":"Lumbar spine fusion","code_information":[{"code":"22558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28335.49,"maximum":51740.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29468.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28335.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29185.55,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30318.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28902.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":51740.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30035.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30290.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31735.75,"additional_payer_notes":"APC"}]}]},{"description":"Lumbar spine fusion","code_information":[{"code":"22630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28335.49,"maximum":51740.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29468.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28335.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29185.55,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30318.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28902.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":51740.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30035.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30290.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31735.75,"additional_payer_notes":"APC"}]}]},{"description":"Lumbar spine fusion combined","code_information":[{"code":"22633","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28335.49,"maximum":51740.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29468.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28335.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29185.55,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30318.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28902.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":51740.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30035.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30290.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31735.75,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct ankle joint","code_information":[{"code":"27702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28335.49,"maximum":51740.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29468.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28335.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29185.55,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30318.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28902.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":51740.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30035.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30290.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31735.75,"additional_payer_notes":"APC"}]}]},{"description":"Nasal/sinus endoscopy dx","code_information":[{"code":"31235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1858.71,"maximum":3394.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1895.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3394.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1986.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2081.76,"additional_payer_notes":"APC"}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31237","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1858.71,"maximum":3394.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1895.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3394.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1986.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2081.76,"additional_payer_notes":"APC"}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1858.71,"maximum":3394.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1895.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3394.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1986.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2081.76,"additional_payer_notes":"APC"}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1858.71,"maximum":3394.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1895.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3394.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1986.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2081.76,"additional_payer_notes":"APC"}]}]},{"description":"Nsl/sins ndsc w/artery lig","code_information":[{"code":"31241","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1858.71,"maximum":3394.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1895.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3394.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1986.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2081.76,"additional_payer_notes":"APC"}]}]},{"description":"Dx laryngoscopy excl nb","code_information":[{"code":"31525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1858.71,"maximum":3394.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1895.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3394.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1986.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2081.76,"additional_payer_notes":"APC"}]}]},{"description":"Dx laryngoscopy w/oper scope","code_information":[{"code":"31526","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1858.71,"maximum":3394.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1895.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3394.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1986.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2081.76,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy w/fb removal","code_information":[{"code":"31530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1858.71,"maximum":3394.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1895.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3394.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1986.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2081.76,"additional_payer_notes":"APC"}]}]},{"description":"Largsc w/ther injection","code_information":[{"code":"31573","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1858.71,"maximum":3394.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1895.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3394.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1986.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2081.76,"additional_payer_notes":"APC"}]}]},{"description":"Largsc w/njx augmentation","code_information":[{"code":"31574","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1858.71,"maximum":3394.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1895.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3394.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1986.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2081.76,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy with biopsy","code_information":[{"code":"31576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1858.71,"maximum":3394.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1895.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3394.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1986.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2081.76,"additional_payer_notes":"APC"}]}]},{"description":"Dx bronchoscope/wash","code_information":[{"code":"31622","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1858.71,"maximum":3394.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1895.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3394.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1986.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2081.76,"additional_payer_notes":"APC"}]}]},{"description":"Dx bronchoscope/brush","code_information":[{"code":"31623","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1858.71,"maximum":3394.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1895.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3394.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1986.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2081.76,"additional_payer_notes":"APC"}]}]},{"description":"Dx bronchoscope/lavage","code_information":[{"code":"31624","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1858.71,"maximum":3394.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1895.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3394.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1986.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2081.76,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy w/biopsy(s)","code_information":[{"code":"31625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1858.71,"maximum":3394.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1895.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3394.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1986.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2081.76,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy w/fb removal","code_information":[{"code":"31635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1858.71,"maximum":3394.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1895.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3394.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1986.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2081.76,"additional_payer_notes":"APC"}]}]},{"description":"Diag bronchoscope/catheter","code_information":[{"code":"31643","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1858.71,"maximum":3394.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1895.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3394.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1986.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2081.76,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy clear airways","code_information":[{"code":"31645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1858.71,"maximum":3394.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1895.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3394.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1986.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2081.76,"additional_payer_notes":"APC"}]}]},{"description":"Bronchial valve remov addl","code_information":[{"code":"31649","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1858.71,"maximum":3394.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1895.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3394.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1986.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2081.76,"additional_payer_notes":"APC"}]}]},{"description":"Intro windpipe wire/tube","code_information":[{"code":"31730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1858.71,"maximum":3394.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1895.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3394.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1986.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2081.76,"additional_payer_notes":"APC"}]}]},{"description":"Dise eval slp do brth flx dx","code_information":[{"code":"42975","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1858.71,"maximum":3394.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1895.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3394.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1986.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2081.76,"additional_payer_notes":"APC"}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31239","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3893.43,"maximum":7109.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3971.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7109.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4162.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4360.65,"additional_payer_notes":"APC"}]}]},{"description":"Exploration maxillary sinus","code_information":[{"code":"31256","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3893.43,"maximum":7109.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3971.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7109.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4162.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4360.65,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy with biopsy","code_information":[{"code":"31510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3893.43,"maximum":7109.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3971.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7109.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4162.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4360.65,"additional_payer_notes":"APC"}]}]},{"description":"Removal of larynx lesion","code_information":[{"code":"31512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3893.43,"maximum":7109.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3971.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7109.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4162.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4360.65,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy for treatment","code_information":[{"code":"31527","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3893.43,"maximum":7109.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3971.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7109.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4162.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4360.65,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy and dilation","code_information":[{"code":"31528","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3893.43,"maximum":7109.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3971.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7109.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4162.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4360.65,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy and dilation","code_information":[{"code":"31529","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3893.43,"maximum":7109.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3971.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7109.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4162.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4360.65,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy w/fb & op scope","code_information":[{"code":"31531","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3893.43,"maximum":7109.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3971.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7109.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4162.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4360.65,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy w/biopsy","code_information":[{"code":"31535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3893.43,"maximum":7109.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3971.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7109.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4162.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4360.65,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy w/bx & op scope","code_information":[{"code":"31536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3893.43,"maximum":7109.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3971.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7109.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4162.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4360.65,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy w/exc of tumor","code_information":[{"code":"31540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3893.43,"maximum":7109.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3971.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7109.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4162.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4360.65,"additional_payer_notes":"APC"}]}]},{"description":"Larynscop w/tumr exc + scope","code_information":[{"code":"31541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3893.43,"maximum":7109.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3971.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7109.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4162.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4360.65,"additional_payer_notes":"APC"}]}]},{"description":"Remove vc lesion w/scope","code_information":[{"code":"31545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3893.43,"maximum":7109.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3971.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7109.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4162.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4360.65,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscope w/vc inj","code_information":[{"code":"31570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3893.43,"maximum":7109.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3971.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7109.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4162.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4360.65,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscop w/vc inj + scope","code_information":[{"code":"31571","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3893.43,"maximum":7109.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3971.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7109.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4162.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4360.65,"additional_payer_notes":"APC"}]}]},{"description":"Largsc w/laser dstrj les","code_information":[{"code":"31572","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3893.43,"maximum":7109.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3971.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7109.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4162.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4360.65,"additional_payer_notes":"APC"}]}]},{"description":"Largsc w/removal lesion","code_information":[{"code":"31578","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3893.43,"maximum":7109.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3971.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7109.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4162.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4360.65,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy/lung bx each","code_information":[{"code":"31628","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3893.43,"maximum":7109.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3971.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7109.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4162.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4360.65,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy/needle bx each","code_information":[{"code":"31629","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3893.43,"maximum":7109.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3971.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7109.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4162.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4360.65,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy dilate/fx repr","code_information":[{"code":"31630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3893.43,"maximum":7109.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3971.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7109.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4162.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4360.65,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy w/tumor excise","code_information":[{"code":"31640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3893.43,"maximum":7109.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3971.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7109.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4162.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4360.65,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy treat blockage","code_information":[{"code":"31641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3893.43,"maximum":7109.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3971.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7109.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4162.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4360.65,"additional_payer_notes":"APC"}]}]},{"description":"Bronchial valve remov init","code_information":[{"code":"31648","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3893.43,"maximum":7109.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3971.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7109.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4162.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4360.65,"additional_payer_notes":"APC"}]}]},{"description":"Bronch ebus samplng 1/2 node","code_information":[{"code":"31652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3893.43,"maximum":7109.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3971.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7109.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4162.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4360.65,"additional_payer_notes":"APC"}]}]},{"description":"Bronch ebus samplng 3/> node","code_information":[{"code":"31653","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3893.43,"maximum":7109.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3971.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7109.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4162.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4360.65,"additional_payer_notes":"APC"}]}]},{"description":"Nsl/sins ndsc total","code_information":[{"code":"31253","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7369.96,"maximum":13457.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7664.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7369.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7591.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7885.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7517.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13457.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7812.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7878.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8254.35,"additional_payer_notes":"APC"}]}]},{"description":"Revision of ethmoid sinus","code_information":[{"code":"31254","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7369.96,"maximum":13457.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7664.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7369.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7591.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7885.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7517.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13457.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7812.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7878.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8254.35,"additional_payer_notes":"APC"}]}]},{"description":"Removal of ethmoid sinus","code_information":[{"code":"31255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7369.96,"maximum":13457.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7664.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7369.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7591.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7885.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7517.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13457.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7812.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7878.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8254.35,"additional_payer_notes":"APC"}]}]},{"description":"Nsl/sins ndsc tot w/sphendt","code_information":[{"code":"31257","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7369.96,"maximum":13457.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7664.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7369.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7591.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7885.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7517.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13457.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7812.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7878.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8254.35,"additional_payer_notes":"APC"}]}]},{"description":"Nsl/sins ndsc sphn tiss rmvl","code_information":[{"code":"31259","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7369.96,"maximum":13457.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7664.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7369.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7591.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7885.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7517.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13457.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7812.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7878.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8254.35,"additional_payer_notes":"APC"}]}]},{"description":"Endoscopy maxillary sinus","code_information":[{"code":"31267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7369.96,"maximum":13457.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7664.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7369.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7591.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7885.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7517.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13457.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7812.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7878.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8254.35,"additional_payer_notes":"APC"}]}]},{"description":"Sinus endoscopy surgical","code_information":[{"code":"31276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7369.96,"maximum":13457.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7664.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7369.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7591.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7885.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7517.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13457.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7812.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7878.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8254.35,"additional_payer_notes":"APC"}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31287","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7369.96,"maximum":13457.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7664.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7369.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7591.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7885.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7517.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13457.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7812.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7878.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8254.35,"additional_payer_notes":"APC"}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31288","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7369.96,"maximum":13457.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7664.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7369.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7591.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7885.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7517.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13457.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7812.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7878.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8254.35,"additional_payer_notes":"APC"}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31292","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7369.96,"maximum":13457.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7664.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7369.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7591.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7885.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7517.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13457.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7812.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7878.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8254.35,"additional_payer_notes":"APC"}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31293","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7369.96,"maximum":13457.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7664.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7369.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7591.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7885.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7517.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13457.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7812.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7878.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8254.35,"additional_payer_notes":"APC"}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31294","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7369.96,"maximum":13457.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7664.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7369.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7591.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7885.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7517.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13457.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7812.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7878.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8254.35,"additional_payer_notes":"APC"}]}]},{"description":"Sinus endo w/balloon dil","code_information":[{"code":"31295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7369.96,"maximum":13457.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7664.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7369.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7591.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7885.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7517.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13457.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7812.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7878.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8254.35,"additional_payer_notes":"APC"}]}]},{"description":"Sinus endo w/balloon dil","code_information":[{"code":"31296","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7369.96,"maximum":13457.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7664.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7369.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7591.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7885.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7517.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13457.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7812.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7878.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8254.35,"additional_payer_notes":"APC"}]}]},{"description":"Sinus endo w/balloon dil","code_information":[{"code":"31297","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7369.96,"maximum":13457.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7664.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7369.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7591.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7885.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7517.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13457.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7812.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7878.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8254.35,"additional_payer_notes":"APC"}]}]},{"description":"Nsl/sins ndsc w/sins dilat","code_information":[{"code":"31298","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7369.96,"maximum":13457.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7664.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7369.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7591.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7885.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7517.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13457.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7812.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7878.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8254.35,"additional_payer_notes":"APC"}]}]},{"description":"Remove vc lesion scope/graft","code_information":[{"code":"31546","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7369.96,"maximum":13457.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7664.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7369.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7591.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7885.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7517.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13457.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7812.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7878.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8254.35,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscop w/arytenoidectom","code_information":[{"code":"31560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7369.96,"maximum":13457.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7664.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7369.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7591.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7885.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7517.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13457.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7812.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7878.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8254.35,"additional_payer_notes":"APC"}]}]},{"description":"Larynscop remve cart + scop","code_information":[{"code":"31561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7369.96,"maximum":13457.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7664.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7369.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7591.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7885.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7517.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13457.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7812.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7878.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8254.35,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy w/markers","code_information":[{"code":"31626","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7369.96,"maximum":13457.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7664.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7369.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7591.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7885.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7517.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13457.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7812.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7878.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8254.35,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy dilate w/stent","code_information":[{"code":"31631","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7369.96,"maximum":13457.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7664.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7369.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7591.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7885.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7517.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13457.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7812.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7878.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8254.35,"additional_payer_notes":"APC"}]}]},{"description":"Bronch w/balloon occlusion","code_information":[{"code":"31634","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7369.96,"maximum":13457.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7664.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7369.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7591.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7885.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7517.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13457.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7812.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7878.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8254.35,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy bronch stents","code_information":[{"code":"31636","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7369.96,"maximum":13457.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7664.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7369.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7591.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7885.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7517.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13457.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7812.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7878.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8254.35,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy revise stent","code_information":[{"code":"31638","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7369.96,"maximum":13457.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7664.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7369.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7591.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7885.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7517.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13457.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7812.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7878.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8254.35,"additional_payer_notes":"APC"}]}]},{"description":"Bronchial valve init insert","code_information":[{"code":"31647","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7369.96,"maximum":13457.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7664.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7369.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7591.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7885.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7517.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13457.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7812.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7878.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8254.35,"additional_payer_notes":"APC"}]}]},{"description":"Bronch thermoplsty 1 lobe","code_information":[{"code":"31660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7369.96,"maximum":13457.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7664.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7369.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7591.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7885.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7517.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13457.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7812.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7878.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8254.35,"additional_payer_notes":"APC"}]}]},{"description":"Bronch thermoplsty 2/> lobes","code_information":[{"code":"31661","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7369.96,"maximum":13457.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7664.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7369.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7591.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7885.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7517.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13457.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7812.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7878.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8254.35,"additional_payer_notes":"APC"}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.34,"maximum":451.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":257.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":252.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":451.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":277.02,"additional_payer_notes":"APC"}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21089","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.34,"maximum":451.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":257.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":252.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":451.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":277.02,"additional_payer_notes":"APC"}]}]},{"description":"Cranio/maxillofacial surgery","code_information":[{"code":"21299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.34,"maximum":451.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":257.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":252.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":451.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":277.02,"additional_payer_notes":"APC"}]}]},{"description":"Head surgery procedure","code_information":[{"code":"21499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.34,"maximum":451.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":257.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":252.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":451.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":277.02,"additional_payer_notes":"APC"}]}]},{"description":"Neck/chest surgery procedure","code_information":[{"code":"21899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.34,"maximum":451.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":257.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":252.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":451.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":277.02,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of nose lesion","code_information":[{"code":"30000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.34,"maximum":451.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":257.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":252.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":451.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":277.02,"additional_payer_notes":"APC"}]}]},{"description":"Repeat control of nosebleed","code_information":[{"code":"30906","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.34,"maximum":451.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":257.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":252.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":451.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":277.02,"additional_payer_notes":"APC"}]}]},{"description":"Nasal surgery procedure","code_information":[{"code":"30999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.34,"maximum":451.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":257.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":252.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":451.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":277.02,"additional_payer_notes":"APC"}]}]},{"description":"Irrigation maxillary sinus","code_information":[{"code":"31000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.34,"maximum":451.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":257.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":252.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":451.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":277.02,"additional_payer_notes":"APC"}]}]},{"description":"Sinus surgery procedure","code_information":[{"code":"31299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.34,"maximum":451.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":257.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":252.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":451.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":277.02,"additional_payer_notes":"APC"}]}]},{"description":"Insert emergency airway","code_information":[{"code":"31500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.34,"maximum":451.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":257.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":252.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":451.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":277.02,"additional_payer_notes":"APC"}]}]},{"description":"Change of windpipe airway","code_information":[{"code":"31502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.34,"maximum":451.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":257.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":252.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":451.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":277.02,"additional_payer_notes":"APC"}]}]},{"description":"Larynx surgery procedure","code_information":[{"code":"31599","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.34,"maximum":451.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":257.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":252.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":451.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":277.02,"additional_payer_notes":"APC"}]}]},{"description":"Incision of windpipe","code_information":[{"code":"31605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.34,"maximum":451.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":257.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":252.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":451.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":277.02,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of lip","code_information":[{"code":"40490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.34,"maximum":451.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":257.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":252.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":451.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":277.02,"additional_payer_notes":"APC"}]}]},{"description":"Lip surgery procedure","code_information":[{"code":"40799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.34,"maximum":451.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":257.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":252.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":451.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":277.02,"additional_payer_notes":"APC"}]}]},{"description":"Repair mouth laceration","code_information":[{"code":"40830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.34,"maximum":451.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":257.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":252.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":451.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":277.02,"additional_payer_notes":"APC"}]}]},{"description":"Mouth surgery procedure","code_information":[{"code":"40899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.34,"maximum":451.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":257.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":252.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":451.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":277.02,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"41005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.34,"maximum":451.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":257.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":252.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":451.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":277.02,"additional_payer_notes":"APC"}]}]},{"description":"Repair tongue laceration","code_information":[{"code":"41251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.34,"maximum":451.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":257.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":252.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":451.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":277.02,"additional_payer_notes":"APC"}]}]},{"description":"Repair tongue laceration","code_information":[{"code":"41252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.34,"maximum":451.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":257.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":252.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":451.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":277.02,"additional_payer_notes":"APC"}]}]},{"description":"Tongue and mouth surgery","code_information":[{"code":"41599","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.34,"maximum":451.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":257.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":252.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":451.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":277.02,"additional_payer_notes":"APC"}]}]},{"description":"Dental surgery procedure","code_information":[{"code":"41899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.34,"maximum":451.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":257.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":252.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":451.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":277.02,"additional_payer_notes":"APC"}]}]},{"description":"Drainage mouth roof lesion","code_information":[{"code":"42000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.34,"maximum":451.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":257.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":252.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":451.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":277.02,"additional_payer_notes":"APC"}]}]},{"description":"Palate/uvula surgery","code_information":[{"code":"42299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.34,"maximum":451.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":257.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":252.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":451.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":277.02,"additional_payer_notes":"APC"}]}]},{"description":"Salivary surgery procedure","code_information":[{"code":"42699","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.34,"maximum":451.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":257.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":252.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":451.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":277.02,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of tonsil abscess","code_information":[{"code":"42700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.34,"maximum":451.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":257.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":252.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":451.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":277.02,"additional_payer_notes":"APC"}]}]},{"description":"Control nose/throat bleeding","code_information":[{"code":"42970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.34,"maximum":451.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":257.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":252.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":451.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":277.02,"additional_payer_notes":"APC"}]}]},{"description":"Throat surgery procedure","code_information":[{"code":"42999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.34,"maximum":451.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":257.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":252.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":451.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":277.02,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of external ear","code_information":[{"code":"69100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.34,"maximum":451.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":257.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":252.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":451.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":277.02,"additional_payer_notes":"APC"}]}]},{"description":"Outer ear surgery procedure","code_information":[{"code":"69399","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.34,"maximum":451.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":257.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":252.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":451.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":277.02,"additional_payer_notes":"APC"}]}]},{"description":"Incision of eardrum","code_information":[{"code":"69420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.34,"maximum":451.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":257.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":252.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":451.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":277.02,"additional_payer_notes":"APC"}]}]},{"description":"Middle ear surgery procedure","code_information":[{"code":"69799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.34,"maximum":451.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":257.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":252.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":451.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":277.02,"additional_payer_notes":"APC"}]}]},{"description":"Inner ear surgery procedure","code_information":[{"code":"69949","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.34,"maximum":451.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":257.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":252.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":451.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":277.02,"additional_payer_notes":"APC"}]}]},{"description":"Temporal bone surgery","code_information":[{"code":"69979","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.34,"maximum":451.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":257.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":252.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":451.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":277.02,"additional_payer_notes":"APC"}]}]},{"description":"Unspecified periodontal proc","code_information":[{"code":"D4999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.34,"maximum":451.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":257.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":247.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":252.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":451.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":277.02,"additional_payer_notes":"APC"}]}]},{"description":"I&cust prep jaw xpnsj 1arch","code_information":[{"code":"0964T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"I&cst prp jw xpn dl arch non","code_information":[{"code":"0965T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"I&cst prp jw xpn dl arch fxd","code_information":[{"code":"0966T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Incision of jaw joint","code_information":[{"code":"21010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Contour of face bone lesion","code_information":[{"code":"21029","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Remove exostosis mandible","code_information":[{"code":"21031","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Remove exostosis maxilla","code_information":[{"code":"21032","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Excise mandible lesion","code_information":[{"code":"21040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21079","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21082","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21083","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21084","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21086","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21088","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of chin","code_information":[{"code":"21121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of chin","code_information":[{"code":"21123","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Reduction of forehead","code_information":[{"code":"21137","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Revision of eyelid","code_information":[{"code":"21280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Revision of eyelid","code_information":[{"code":"21282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Revision of jaw muscle/bone","code_information":[{"code":"21296","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Closed tx nose fx w/ stablj","code_information":[{"code":"21320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Open tx nose fx uncomplicatd","code_information":[{"code":"21325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Open tx nose & septal fx","code_information":[{"code":"21335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Closed tx septal&nose fx","code_information":[{"code":"21337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Perq tx nasoethmoid fx","code_information":[{"code":"21340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Perq tx malar fracture","code_information":[{"code":"21355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Treat mouth roof fracture","code_information":[{"code":"21421","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Treat dental ridge fracture","code_information":[{"code":"21440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Repair dislocated jaw","code_information":[{"code":"21490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Removal of nose polyp(s)","code_information":[{"code":"30115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Removal of intranasal lesion","code_information":[{"code":"30117","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Removal of intranasal lesion","code_information":[{"code":"30118","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Revision of nose","code_information":[{"code":"30120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Excise inferior turbinate","code_information":[{"code":"30130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Resect inferior turbinate","code_information":[{"code":"30140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Remove nasal foreign body","code_information":[{"code":"30310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Repair of nasal septum","code_information":[{"code":"30520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Repair nasal septum defect","code_information":[{"code":"30630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Ther fx nasal inf turbinate","code_information":[{"code":"30930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Exploration maxillary sinus","code_information":[{"code":"31020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Removal of ethmoid sinus","code_information":[{"code":"31205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Removal of larynx lesion","code_information":[{"code":"31300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Incision of windpipe","code_information":[{"code":"31600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Surgery/speech prosthesis","code_information":[{"code":"31611","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Puncture/clear windpipe","code_information":[{"code":"31612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Repair windpipe opening","code_information":[{"code":"31613","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Closure of windpipe lesion","code_information":[{"code":"31820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Repair of windpipe defect","code_information":[{"code":"31825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Revise windpipe scar","code_information":[{"code":"31830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Partial excision of lip","code_information":[{"code":"40500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Partial excision of lip","code_information":[{"code":"40510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Partial excision of lip","code_information":[{"code":"40520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct lip with flap","code_information":[{"code":"40525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of lip","code_information":[{"code":"40530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Repair cleft lip/nasal","code_information":[{"code":"40720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Excision of mouth lesion","code_information":[{"code":"40810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Excise/repair mouth lesion","code_information":[{"code":"40814","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Excision of mouth lesion","code_information":[{"code":"40816","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of mouth lesion","code_information":[{"code":"40820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"41008","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"41017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of tongue","code_information":[{"code":"41105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Excision of tongue lesion","code_information":[{"code":"41110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Excision of tongue lesion","code_information":[{"code":"41112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Excision of tongue lesion","code_information":[{"code":"41113","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Excision of tongue lesion","code_information":[{"code":"41114","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Excision of mouth lesion","code_information":[{"code":"41116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Tongue to lip surgery","code_information":[{"code":"41510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction tongue fold","code_information":[{"code":"41520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Tongue base vol reduction","code_information":[{"code":"41530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Excision gum each quadrant","code_information":[{"code":"41820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Excision of gum lesion","code_information":[{"code":"41825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Excision of gum lesion","code_information":[{"code":"41826","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Removal of gum tissue","code_information":[{"code":"41830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Repair gum","code_information":[{"code":"41872","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Repair tooth socket","code_information":[{"code":"41874","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Excision lesion mouth roof","code_information":[{"code":"42104","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Excision lesion mouth roof","code_information":[{"code":"42106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Excision of uvula","code_information":[{"code":"42140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Treatment mouth roof lesion","code_information":[{"code":"42160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct cleft palate","code_information":[{"code":"42205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of salivary gland","code_information":[{"code":"42305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Removal of salivary stone","code_information":[{"code":"42330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Removal of salivary stone","code_information":[{"code":"42335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Removal of salivary stone","code_information":[{"code":"42340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Excision of salivary cyst","code_information":[{"code":"42408","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of salivary cyst","code_information":[{"code":"42409","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Parotid duct diversion","code_information":[{"code":"42510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Closure of salivary fistula","code_information":[{"code":"42600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Ligation of salivary duct","code_information":[{"code":"42665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of throat abscess","code_information":[{"code":"42720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of upper nose/throat","code_information":[{"code":"42804","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of upper nose/throat","code_information":[{"code":"42806","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Excise pharynx lesion","code_information":[{"code":"42808","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Excision of neck cyst","code_information":[{"code":"42810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Remove tonsils and adenoids","code_information":[{"code":"42821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Removal of tonsils","code_information":[{"code":"42826","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Removal of adenoids","code_information":[{"code":"42830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Removal of adenoids","code_information":[{"code":"42831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Removal of adenoids","code_information":[{"code":"42835","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Removal of adenoids","code_information":[{"code":"42836","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Excision of tonsil tags","code_information":[{"code":"42860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Control throat bleeding","code_information":[{"code":"42962","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Control nose/throat bleeding","code_information":[{"code":"42972","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Repair esophagus opening","code_information":[{"code":"43420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Decompress eye socket","code_information":[{"code":"61330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Treat skull fracture","code_information":[{"code":"62000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Revise external ear","code_information":[{"code":"69300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Incision of eardrum","code_information":[{"code":"69421","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Remove ventilating tube","code_information":[{"code":"69424","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of middle ear","code_information":[{"code":"69440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Eardrum revision","code_information":[{"code":"69450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Repair of eardrum","code_information":[{"code":"69620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Release middle ear bone","code_information":[{"code":"69650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Repair middle ear structures","code_information":[{"code":"69666","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Repair middle ear structures","code_information":[{"code":"69667","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Remove middle ear nerve","code_information":[{"code":"69676","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Remove/repair hearing aid","code_information":[{"code":"69711","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Incise inner ear nerve","code_information":[{"code":"69915","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Gingivectomy/plasty 4 or mor","code_information":[{"code":"D4210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Gingivectomy/plasty 1 to 3","code_information":[{"code":"D4211","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Gingivectomy/plasty rest","code_information":[{"code":"D4212","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Ana crown exp 4 or> per quad","code_information":[{"code":"D4230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Gingival flap proc w/ planin","code_information":[{"code":"D4240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Osseous surg 1 to 3 teeth","code_information":[{"code":"D4261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Malig tumor exc to 1.25 cm","code_information":[{"code":"D7440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Malig tumor > 1.25 cm","code_information":[{"code":"D7441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Rem odontogen cyst to 1.25cm","code_information":[{"code":"D7450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Rem odontogen cyst > 1.25 cm","code_information":[{"code":"D7451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Rem exostosis any site","code_information":[{"code":"D7471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Closd rductn splint alveolus","code_information":[{"code":"D7670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Alveolus clsd reduc stblz te","code_information":[{"code":"D7771","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Facility svs dental rehab","code_information":[{"code":"G0330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3462.26,"maximum":6322.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3600.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3462.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3566.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3704.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3531.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6322.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3670.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3701.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3877.74,"additional_payer_notes":"APC"}]}]},{"description":"Repos car modulj tranvns elt","code_information":[{"code":"0415T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":655.08,"maximum":1196.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":668.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1196.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":733.69,"additional_payer_notes":"APC"}]}]},{"description":"Rpos prv ccm-d trnsvns eltrd","code_information":[{"code":"0924T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":655.08,"maximum":1196.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":668.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1196.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":733.69,"additional_payer_notes":"APC"}]}]},{"description":"Active thrc irrigation spx","code_information":[{"code":"1021T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":655.08,"maximum":1196.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":668.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1196.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":733.69,"additional_payer_notes":"APC"}]}]},{"description":"Remove lung catheter","code_information":[{"code":"32552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":655.08,"maximum":1196.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":668.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1196.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":733.69,"additional_payer_notes":"APC"}]}]},{"description":"Aspirate pleura w/o imaging","code_information":[{"code":"32554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":655.08,"maximum":1196.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":668.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1196.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":733.69,"additional_payer_notes":"APC"}]}]},{"description":"Aspirate pleura w/ imaging","code_information":[{"code":"32555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":655.08,"maximum":1196.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":668.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1196.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":733.69,"additional_payer_notes":"APC"}]}]},{"description":"Treat pleurodesis w/agent","code_information":[{"code":"32560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":655.08,"maximum":1196.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":668.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1196.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":733.69,"additional_payer_notes":"APC"}]}]},{"description":"Lyse chest fibrin init day","code_information":[{"code":"32561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":655.08,"maximum":1196.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":668.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1196.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":733.69,"additional_payer_notes":"APC"}]}]},{"description":"Lyse chest fibrin subq day","code_information":[{"code":"32562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":655.08,"maximum":1196.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":668.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1196.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":733.69,"additional_payer_notes":"APC"}]}]},{"description":"Therapeutic pneumothorax","code_information":[{"code":"32960","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":655.08,"maximum":1196.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":668.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1196.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":733.69,"additional_payer_notes":"APC"}]}]},{"description":"Chest surgery procedure","code_information":[{"code":"32999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":655.08,"maximum":1196.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":668.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1196.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":733.69,"additional_payer_notes":"APC"}]}]},{"description":"Cardiac surgery procedure","code_information":[{"code":"33999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":655.08,"maximum":1196.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":668.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1196.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":733.69,"additional_payer_notes":"APC"}]}]},{"description":"Removal of vein clot","code_information":[{"code":"34471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":655.08,"maximum":1196.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":668.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1196.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":733.69,"additional_payer_notes":"APC"}]}]},{"description":"Pseudoaneurysm injection trt","code_information":[{"code":"36002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":655.08,"maximum":1196.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":668.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1196.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":733.69,"additional_payer_notes":"APC"}]}]},{"description":"Insj picc rs&i <5 yr","code_information":[{"code":"36572","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":655.08,"maximum":1196.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":668.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1196.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":733.69,"additional_payer_notes":"APC"}]}]},{"description":"Repair tunneled cv cath","code_information":[{"code":"36575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":655.08,"maximum":1196.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":668.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1196.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":733.69,"additional_payer_notes":"APC"}]}]},{"description":"Removal tunneled cv cath","code_information":[{"code":"36589","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":655.08,"maximum":1196.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":668.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1196.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":733.69,"additional_payer_notes":"APC"}]}]},{"description":"Vascular endoscopy procedure","code_information":[{"code":"37501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":655.08,"maximum":1196.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":668.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1196.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":733.69,"additional_payer_notes":"APC"}]}]},{"description":"Vascular surgery procedure","code_information":[{"code":"37799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":655.08,"maximum":1196.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":668.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1196.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":733.69,"additional_payer_notes":"APC"}]}]},{"description":"Insertion of chest tube","code_information":[{"code":"32551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1643.86,"maximum":3001.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1676.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3001.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1757.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1841.12,"additional_payer_notes":"APC"}]}]},{"description":"Insert cath pleura w/ image","code_information":[{"code":"32557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1643.86,"maximum":3001.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1676.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3001.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1757.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1841.12,"additional_payer_notes":"APC"}]}]},{"description":"Pericardiocentesis w/imaging","code_information":[{"code":"33016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1643.86,"maximum":3001.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1676.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3001.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1757.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1841.12,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1643.86,"maximum":3001.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1676.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3001.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1757.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1841.12,"additional_payer_notes":"APC"}]}]},{"description":"Insert picc cath","code_information":[{"code":"36568","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1643.86,"maximum":3001.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1676.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3001.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1757.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1841.12,"additional_payer_notes":"APC"}]}]},{"description":"Insert picc cath","code_information":[{"code":"36569","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1643.86,"maximum":3001.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1676.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3001.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1757.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1841.12,"additional_payer_notes":"APC"}]}]},{"description":"Insj picc rs&i 5 yr+","code_information":[{"code":"36573","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1643.86,"maximum":3001.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1676.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3001.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1757.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1841.12,"additional_payer_notes":"APC"}]}]},{"description":"Repair tunneled cv cath","code_information":[{"code":"36576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1643.86,"maximum":3001.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1676.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3001.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1757.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1841.12,"additional_payer_notes":"APC"}]}]},{"description":"Replace cvad cath","code_information":[{"code":"36580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1643.86,"maximum":3001.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1676.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3001.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1757.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1841.12,"additional_payer_notes":"APC"}]}]},{"description":"Replace picc cath","code_information":[{"code":"36584","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1643.86,"maximum":3001.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1676.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3001.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1757.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1841.12,"additional_payer_notes":"APC"}]}]},{"description":"Removal tunneled cv cath","code_information":[{"code":"36590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1643.86,"maximum":3001.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1676.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3001.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1757.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1841.12,"additional_payer_notes":"APC"}]}]},{"description":"Mech remov tunneled cv cath","code_information":[{"code":"36596","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1643.86,"maximum":3001.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1676.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3001.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1757.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1841.12,"additional_payer_notes":"APC"}]}]},{"description":"Reposition venous catheter","code_information":[{"code":"36597","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1643.86,"maximum":3001.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1676.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3001.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1757.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1841.12,"additional_payer_notes":"APC"}]}]},{"description":"External cannula declotting","code_information":[{"code":"36860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1643.86,"maximum":3001.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1676.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3001.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1757.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1841.12,"additional_payer_notes":"APC"}]}]},{"description":"Intro cath dialysis circuit","code_information":[{"code":"36901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1643.86,"maximum":3001.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1676.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3001.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1757.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1841.12,"additional_payer_notes":"APC"}]}]},{"description":"Insert/place heart catheter","code_information":[{"code":"93503","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1643.86,"maximum":3001.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1676.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3001.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1757.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1841.12,"additional_payer_notes":"APC"}]}]},{"description":"Ev cath dir chem abltj w/img","code_information":[{"code":"0524T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmv 2chmbr ldls pm cmpl","code_information":[{"code":"0798T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmvl 2chmbr ldls pm ra","code_information":[{"code":"0799T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmvl 2chmbr ldls pm rv","code_information":[{"code":"0800T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmv 1chmbr ldls pm ra","code_information":[{"code":"0824T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Ligation nasal sinus artery","code_information":[{"code":"30915","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Ligation upper jaw artery","code_information":[{"code":"30920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Reposition pacing-defib lead","code_information":[{"code":"33215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Reposition l ventric lead","code_information":[{"code":"33226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmvl perm ldls pm","code_information":[{"code":"33275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Removal of vein clot","code_information":[{"code":"34421","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Removal of vein clot","code_information":[{"code":"34490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Leg vein fusion","code_information":[{"code":"34530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35184","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35207","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35231","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Explore limb vessels","code_information":[{"code":"35860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Excision graft extremity","code_information":[{"code":"35903","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Place cath thoracic aorta","code_information":[{"code":"36221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Place cath carotid/inom art","code_information":[{"code":"36222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Place cath subclavian art","code_information":[{"code":"36225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Ins cath ren art 1st unilat","code_information":[{"code":"36251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Ins cath ren art 1st bilat","code_information":[{"code":"36252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Ins cath ren art 2nd+ bilat","code_information":[{"code":"36254","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Endovenous mchnchem 1st vein","code_information":[{"code":"36473","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Endovenous rf 1st vein","code_information":[{"code":"36475","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Endovenous laser 1st vein","code_information":[{"code":"36478","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Insert non-tunnel cv cath","code_information":[{"code":"36555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Insert non-tunnel cv cath","code_information":[{"code":"36556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Insert tunneled cv cath","code_information":[{"code":"36558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Insert tunneled cv cath","code_information":[{"code":"36560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Insert tunneled cv cath","code_information":[{"code":"36561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Insert tunneled cv cath","code_information":[{"code":"36565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Insert picvad cath","code_information":[{"code":"36570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Insert picvad cath","code_information":[{"code":"36571","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Replace tunneled cv cath","code_information":[{"code":"36578","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Replace tunneled cv cath","code_information":[{"code":"36581","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Replace tunneled cv cath","code_information":[{"code":"36582","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Replace picvad cath","code_information":[{"code":"36585","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Mech remov tunneled cv cath","code_information":[{"code":"36595","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Insertion catheter artery","code_information":[{"code":"36640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Insertion of cannula","code_information":[{"code":"36810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Av fusion direct any site","code_information":[{"code":"36821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Artery to vein shunt","code_information":[{"code":"36835","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Venous m-thrombectomy add-on","code_information":[{"code":"37188","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Redo endovas vena cava filtr","code_information":[{"code":"37192","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Rem endovas vena cava filter","code_information":[{"code":"37193","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Remove intrvas foreign body","code_information":[{"code":"37197","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Thrombolytic venous therapy","code_information":[{"code":"37212","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Thromblytic art/ven therapy","code_information":[{"code":"37213","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Cessj therapy cath removal","code_information":[{"code":"37214","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Ligation of neck vein","code_information":[{"code":"37565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Ligation of neck artery","code_information":[{"code":"37600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Ligation of neck artery","code_information":[{"code":"37605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Ligation of neck artery","code_information":[{"code":"37606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Ligation of a-v fistula","code_information":[{"code":"37607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Ligation of neck artery","code_information":[{"code":"37615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Revision of major vein","code_information":[{"code":"37650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Revise leg vein","code_information":[{"code":"37700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Ligate/strip short leg vein","code_information":[{"code":"37718","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Ligate/strip long leg vein","code_information":[{"code":"37722","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Removal of leg veins/lesion","code_information":[{"code":"37735","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Ligate leg veins radical","code_information":[{"code":"37760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Ligate leg veins open","code_information":[{"code":"37761","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Stab phleb veins xtr 10-20","code_information":[{"code":"37765","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Phleb veins - extrem 20+","code_information":[{"code":"37766","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Revision of leg vein","code_information":[{"code":"37780","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Ligate/divide/excise vein","code_information":[{"code":"37785","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Remove tunneled ip cath","code_information":[{"code":"49422","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Removal of shunt","code_information":[{"code":"49429","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of heart lining","code_information":[{"code":"93505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3297.29,"maximum":6020.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3363.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6020.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3524.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3692.97,"additional_payer_notes":"APC"}]}]},{"description":"Insj bioprostc vlv fem vn","code_information":[{"code":"0744T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Removal of artery clot","code_information":[{"code":"34101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Removal of arm artery clot","code_information":[{"code":"34111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Removal of artery clot","code_information":[{"code":"34201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Removal of leg artery clot","code_information":[{"code":"34203","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Repair valve femoral vein","code_information":[{"code":"34501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Transposition of vein valve","code_information":[{"code":"34510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Cross-over vein graft","code_information":[{"code":"34520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Repair defect of artery","code_information":[{"code":"35011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Repair defect of arm artery","code_information":[{"code":"35045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35188","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35236","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35256","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35266","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Rechanneling of artery","code_information":[{"code":"35321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Rechanneling of artery","code_information":[{"code":"35372","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Explore neck vessels","code_information":[{"code":"35800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Removal of clot in graft","code_information":[{"code":"35875","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Removal of clot in graft","code_information":[{"code":"35876","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Revise graft w/vein","code_information":[{"code":"35879","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Revise graft w/vein","code_information":[{"code":"35881","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Revise Graft w/Nonauto Graft","code_information":[{"code":"35883","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Revise graft w/vein","code_information":[{"code":"35884","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Place cath carotid/inom art","code_information":[{"code":"36223","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Place cath carotd art","code_information":[{"code":"36224","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Place cath vertebral art","code_information":[{"code":"36226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Ins cath ren art 2nd+ unilat","code_information":[{"code":"36253","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Insertion of infusion pump","code_information":[{"code":"36260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Endoven ther chem adhes 1st","code_information":[{"code":"36482","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Insert tunneled cv cath","code_information":[{"code":"36557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Insert tunneled cv cath","code_information":[{"code":"36563","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Insert tunneled cv cath","code_information":[{"code":"36566","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Replace tunneled cv cath","code_information":[{"code":"36583","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Insertion of cannula","code_information":[{"code":"36800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Insertion of cannula","code_information":[{"code":"36815","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Av fuse uppr arm cephalic","code_information":[{"code":"36818","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Av fuse uppr arm basilic","code_information":[{"code":"36819","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Av fusion/forearm vein","code_information":[{"code":"36820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Artery-vein autograft","code_information":[{"code":"36825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Artery-vein nonautograft","code_information":[{"code":"36830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Open thrombect av fistula","code_information":[{"code":"36831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Av fistula revision open","code_information":[{"code":"36832","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Av fistula revision","code_information":[{"code":"36833","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Dist revas ligation hemo","code_information":[{"code":"36838","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Cannula declotting","code_information":[{"code":"36861","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Ins endovas vena cava filtr","code_information":[{"code":"37191","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Transcatheter biopsy","code_information":[{"code":"37200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Thrombolytic art therapy","code_information":[{"code":"37211","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Ligation of abdomen artery","code_information":[{"code":"37617","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Ligation of inf vena cava","code_information":[{"code":"37619","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Insert tun ip cath w/port","code_information":[{"code":"49419","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5810.88,"maximum":10610.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5927.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10610.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6211.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6508.18,"additional_payer_notes":"APC"}]}]},{"description":"Tcat impl wrls l atr prs snr","code_information":[{"code":"0933T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3385.48,"maximum":6181.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3520.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3385.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3487.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3622.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3453.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6181.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3588.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3619.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3791.74,"additional_payer_notes":"APC"}]}]},{"description":"Right heart cath","code_information":[{"code":"93451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3385.48,"maximum":6181.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3520.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3385.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3487.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3622.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3453.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6181.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3588.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3619.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3791.74,"additional_payer_notes":"APC"}]}]},{"description":"Left hrt cath w/ventrclgrphy","code_information":[{"code":"93452","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3385.48,"maximum":6181.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3520.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3385.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3487.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3622.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3453.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6181.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3588.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3619.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3791.74,"additional_payer_notes":"APC"}]}]},{"description":"R&l hrt cath w/ventriclgrphy","code_information":[{"code":"93453","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3385.48,"maximum":6181.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3520.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3385.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3487.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3622.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3453.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6181.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3588.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3619.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3791.74,"additional_payer_notes":"APC"}]}]},{"description":"Coronary artery angio s&i","code_information":[{"code":"93454","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3385.48,"maximum":6181.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3520.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3385.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3487.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3622.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3453.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6181.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3588.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3619.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3791.74,"additional_payer_notes":"APC"}]}]},{"description":"Coronary art/grft angio s&i","code_information":[{"code":"93455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3385.48,"maximum":6181.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3520.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3385.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3487.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3622.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3453.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6181.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3588.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3619.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3791.74,"additional_payer_notes":"APC"}]}]},{"description":"R hrt coronary artery angio","code_information":[{"code":"93456","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3385.48,"maximum":6181.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3520.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3385.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3487.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3622.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3453.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6181.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3588.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3619.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3791.74,"additional_payer_notes":"APC"}]}]},{"description":"R hrt art/grft angio","code_information":[{"code":"93457","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3385.48,"maximum":6181.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3520.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3385.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3487.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3622.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3453.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6181.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3588.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3619.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3791.74,"additional_payer_notes":"APC"}]}]},{"description":"L hrt artery/ventricle angio","code_information":[{"code":"93458","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3385.48,"maximum":6181.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3520.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3385.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3487.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3622.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3453.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6181.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3588.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3619.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3791.74,"additional_payer_notes":"APC"}]}]},{"description":"L hrt art/grft angio","code_information":[{"code":"93459","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3385.48,"maximum":6181.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3520.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3385.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3487.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3622.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3453.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6181.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3588.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3619.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3791.74,"additional_payer_notes":"APC"}]}]},{"description":"R&l hrt art/ventricle angio","code_information":[{"code":"93460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3385.48,"maximum":6181.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3520.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3385.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3487.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3622.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3453.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6181.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3588.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3619.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3791.74,"additional_payer_notes":"APC"}]}]},{"description":"R&l hrt art/ventricle angio","code_information":[{"code":"93461","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3385.48,"maximum":6181.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3520.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3385.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3487.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3622.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3453.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6181.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3588.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3619.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3791.74,"additional_payer_notes":"APC"}]}]},{"description":"R hrt cath chd nml nt cnj","code_information":[{"code":"93593","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3385.48,"maximum":6181.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3520.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3385.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3487.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3622.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3453.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6181.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3588.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3619.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3791.74,"additional_payer_notes":"APC"}]}]},{"description":"R hrt cath chd abnl nt cnj","code_information":[{"code":"93594","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3385.48,"maximum":6181.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3520.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3385.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3487.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3622.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3453.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6181.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3588.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3619.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3791.74,"additional_payer_notes":"APC"}]}]},{"description":"L hrt cath chd nm/abn nt cnj","code_information":[{"code":"93595","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3385.48,"maximum":6181.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3520.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3385.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3487.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3622.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3453.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6181.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3588.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3619.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3791.74,"additional_payer_notes":"APC"}]}]},{"description":"R&l hrt cath chd nml nt cnj","code_information":[{"code":"93596","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3385.48,"maximum":6181.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3520.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3385.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3487.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3622.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3453.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6181.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3588.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3619.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3791.74,"additional_payer_notes":"APC"}]}]},{"description":"R&l hrt cath chd abnl nt cnj","code_information":[{"code":"93597","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3385.48,"maximum":6181.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3520.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3385.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3487.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3622.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3453.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6181.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3588.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3619.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3791.74,"additional_payer_notes":"APC"}]}]},{"description":"Trnscth renal symp denrv unl","code_information":[{"code":"0338T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5943.58,"maximum":10852.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6181.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5943.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6121.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6359.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6062.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10852.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6300.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6353.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6656.81,"additional_payer_notes":"APC"}]}]},{"description":"Trnscth renal symp denrv bil","code_information":[{"code":"0339T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5943.58,"maximum":10852.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6181.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5943.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6121.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6359.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6062.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10852.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6300.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6353.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6656.81,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmvl/dblk icar mas perq","code_information":[{"code":"0644T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5943.58,"maximum":10852.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6181.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5943.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6121.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6359.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6062.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10852.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6300.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6353.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6656.81,"additional_payer_notes":"APC"}]}]},{"description":"Intro cath dialysis circuit","code_information":[{"code":"36902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5943.58,"maximum":10852.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6181.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5943.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6121.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6359.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6062.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10852.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6300.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6353.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6656.81,"additional_payer_notes":"APC"}]}]},{"description":"Thrmbc/nfs dialysis circuit","code_information":[{"code":"36904","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5943.58,"maximum":10852.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6181.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5943.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6121.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6359.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6062.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10852.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6300.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6353.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6656.81,"additional_payer_notes":"APC"}]}]},{"description":"Remove hepatic shunt (tips)","code_information":[{"code":"37183","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5943.58,"maximum":10852.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6181.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5943.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6121.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6359.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6062.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10852.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6300.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6353.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6656.81,"additional_payer_notes":"APC"}]}]},{"description":"Trluml balo angiop 1st art","code_information":[{"code":"37246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5943.58,"maximum":10852.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6181.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5943.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6121.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6359.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6062.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10852.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6300.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6353.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6656.81,"additional_payer_notes":"APC"}]}]},{"description":"Trluml balo angiop 1st vein","code_information":[{"code":"37248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5943.58,"maximum":10852.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6181.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5943.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6121.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6359.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6062.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10852.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6300.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6353.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6656.81,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evasc ivt angio sf 1st","code_information":[{"code":"37254","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5943.58,"maximum":10852.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6181.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5943.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6121.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6359.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6062.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10852.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6300.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6353.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6656.81,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evasc ivt angio cplx 1","code_information":[{"code":"37256","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5943.58,"maximum":10852.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6181.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5943.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6121.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6359.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6062.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10852.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6300.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6353.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6656.81,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evasc fpvt angio sf 1","code_information":[{"code":"37263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5943.58,"maximum":10852.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6181.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5943.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6121.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6359.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6062.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10852.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6300.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6353.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6656.81,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evsc fpvt angio cplx 1","code_information":[{"code":"37265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5943.58,"maximum":10852.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6181.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5943.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6121.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6359.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6062.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10852.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6300.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6353.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6656.81,"additional_payer_notes":"APC"}]}]},{"description":"Prq cardiac angioplast 1 art","code_information":[{"code":"92920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5943.58,"maximum":10852.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6181.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5943.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6121.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6359.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6062.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10852.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6300.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6353.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6656.81,"additional_payer_notes":"APC"}]}]},{"description":"Revision of aortic valve","code_information":[{"code":"92986","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5943.58,"maximum":10852.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6181.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5943.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6121.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6359.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6062.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10852.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6300.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6353.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6656.81,"additional_payer_notes":"APC"}]}]},{"description":"Trluml perip athrc renal art","code_information":[{"code":"0234T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Trluml perip athrc abd aorta","code_information":[{"code":"0236T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Trluml perip athrc brchiocph","code_information":[{"code":"0237T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Ev fempop artl revsc","code_information":[{"code":"0505T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Prq tcat ther rx ntrac balo1","code_information":[{"code":"0913T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Perq p-art revsc 1 nm nt uni","code_information":[{"code":"33900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Perq p-art revsc 1 nm nt bi","code_information":[{"code":"33901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Perq p-art revsc 1 abnor bi","code_information":[{"code":"33903","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Intro cath dialysis circuit","code_information":[{"code":"36903","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Thrmbc/nfs dialysis circuit","code_information":[{"code":"36905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Venous mech thrombectomy","code_information":[{"code":"37187","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Open/perq place stent 1st","code_information":[{"code":"37236","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Open/perq place stent same","code_information":[{"code":"37238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Vasc embolize/occlude venous","code_information":[{"code":"37241","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Vasc embolize/occlude organ","code_information":[{"code":"37243","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Vasc embolize/occlude bleed","code_information":[{"code":"37244","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evasc ivt stent sf 1st","code_information":[{"code":"37258","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evasc ivt st cplx 1st","code_information":[{"code":"37260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evsc fpvt stent sf 1st","code_information":[{"code":"37267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evasc fpvt st cplx 1st","code_information":[{"code":"37269","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evsc tpvt angio sf 1st","code_information":[{"code":"37280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Rvsc evsc tpvt angio cplx 1","code_information":[{"code":"37282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evasc imvt angio sf 1","code_information":[{"code":"37296","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evsc imvt angio cplx 1","code_information":[{"code":"37298","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Endovasc tempory vessel occl","code_information":[{"code":"61623","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Transcath occlusion non-cns","code_information":[{"code":"61626","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Prq card angio/athrect 1 art","code_information":[{"code":"92924","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Prq card stent w/angio 1 vsl","code_information":[{"code":"92928","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Prq revasc byp graft 1 vsl","code_information":[{"code":"92937","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Prq card revasc chronic 1vsl","code_information":[{"code":"92943","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Prq trl rvs ch occ ant&rtrgr","code_information":[{"code":"92945","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Revision of mitral valve","code_information":[{"code":"92987","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Revision of pulmonary valve","code_information":[{"code":"92990","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Pul art balloon repr percut","code_information":[{"code":"92997","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Sim ang w/prs cath rad emb","code_information":[{"code":"C8004","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Perc drug-el cor stent sing","code_information":[{"code":"C9600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Perc d-e cor revasc t cabg s","code_information":[{"code":"C9604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Revasc intravasc lithotripsy","code_information":[{"code":"C9764","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Revasc lithotrip tibi/perone","code_information":[{"code":"C9772","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Blind cor sinus reducer impl","code_information":[{"code":"C9783","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12055.35,"maximum":22013.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12296.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22013.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12887.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13502.0,"additional_payer_notes":"APC"}]}]},{"description":"Trluml perip athrc iliac art","code_information":[{"code":"0238T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Perq tcat us abltj nrv p-art","code_information":[{"code":"0632T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Tcat impltj c sins rdctj dev","code_information":[{"code":"0645T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Prq tcat thrm ablt nrv p-art","code_information":[{"code":"0793T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Tcat impl wrls ivc snr","code_information":[{"code":"0981T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Perq p-art revsc 1 abnor uni","code_information":[{"code":"33902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Prq av fstl crtj uxtr 1 acs","code_information":[{"code":"36836","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Prq av fstl crt uxtr sep acs","code_information":[{"code":"36837","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Thrmbc/nfs dialysis circuit","code_information":[{"code":"36906","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Insert hepatic shunt (tips)","code_information":[{"code":"37182","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Prim art m-thrmbc 1st vsl","code_information":[{"code":"37184","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Vasc embolize/occlude artery","code_information":[{"code":"37242","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evsc fpvt athrc sf 1st","code_information":[{"code":"37271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evsc fpvt athrc cplx 1","code_information":[{"code":"37273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Rvsc evsc fpvt st athrc sf 1","code_information":[{"code":"37275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Rvsc evsc fpvt st athr cpx 1","code_information":[{"code":"37277","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evasc tpvt st sf 1st","code_information":[{"code":"37284","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evasc tpvt st cplx 1st","code_information":[{"code":"37286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evsc tpvt athrc sf 1st","code_information":[{"code":"37288","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evsc tpvt athrc cplx 1","code_information":[{"code":"37290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Rvsc evsc tpvt st athrc sf 1","code_information":[{"code":"37292","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Rvsc evsc tpvt st athr cpx 1","code_information":[{"code":"37294","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Transcath occlusion cns","code_information":[{"code":"61624","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Prq tcat plmt ntrac st 2+les","code_information":[{"code":"92930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Prq card stent/ath/angio","code_information":[{"code":"92933","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Transcath closure of asd","code_information":[{"code":"93580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Transcath closure of vsd","code_information":[{"code":"93581","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Perq transcath closure pda","code_information":[{"code":"93582","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Perq transcath cls mitral","code_information":[{"code":"93590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Perq transcath cls aortic","code_information":[{"code":"93591","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Perc d-e cor stent ather s","code_information":[{"code":"C9602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Perc d-e cor revasc chro sin","code_information":[{"code":"C9607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Revasc intra lithotrip-stent","code_information":[{"code":"C9765","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Revasc intra lithotrip-ather","code_information":[{"code":"C9766","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Revasc lithotrip-stent-ather","code_information":[{"code":"C9767","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Revasc lithotr-stent tib/per","code_information":[{"code":"C9773","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Revasc lithotr-ather tib/per","code_information":[{"code":"C9774","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Revasc lith-sten-ath tib/per","code_information":[{"code":"C9775","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Vasc emb/occ w/prs cath","code_information":[{"code":"C9797","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19143.34,"maximum":34955.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19526.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34955.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20464.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21440.54,"additional_payer_notes":"APC"}]}]},{"description":"Bundle of His recording","code_information":[{"code":"93600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8145.02,"maximum":14872.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8470.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8145.02,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8389.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8715.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8307.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14872.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8633.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8707.03,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9122.43,"additional_payer_notes":"APC"}]}]},{"description":"Intra-atrial recording","code_information":[{"code":"93602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8145.02,"maximum":14872.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8470.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8145.02,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8389.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8715.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8307.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14872.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8633.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8707.03,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9122.43,"additional_payer_notes":"APC"}]}]},{"description":"Intra-atrial pacing","code_information":[{"code":"93610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8145.02,"maximum":14872.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8470.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8145.02,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8389.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8715.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8307.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14872.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8633.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8707.03,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9122.43,"additional_payer_notes":"APC"}]}]},{"description":"Intraventricular pacing","code_information":[{"code":"93612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8145.02,"maximum":14872.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8470.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8145.02,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8389.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8715.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8307.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14872.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8633.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8707.03,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9122.43,"additional_payer_notes":"APC"}]}]},{"description":"Electrophysiology evaluation","code_information":[{"code":"93619","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8145.02,"maximum":14872.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8470.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8145.02,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8389.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8715.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8307.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14872.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8633.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8707.03,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9122.43,"additional_payer_notes":"APC"}]}]},{"description":"Electrophysiology evaluation","code_information":[{"code":"93620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8145.02,"maximum":14872.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8470.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8145.02,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8389.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8715.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8307.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14872.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8633.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8707.03,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9122.43,"additional_payer_notes":"APC"}]}]},{"description":"Electrophysiologic study","code_information":[{"code":"93624","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8145.02,"maximum":14872.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8470.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8145.02,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8389.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8715.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8307.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14872.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8633.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8707.03,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9122.43,"additional_payer_notes":"APC"}]}]},{"description":"Ablate heart dysrhythm focus","code_information":[{"code":"93650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8145.02,"maximum":14872.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8470.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8145.02,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8389.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8715.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8307.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14872.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8633.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8707.03,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9122.43,"additional_payer_notes":"APC"}]}]},{"description":"Ep & ablate supravent arrhyt","code_information":[{"code":"93653","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27295.22,"maximum":49841.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28387.02,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27295.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28114.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29205.88,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27841.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":49841.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28932.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29178.59,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30570.64,"additional_payer_notes":"APC"}]}]},{"description":"Ep & ablate ventric tachy","code_information":[{"code":"93654","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27295.22,"maximum":49841.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28387.02,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27295.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28114.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29205.88,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27841.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":49841.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28932.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29178.59,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30570.64,"additional_payer_notes":"APC"}]}]},{"description":"Tx atrial fib pulm vein isol","code_information":[{"code":"93656","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27295.22,"maximum":49841.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28387.02,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27295.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28114.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29205.88,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27841.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":49841.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28932.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29178.59,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30570.64,"additional_payer_notes":"APC"}]}]},{"description":"Insj/rplc car modulj atr elt","code_information":[{"code":"0410T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8641.82,"maximum":15779.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8987.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8641.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8901.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9246.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8814.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15779.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9160.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9238.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9678.83,"additional_payer_notes":"APC"}]}]},{"description":"Insj/rplc car modulj vnt elt","code_information":[{"code":"0411T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8641.82,"maximum":15779.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8987.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8641.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8901.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9246.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8814.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15779.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9160.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9238.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9678.83,"additional_payer_notes":"APC"}]}]},{"description":"Insj/rplcmt iims eltrd only","code_information":[{"code":"0526T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8641.82,"maximum":15779.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8987.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8641.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8901.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9246.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8814.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15779.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9160.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9238.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9678.83,"additional_payer_notes":"APC"}]}]},{"description":"Insj/rplcmt iims implt mntr","code_information":[{"code":"0527T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8641.82,"maximum":15779.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8987.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8641.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8901.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9246.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8814.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15779.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9160.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9238.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9678.83,"additional_payer_notes":"APC"}]}]},{"description":"Insertion ss dfb electrode","code_information":[{"code":"0572T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8641.82,"maximum":15779.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8987.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8641.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8901.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9246.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8814.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15779.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9160.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9238.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9678.83,"additional_payer_notes":"APC"}]}]},{"description":"Insj perm ccm-d sys 1 lead","code_information":[{"code":"0917T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8641.82,"maximum":15779.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8987.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8641.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8901.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9246.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8814.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15779.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9160.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9238.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9678.83,"additional_payer_notes":"APC"}]}]},{"description":"Insj perm ccm-d sys dual ld","code_information":[{"code":"0918T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8641.82,"maximum":15779.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8987.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8641.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8901.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9246.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8814.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15779.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9160.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9238.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9678.83,"additional_payer_notes":"APC"}]}]},{"description":"Insert electrd/pm cath sngl","code_information":[{"code":"33210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8641.82,"maximum":15779.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8987.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8641.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8901.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9246.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8814.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15779.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9160.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9238.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9678.83,"additional_payer_notes":"APC"}]}]},{"description":"Insert card electrodes dual","code_information":[{"code":"33211","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8641.82,"maximum":15779.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8987.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8641.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8901.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9246.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8814.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15779.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9160.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9238.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9678.83,"additional_payer_notes":"APC"}]}]},{"description":"Insert pulse gen sngl lead","code_information":[{"code":"33212","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8641.82,"maximum":15779.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8987.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8641.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8901.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9246.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8814.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15779.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9160.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9238.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9678.83,"additional_payer_notes":"APC"}]}]},{"description":"Insert 1 electrode pm-defib","code_information":[{"code":"33216","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8641.82,"maximum":15779.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8987.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8641.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8901.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9246.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8814.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15779.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9160.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9238.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9678.83,"additional_payer_notes":"APC"}]}]},{"description":"Insert 2 electrode pm-defib","code_information":[{"code":"33217","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8641.82,"maximum":15779.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8987.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8641.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8901.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9246.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8814.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15779.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9160.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9238.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9678.83,"additional_payer_notes":"APC"}]}]},{"description":"Remove&replace pm gen singl","code_information":[{"code":"33227","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8641.82,"maximum":15779.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8987.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8641.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8901.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9246.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8814.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15779.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9160.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9238.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9678.83,"additional_payer_notes":"APC"}]}]},{"description":"Removal of pm generator","code_information":[{"code":"33233","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8641.82,"maximum":15779.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8987.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8641.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8901.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9246.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8814.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15779.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9160.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9238.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9678.83,"additional_payer_notes":"APC"}]}]},{"description":"Insj subq impltbl dfb elctrd","code_information":[{"code":"33271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8641.82,"maximum":15779.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8987.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8641.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8901.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9246.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8814.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15779.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9160.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9238.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9678.83,"additional_payer_notes":"APC"}]}]},{"description":"Insj subq car rhythm mntr","code_information":[{"code":"33285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8641.82,"maximum":15779.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8987.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8641.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8901.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9246.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8814.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15779.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9160.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9238.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9678.83,"additional_payer_notes":"APC"}]}]},{"description":"Insj wcs lv eltrd only","code_information":[{"code":"0516T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10914.8,"maximum":19930.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11351.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10914.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11242.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11678.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11133.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19930.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11569.69,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11667.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12224.58,"additional_payer_notes":"APC"}]}]},{"description":"Insj wcs lv pg compnt","code_information":[{"code":"0517T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10914.8,"maximum":19930.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11351.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10914.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11242.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11678.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11133.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19930.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11569.69,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11667.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12224.58,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl & rplcmt pg compnt wcs","code_information":[{"code":"0519T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10914.8,"maximum":19930.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11351.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10914.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11242.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11678.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11133.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19930.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11569.69,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11667.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12224.58,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl&rplcmt pg wcs new eltrd","code_information":[{"code":"0520T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10914.8,"maximum":19930.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11351.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10914.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11242.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11678.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11133.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19930.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11569.69,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11667.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12224.58,"additional_payer_notes":"APC"}]}]},{"description":"Insert heart pm atrial","code_information":[{"code":"33206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10914.8,"maximum":19930.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11351.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10914.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11242.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11678.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11133.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19930.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11569.69,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11667.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12224.58,"additional_payer_notes":"APC"}]}]},{"description":"Insert heart pm ventricular","code_information":[{"code":"33207","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10914.8,"maximum":19930.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11351.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10914.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11242.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11678.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11133.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19930.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11569.69,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11667.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12224.58,"additional_payer_notes":"APC"}]}]},{"description":"Insrt heart pm atrial & vent","code_information":[{"code":"33208","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10914.8,"maximum":19930.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11351.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10914.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11242.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11678.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11133.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19930.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11569.69,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11667.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12224.58,"additional_payer_notes":"APC"}]}]},{"description":"Insert pulse gen dual leads","code_information":[{"code":"33213","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10914.8,"maximum":19930.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11351.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10914.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11242.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11678.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11133.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19930.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11569.69,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11667.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12224.58,"additional_payer_notes":"APC"}]}]},{"description":"Upgrade of pacemaker system","code_information":[{"code":"33214","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10914.8,"maximum":19930.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11351.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10914.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11242.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11678.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11133.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19930.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11569.69,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11667.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12224.58,"additional_payer_notes":"APC"}]}]},{"description":"Insert pacing lead & connect","code_information":[{"code":"33224","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10914.8,"maximum":19930.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11351.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10914.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11242.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11678.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11133.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19930.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11569.69,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11667.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12224.58,"additional_payer_notes":"APC"}]}]},{"description":"Remv&replc pm gen dual lead","code_information":[{"code":"33228","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10914.8,"maximum":19930.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11351.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10914.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11242.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11678.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11133.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19930.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11569.69,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11667.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12224.58,"additional_payer_notes":"APC"}]}]},{"description":"Insj/rplcmt compl iims","code_information":[{"code":"0525T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20114.58,"maximum":36729.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20919.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20114.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20718.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21522.6,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20516.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36729.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21321.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21502.49,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22528.33,"additional_payer_notes":"APC"}]}]},{"description":"Tcat ins 2chmbr ldls pm cmpl","code_information":[{"code":"0795T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20114.58,"maximum":36729.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20919.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20114.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20718.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21522.6,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20516.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36729.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21321.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21502.49,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22528.33,"additional_payer_notes":"APC"}]}]},{"description":"Tcat ins 2chmbr ldls pm ra","code_information":[{"code":"0796T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20114.58,"maximum":36729.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20919.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20114.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20718.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21522.6,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20516.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36729.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21321.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21502.49,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22528.33,"additional_payer_notes":"APC"}]}]},{"description":"Tcat ins 2chmbr ldls pm rv","code_information":[{"code":"0797T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20114.58,"maximum":36729.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20919.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20114.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20718.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21522.6,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20516.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36729.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21321.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21502.49,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22528.33,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmv&rpl 2chmbr ldls pm","code_information":[{"code":"0801T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20114.58,"maximum":36729.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20919.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20114.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20718.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21522.6,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20516.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36729.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21321.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21502.49,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22528.33,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmv&rpl2chmb ldls pm ra","code_information":[{"code":"0802T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20114.58,"maximum":36729.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20919.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20114.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20718.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21522.6,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20516.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36729.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21321.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21502.49,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22528.33,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmv&rpl2chmb ldls pm rv","code_information":[{"code":"0803T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20114.58,"maximum":36729.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20919.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20114.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20718.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21522.6,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20516.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36729.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21321.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21502.49,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22528.33,"additional_payer_notes":"APC"}]}]},{"description":"Tcat ins 1chmbr ldls pm ra","code_information":[{"code":"0823T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20114.58,"maximum":36729.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20919.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20114.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20718.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21522.6,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20516.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36729.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21321.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21502.49,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22528.33,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmv&rpl1chmb ldls pm ra","code_information":[{"code":"0825T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20114.58,"maximum":36729.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20919.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20114.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20718.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21522.6,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20516.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36729.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21321.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21502.49,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22528.33,"additional_payer_notes":"APC"}]}]},{"description":"Insert pulse gen mult leads","code_information":[{"code":"33221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20114.58,"maximum":36729.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20919.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20114.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20718.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21522.6,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20516.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36729.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21321.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21502.49,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22528.33,"additional_payer_notes":"APC"}]}]},{"description":"Remv&replc pm gen mult leads","code_information":[{"code":"33229","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20114.58,"maximum":36729.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20919.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20114.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20718.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21522.6,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20516.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36729.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21321.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21502.49,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22528.33,"additional_payer_notes":"APC"}]}]},{"description":"Tcat insj/rpl perm ldls pm","code_information":[{"code":"33274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20114.58,"maximum":36729.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20919.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20114.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20718.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21522.6,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20516.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36729.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21321.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21502.49,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22528.33,"additional_payer_notes":"APC"}]}]},{"description":"Insj/rplc car modulj pls gn","code_information":[{"code":"0409T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23228.5,"maximum":42415.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24157.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23228.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23925.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24854.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23693.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":42415.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24622.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24831.27,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26015.92,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl & rpl car modulj pls gn","code_information":[{"code":"0414T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23228.5,"maximum":42415.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24157.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23228.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23925.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24854.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23693.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":42415.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24622.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24831.27,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26015.92,"additional_payer_notes":"APC"}]}]},{"description":"Insj wcs lv compl sys","code_information":[{"code":"0515T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23228.5,"maximum":42415.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24157.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23228.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23925.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24854.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23693.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":42415.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24622.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24831.27,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26015.92,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl&rplcmt ss impl dfb pg","code_information":[{"code":"0614T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23228.5,"maximum":42415.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24157.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23228.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23925.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24854.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23693.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":42415.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24622.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24831.27,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26015.92,"additional_payer_notes":"APC"}]}]},{"description":"Insj perm ccm-d sys pg only","code_information":[{"code":"0916T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23228.5,"maximum":42415.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24157.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23228.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23925.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24854.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23693.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":42415.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24622.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24831.27,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26015.92,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl&rplcmt perm ccm-d pg","code_information":[{"code":"0923T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23228.5,"maximum":42415.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24157.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23228.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23925.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24854.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23693.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":42415.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24622.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24831.27,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26015.92,"additional_payer_notes":"APC"}]}]},{"description":"Insrt pulse gen w/dual leads","code_information":[{"code":"33230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23228.5,"maximum":42415.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24157.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23228.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23925.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24854.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23693.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":42415.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24622.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24831.27,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26015.92,"additional_payer_notes":"APC"}]}]},{"description":"Insrt pulse gen w/singl lead","code_information":[{"code":"33240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23228.5,"maximum":42415.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24157.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23228.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23925.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24854.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23693.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":42415.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24622.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24831.27,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26015.92,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl& replc pulse gen 1 lead","code_information":[{"code":"33262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23228.5,"maximum":42415.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24157.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23228.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23925.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24854.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23693.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":42415.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24622.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24831.27,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26015.92,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl & rplcmt dfb gen 2 lead","code_information":[{"code":"33263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23228.5,"maximum":42415.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24157.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23228.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23925.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24854.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23693.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":42415.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24622.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24831.27,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26015.92,"additional_payer_notes":"APC"}]}]},{"description":"Insj/rplc cardiac modulj sys","code_information":[{"code":"0408T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32778.73,"maximum":59853.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34089.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32778.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33762.09,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35073.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33434.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":59853.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34745.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35040.46,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36712.18,"additional_payer_notes":"APC"}]}]},{"description":"Insj/rplcmt icds ss eltrd","code_information":[{"code":"0571T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32778.73,"maximum":59853.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34089.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32778.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33762.09,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35073.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33434.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":59853.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34745.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35040.46,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36712.18,"additional_payer_notes":"APC"}]}]},{"description":"Insj perm ccm-d sys pg&eltrd","code_information":[{"code":"0915T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32778.73,"maximum":59853.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34089.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32778.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33762.09,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35073.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33434.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":59853.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34745.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35040.46,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36712.18,"additional_payer_notes":"APC"}]}]},{"description":"Insrt pulse gen w/mult leads","code_information":[{"code":"33231","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32778.73,"maximum":59853.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34089.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32778.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33762.09,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35073.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33434.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":59853.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34745.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35040.46,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36712.18,"additional_payer_notes":"APC"}]}]},{"description":"Insj/rplcmt defib w/lead(s)","code_information":[{"code":"33249","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32778.73,"maximum":59853.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34089.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32778.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33762.09,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35073.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33434.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":59853.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34745.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35040.46,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36712.18,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl & rplcmt dfb gen mlt ld","code_information":[{"code":"33264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32778.73,"maximum":59853.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34089.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32778.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33762.09,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35073.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33434.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":59853.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34745.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35040.46,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36712.18,"additional_payer_notes":"APC"}]}]},{"description":"Ins/rep subq defibrillator","code_information":[{"code":"33270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32778.73,"maximum":59853.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34089.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32778.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33762.09,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35073.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33434.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":59853.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34745.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35040.46,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36712.18,"additional_payer_notes":"APC"}]}]},{"description":"Blood transfusion service","code_information":[{"code":"36430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":460.71,"maximum":841.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":479.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":460.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":474.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":492.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":469.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":841.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":488.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":492.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":515.99,"additional_payer_notes":"APC"}]}]},{"description":"Bl push transfuse 2 yr/<","code_information":[{"code":"36440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":460.71,"maximum":841.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":479.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":460.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":474.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":492.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":469.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":841.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":488.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":492.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":515.99,"additional_payer_notes":"APC"}]}]},{"description":"Bl exchange/transfuse nb","code_information":[{"code":"36450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":460.71,"maximum":841.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":479.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":460.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":474.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":492.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":469.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":841.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":488.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":492.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":515.99,"additional_payer_notes":"APC"}]}]},{"description":"Bl exchange/transfuse non-nb","code_information":[{"code":"36455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":460.71,"maximum":841.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":479.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":460.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":474.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":492.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":469.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":841.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":488.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":492.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":515.99,"additional_payer_notes":"APC"}]}]},{"description":"Prtl exchange transfuse nb","code_information":[{"code":"36456","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":460.71,"maximum":841.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":479.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":460.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":474.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":492.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":469.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":841.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":488.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":492.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":515.99,"additional_payer_notes":"APC"}]}]},{"description":"Transfusion service fetal","code_information":[{"code":"36460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":460.71,"maximum":841.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":479.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":460.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":474.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":492.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":469.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":841.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":488.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":492.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":515.99,"additional_payer_notes":"APC"}]}]},{"description":"Apheresis platelets","code_information":[{"code":"36513","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":460.71,"maximum":841.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":479.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":460.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":474.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":492.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":469.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":841.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":488.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":492.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":515.99,"additional_payer_notes":"APC"}]}]},{"description":"Cryopreserve stem cells","code_information":[{"code":"38207","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":460.71,"maximum":841.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":479.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":460.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":474.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":492.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":469.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":841.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":488.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":492.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":515.99,"additional_payer_notes":"APC"}]}]},{"description":"Thaw preserved stem cells","code_information":[{"code":"38208","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":460.71,"maximum":841.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":479.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":460.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":474.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":492.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":469.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":841.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":488.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":492.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":515.99,"additional_payer_notes":"APC"}]}]},{"description":"Wash harvest stem cells","code_information":[{"code":"38209","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":460.71,"maximum":841.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":479.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":460.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":474.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":492.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":469.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":841.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":488.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":492.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":515.99,"additional_payer_notes":"APC"}]}]},{"description":"T-cell depletion of harvest","code_information":[{"code":"38210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":460.71,"maximum":841.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":479.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":460.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":474.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":492.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":469.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":841.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":488.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":492.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":515.99,"additional_payer_notes":"APC"}]}]},{"description":"Tumor cell deplete of harvst","code_information":[{"code":"38211","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":460.71,"maximum":841.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":479.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":460.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":474.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":492.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":469.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":841.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":488.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":492.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":515.99,"additional_payer_notes":"APC"}]}]},{"description":"Rbc depletion of harvest","code_information":[{"code":"38212","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":460.71,"maximum":841.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":479.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":460.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":474.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":492.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":469.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":841.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":488.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":492.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":515.99,"additional_payer_notes":"APC"}]}]},{"description":"Platelet deplete of harvest","code_information":[{"code":"38213","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":460.71,"maximum":841.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":479.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":460.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":474.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":492.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":469.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":841.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":488.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":492.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":515.99,"additional_payer_notes":"APC"}]}]},{"description":"Volume deplete of harvest","code_information":[{"code":"38214","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":460.71,"maximum":841.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":479.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":460.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":474.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":492.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":469.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":841.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":488.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":492.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":515.99,"additional_payer_notes":"APC"}]}]},{"description":"Harvest stem cell concentrte","code_information":[{"code":"38215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":460.71,"maximum":841.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":479.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":460.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":474.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":492.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":469.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":841.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":488.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":492.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":515.99,"additional_payer_notes":"APC"}]}]},{"description":"Blood/lymph system procedure","code_information":[{"code":"38999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":460.71,"maximum":841.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":479.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":460.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":474.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":492.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":469.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":841.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":488.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":492.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":515.99,"additional_payer_notes":"APC"}]}]},{"description":"Mag ctrld capsule endoscopy","code_information":[{"code":"0651T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Egd vol adjmt bariatric balo","code_information":[{"code":"0813T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Upr gi bld detcj snr capsule","code_information":[{"code":"0977T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Removal foreign body mouth","code_information":[{"code":"40804","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy flex dx brush","code_information":[{"code":"43197","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Esophagosc flex trnsn biopsy","code_information":[{"code":"43198","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy flexible brush","code_information":[{"code":"43200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Egd diagnostic brush wash","code_information":[{"code":"43235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Uppr gi scope w/submuc inj","code_information":[{"code":"43236","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Egd biopsy single/multiple","code_information":[{"code":"43239","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Egd remove foreign body","code_information":[{"code":"43247","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Egd guide wire insertion","code_information":[{"code":"43248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Egd flx trnsorl rmvl balo","code_information":[{"code":"43291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Dilate esophagus 1/mult pass","code_information":[{"code":"43450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Esophagus surgery procedure","code_information":[{"code":"43499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Surgical opening of stomach","code_information":[{"code":"43510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Dx duod intub w/asp spec","code_information":[{"code":"43756","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Dx duod intub w/asp specs","code_information":[{"code":"43757","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Place gastrostomy tube","code_information":[{"code":"43831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Stomach surgery procedure","code_information":[{"code":"43999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of bowel","code_information":[{"code":"44100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy br/wa","code_information":[{"code":"44380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44382","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Intro gastrointestinal tube","code_information":[{"code":"44500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Unlisted px small intestine","code_information":[{"code":"44799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Removal biliary drg cath","code_information":[{"code":"47537","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Bile tract surgery procedure","code_information":[{"code":"47999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Abd paracentesis","code_information":[{"code":"49082","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Abd paracentesis w/imaging","code_information":[{"code":"49083","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Peritoneal lavage","code_information":[{"code":"49084","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Replace g/c tube perc","code_information":[{"code":"49450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Replace duod/jej tube perc","code_information":[{"code":"49451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Replace g-j tube perc","code_information":[{"code":"49452","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Fix g/colon tube w/device","code_information":[{"code":"49460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Abdomen surgery procedure","code_information":[{"code":"49999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Perq elec nrv field stimj cn","code_information":[{"code":"64567","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Gi tract capsule endoscopy","code_information":[{"code":"91110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Esophageal Capsule Endoscopy","code_information":[{"code":"91111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Gi wireless capsule measure","code_information":[{"code":"91112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.15,"maximum":1729.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":966.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1729.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1012.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1060.8,"additional_payer_notes":"APC"}]}]},{"description":"Insj gtube perq mag gastrpxy","code_information":[{"code":"0647T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Egd flx transnasal dx br/wa","code_information":[{"code":"0652T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Egd flx transnasal bx 1/ml","code_information":[{"code":"0653T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Insert cath pleura w/o image","code_information":[{"code":"32556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy rigid trnso dx","code_information":[{"code":"43191","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscp rig trnso inject","code_information":[{"code":"43192","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscp rig trnso biopsy","code_information":[{"code":"43193","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscp rig trnso rem fb","code_information":[{"code":"43194","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscp guide wire dilat","code_information":[{"code":"43196","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Esoph scope w/submucous inj","code_information":[{"code":"43201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy flex biopsy","code_information":[{"code":"43202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Esoph scope w/sclerosis inj","code_information":[{"code":"43204","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Esophagus endoscopy/ligation","code_information":[{"code":"43205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Esoph optical endomicroscopy","code_information":[{"code":"43206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscop mucosal resect","code_information":[{"code":"43211","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy retro balloon","code_information":[{"code":"43213","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Esophagosc dilate balloon 30","code_information":[{"code":"43214","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy flex remove fb","code_information":[{"code":"43215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy lesion removal","code_information":[{"code":"43216","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy snare les remv","code_information":[{"code":"43217","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy balloon <30mm","code_information":[{"code":"43220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Esoph endoscopy dilation","code_information":[{"code":"43226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy control bleed","code_information":[{"code":"43227","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscop ultrasound exam","code_information":[{"code":"43231","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy w/us needle bx","code_information":[{"code":"43232","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Egd balloon dil esoph30 mm/>","code_information":[{"code":"43233","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Endoscopic us exam esoph","code_information":[{"code":"43237","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Egd us fine needle bx/aspir","code_information":[{"code":"43238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Egd tube/cath insertion","code_information":[{"code":"43241","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Egd us fine needle bx/aspir","code_information":[{"code":"43242","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Egd injection varices","code_information":[{"code":"43243","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Egd varices ligation","code_information":[{"code":"43244","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Egd dilate stricture","code_information":[{"code":"43245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Egd place gastrostomy tube","code_information":[{"code":"43246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Esoph egd dilation <30 mm","code_information":[{"code":"43249","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Egd cautery tumor polyp","code_information":[{"code":"43250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Egd remove lesion snare","code_information":[{"code":"43251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Egd optical endomicroscopy","code_information":[{"code":"43252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Egd us transmural injxn/mark","code_information":[{"code":"43253","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Egd endo mucosal resection","code_information":[{"code":"43254","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Egd control bleeding any","code_information":[{"code":"43255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Egd us exam duodenum/jejunum","code_information":[{"code":"43259","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Ercp sphincter pressure meas","code_information":[{"code":"43263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Egd lesion ablation","code_information":[{"code":"43270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Ercp remove forgn body duct","code_information":[{"code":"43275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Egd flx trnsorl dplmnt balo","code_information":[{"code":"43290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Dilate esophagus","code_information":[{"code":"43453","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Place gastrostomy tube","code_information":[{"code":"43830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Open bowel to skin","code_information":[{"code":"44300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy/biopsy","code_information":[{"code":"44361","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44363","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44364","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44366","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44369","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44372","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44373","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44376","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy/biopsy","code_information":[{"code":"44377","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44378","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy br/wa","code_information":[{"code":"44381","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44384","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Exchange drainage catheter","code_information":[{"code":"49423","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Embedded IP Cath Exit-Site","code_information":[{"code":"49436","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Place gastrostomy tube perc","code_information":[{"code":"49440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Place duod/jej tube perc","code_information":[{"code":"49441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Change g-tube to g-j perc","code_information":[{"code":"49446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2003.87,"maximum":3659.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2043.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3659.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2142.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2244.34,"additional_payer_notes":"APC"}]}]},{"description":"Egd flx transnasal tube/cath","code_information":[{"code":"0654T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4026.19,"maximum":7351.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4026.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4146.97,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4308.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4106.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7351.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4267.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4304.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4509.33,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy rigid balloon","code_information":[{"code":"43195","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4026.19,"maximum":7351.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4026.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4146.97,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4308.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4106.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7351.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4267.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4304.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4509.33,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy lesion ablate","code_information":[{"code":"43229","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4026.19,"maximum":7351.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4026.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4146.97,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4308.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4106.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7351.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4267.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4304.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4509.33,"additional_payer_notes":"APC"}]}]},{"description":"Egd w/thrml txmnt gerd","code_information":[{"code":"43257","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4026.19,"maximum":7351.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4026.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4146.97,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4308.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4106.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7351.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4267.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4304.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4509.33,"additional_payer_notes":"APC"}]}]},{"description":"Ercp w/specimen collection","code_information":[{"code":"43260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4026.19,"maximum":7351.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4026.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4146.97,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4308.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4106.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7351.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4267.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4304.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4509.33,"additional_payer_notes":"APC"}]}]},{"description":"Endo cholangiopancreatograph","code_information":[{"code":"43261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4026.19,"maximum":7351.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4026.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4146.97,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4308.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4106.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7351.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4267.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4304.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4509.33,"additional_payer_notes":"APC"}]}]},{"description":"Endo cholangiopancreatograph","code_information":[{"code":"43262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4026.19,"maximum":7351.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4026.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4146.97,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4308.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4106.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7351.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4267.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4304.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4509.33,"additional_payer_notes":"APC"}]}]},{"description":"Ercp remove duct calculi","code_information":[{"code":"43264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4026.19,"maximum":7351.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4026.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4146.97,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4308.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4106.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7351.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4267.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4304.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4509.33,"additional_payer_notes":"APC"}]}]},{"description":"Ercp ea duct/ampulla dilate","code_information":[{"code":"43277","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4026.19,"maximum":7351.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4026.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4146.97,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4308.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4106.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7351.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4267.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4304.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4509.33,"additional_payer_notes":"APC"}]}]},{"description":"Ercp lesion ablate w/dilate","code_information":[{"code":"43278","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4026.19,"maximum":7351.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4026.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4146.97,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4308.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4106.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7351.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4267.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4304.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4509.33,"additional_payer_notes":"APC"}]}]},{"description":"Lap rmvl gastr adj device","code_information":[{"code":"43772","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4026.19,"maximum":7351.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4026.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4146.97,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4308.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4106.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7351.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4267.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4304.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4509.33,"additional_payer_notes":"APC"}]}]},{"description":"Lap rmvl gastr adj all parts","code_information":[{"code":"43774","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4026.19,"maximum":7351.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4026.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4146.97,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4308.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4106.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7351.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4267.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4304.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4509.33,"additional_payer_notes":"APC"}]}]},{"description":"Repair of stomach lesion","code_information":[{"code":"43840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4026.19,"maximum":7351.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4026.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4146.97,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4308.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4106.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7351.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4267.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4304.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4509.33,"additional_payer_notes":"APC"}]}]},{"description":"Repair stomach opening","code_information":[{"code":"43870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4026.19,"maximum":7351.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4026.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4146.97,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4308.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4106.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7351.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4267.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4304.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4509.33,"additional_payer_notes":"APC"}]}]},{"description":"Suture small intestine","code_information":[{"code":"44602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4026.19,"maximum":7351.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4026.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4146.97,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4308.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4106.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7351.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4267.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4304.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4509.33,"additional_payer_notes":"APC"}]}]},{"description":"Esophag mucosal integ add-on","code_information":[{"code":"C9777","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4026.19,"maximum":7351.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4026.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4146.97,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4308.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4106.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7351.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4267.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4304.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4509.33,"additional_payer_notes":"APC"}]}]},{"description":"ESD endoscopy or colonoscopy","code_information":[{"code":"C9779","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4026.19,"maximum":7351.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4026.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4146.97,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4308.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4106.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7351.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4267.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4304.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4509.33,"additional_payer_notes":"APC"}]}]},{"description":"Endoscopy of bowel pouch","code_information":[{"code":"44385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.14,"maximum":1773.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":990.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1773.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1038.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1087.67,"additional_payer_notes":"APC"}]}]},{"description":"Endoscopy bowel pouch/biop","code_information":[{"code":"44386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.14,"maximum":1773.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":990.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1773.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1038.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1087.67,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy thru stoma spx","code_information":[{"code":"44388","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.14,"maximum":1773.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":990.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1773.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1038.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1087.67,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy for foreign body","code_information":[{"code":"44390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.14,"maximum":1773.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":990.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1773.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1038.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1087.67,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/decompression","code_information":[{"code":"44408","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.14,"maximum":1773.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":990.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1773.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1038.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1087.67,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy dx","code_information":[{"code":"45300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.14,"maximum":1773.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":990.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1773.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1038.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1087.67,"additional_payer_notes":"APC"}]}]},{"description":"Diagnostic sigmoidoscopy","code_information":[{"code":"45330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.14,"maximum":1773.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":990.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1773.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1038.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1087.67,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy and biopsy","code_information":[{"code":"45331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.14,"maximum":1773.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":990.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1773.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1038.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1087.67,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy & polypectomy","code_information":[{"code":"45333","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.14,"maximum":1773.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":990.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1773.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1038.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1087.67,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy w/submuc inj","code_information":[{"code":"45335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.14,"maximum":1773.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":990.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1773.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1038.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1087.67,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy & decompress","code_information":[{"code":"45337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.14,"maximum":1773.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":990.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1773.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1038.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1087.67,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy W/Ultrasound","code_information":[{"code":"45341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.14,"maximum":1773.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":990.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1773.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1038.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1087.67,"additional_payer_notes":"APC"}]}]},{"description":"Diagnostic colonoscopy","code_information":[{"code":"45378","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.14,"maximum":1773.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":990.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1773.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1038.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1087.67,"additional_payer_notes":"APC"}]}]},{"description":"Unlisted procedure colon","code_information":[{"code":"45399","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.14,"maximum":1773.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":990.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1773.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1038.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1087.67,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of rectal prolapse","code_information":[{"code":"45520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.14,"maximum":1773.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":990.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1773.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1038.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1087.67,"additional_payer_notes":"APC"}]}]},{"description":"Reduction of rectal prolapse","code_information":[{"code":"45900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.14,"maximum":1773.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":990.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1773.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1038.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1087.67,"additional_payer_notes":"APC"}]}]},{"description":"Rectum surgery procedure","code_information":[{"code":"45999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.14,"maximum":1773.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":990.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1773.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1038.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1087.67,"additional_payer_notes":"APC"}]}]},{"description":"Incision of anal abscess","code_information":[{"code":"46050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.14,"maximum":1773.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":990.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1773.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1038.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1087.67,"additional_payer_notes":"APC"}]}]},{"description":"Ligation of hemorrhoid(s)","code_information":[{"code":"46221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.14,"maximum":1773.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":990.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1773.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1038.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1087.67,"additional_payer_notes":"APC"}]}]},{"description":"Injection into hemorrhoid(s)","code_information":[{"code":"46500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.14,"maximum":1773.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":990.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1773.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1038.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1087.67,"additional_payer_notes":"APC"}]}]},{"description":"Anoscopy remove for body","code_information":[{"code":"46608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.14,"maximum":1773.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":990.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1773.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1038.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1087.67,"additional_payer_notes":"APC"}]}]},{"description":"Anoscopy","code_information":[{"code":"46611","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.14,"maximum":1773.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":990.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1773.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1038.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1087.67,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of anal fissure","code_information":[{"code":"46942","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.14,"maximum":1773.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":990.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1773.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1038.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1087.67,"additional_payer_notes":"APC"}]}]},{"description":"Anus surgery procedure","code_information":[{"code":"46999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.14,"maximum":1773.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":990.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1773.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1038.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1087.67,"additional_payer_notes":"APC"}]}]},{"description":"Gi trc img intral colon i&r","code_information":[{"code":"91113","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.14,"maximum":1773.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":990.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1773.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1038.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1087.67,"additional_payer_notes":"APC"}]}]},{"description":"Place endorectal app","code_information":[{"code":"C9725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.14,"maximum":1773.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":990.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1773.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1038.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1087.67,"additional_payer_notes":"APC"}]}]},{"description":"CA screen;flexi sigmoidscope","code_information":[{"code":"G0104","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.14,"maximum":1773.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":990.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1773.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1038.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1087.67,"additional_payer_notes":"APC"}]}]},{"description":"Colorectal scrn; hi risk ind","code_information":[{"code":"G0105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.14,"maximum":1773.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":990.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1773.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1038.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1087.67,"additional_payer_notes":"APC"}]}]},{"description":"Colon ca scrn not hi rsk ind","code_information":[{"code":"G0121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.14,"maximum":1773.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":990.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1773.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1038.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1087.67,"additional_payer_notes":"APC"}]}]},{"description":"Fecal microbiota prep instil","code_information":[{"code":"G0455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.14,"maximum":1773.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":990.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1773.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1038.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1087.67,"additional_payer_notes":"APC"}]}]},{"description":"Anosc sbmcsl njx bulking agt","code_information":[{"code":"0963T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Tranal ins tmp clrc anst dev","code_information":[{"code":"0967T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy with biopsy","code_information":[{"code":"44389","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy for bleeding","code_information":[{"code":"44391","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy & polypectomy","code_information":[{"code":"44392","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/snare","code_information":[{"code":"44394","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy with ablation","code_information":[{"code":"44401","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/resection","code_information":[{"code":"44403","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/injection","code_information":[{"code":"44404","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/dilation","code_information":[{"code":"44405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/ultrasound","code_information":[{"code":"44406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/ndl aspir/bx","code_information":[{"code":"44407","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of pelvic abscess","code_information":[{"code":"45000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of rectal abscess","code_information":[{"code":"45005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Excision of rectal stricture","code_information":[{"code":"45150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy dilate","code_information":[{"code":"45303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy w/bx","code_information":[{"code":"45305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy removal","code_information":[{"code":"45309","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy removal","code_information":[{"code":"45315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy bleed","code_information":[{"code":"45317","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy w/fb removal","code_information":[{"code":"45332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy for bleeding","code_information":[{"code":"45334","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy w/tumr remove","code_information":[{"code":"45338","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Sig w/tndsc balloon dilation","code_information":[{"code":"45340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy W/Us Guide Bx","code_information":[{"code":"45342","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy w/ablation","code_information":[{"code":"45346","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Sgmdsc w/band ligation","code_information":[{"code":"45350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/fb removal","code_information":[{"code":"45379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy and biopsy","code_information":[{"code":"45380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy submucous njx","code_information":[{"code":"45381","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/control bleed","code_information":[{"code":"45382","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/lesion removal","code_information":[{"code":"45384","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/lesion removal","code_information":[{"code":"45385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/balloon dilat","code_information":[{"code":"45386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/ablation","code_information":[{"code":"45388","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/endoscope us","code_information":[{"code":"45391","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/endoscopic fnb","code_information":[{"code":"45392","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/decompression","code_information":[{"code":"45393","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/band ligation","code_information":[{"code":"45398","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Dilation of anal sphincter","code_information":[{"code":"45905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Dilation of rectal narrowing","code_information":[{"code":"45910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Remove rectal obstruction","code_information":[{"code":"45915","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Removal of rectal marker","code_information":[{"code":"46030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Incision of rectal abscess","code_information":[{"code":"46040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Excise anal ext tag/papilla","code_information":[{"code":"46220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Removal of hemorrhoid clot","code_information":[{"code":"46320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Chemodenervation anal musc","code_information":[{"code":"46505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Anoscopy and dilation","code_information":[{"code":"46604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Anoscopy and biopsy","code_information":[{"code":"46606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Diagnostic anoscopy & biopsy","code_information":[{"code":"46607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Anoscopy control bleeding","code_information":[{"code":"46614","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Destroy internal hemorrhoids","code_information":[{"code":"46930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Place cecostomy tube perc","code_information":[{"code":"49442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1249.63,"maximum":2281.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1274.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2281.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1335.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.58,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of rectal abscess","code_information":[{"code":"45020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of rectum","code_information":[{"code":"45100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Removal of anorectal lesion","code_information":[{"code":"45108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Excision of rectal lesion","code_information":[{"code":"45160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Exc rect tum transanal part","code_information":[{"code":"45171","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Exc rect tum transanal full","code_information":[{"code":"45172","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Destruction rectal tumor","code_information":[{"code":"45190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy fb","code_information":[{"code":"45307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy removal","code_information":[{"code":"45308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy ablate","code_information":[{"code":"45320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy volvul","code_information":[{"code":"45321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy w/resection","code_information":[{"code":"45349","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/resection","code_information":[{"code":"45390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair of rectum","code_information":[{"code":"45500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair of rectum","code_information":[{"code":"45505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Correct rectal prolapse","code_information":[{"code":"45541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair of rectocele","code_information":[{"code":"45560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Surg dx exam anorectal","code_information":[{"code":"45990","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Placement of seton","code_information":[{"code":"46020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Incision of rectal abscess","code_information":[{"code":"46045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Incision of rectal abscess","code_information":[{"code":"46060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Incision of anal septum","code_information":[{"code":"46070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Incision of anal sphincter","code_information":[{"code":"46080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Removal of anal fissure","code_information":[{"code":"46200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Removal of anal tags","code_information":[{"code":"46230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove ext hem groups 2+","code_information":[{"code":"46250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove int/ext hem 1 group","code_information":[{"code":"46255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove in/ex hem grp & fiss","code_information":[{"code":"46257","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove in/ex hem grp w/fistu","code_information":[{"code":"46258","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove in/ex hem groups 2+","code_information":[{"code":"46260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove in/ex hem grps & fiss","code_information":[{"code":"46261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove in/ex hem grps w/fist","code_information":[{"code":"46262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove anal fist subq","code_information":[{"code":"46270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove anal fist inter","code_information":[{"code":"46275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove anal fist complex","code_information":[{"code":"46280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove anal fist 2 stage","code_information":[{"code":"46285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair anal fistula","code_information":[{"code":"46288","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Anoscopy remove lesion","code_information":[{"code":"46610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Anoscopy remove lesions","code_information":[{"code":"46612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Anoscopy","code_information":[{"code":"46615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair of anal stricture","code_information":[{"code":"46700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Repr of anal fistula w/glue","code_information":[{"code":"46706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair anorectal fist w/plug","code_information":[{"code":"46707","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair of anal sphincter","code_information":[{"code":"46750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of anus","code_information":[{"code":"46753","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Removal of suture from anus","code_information":[{"code":"46754","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair of anal sphincter","code_information":[{"code":"46760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair of anal sphincter","code_information":[{"code":"46761","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Laser surgery anal lesions","code_information":[{"code":"46917","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Excision of anal lesion(s)","code_information":[{"code":"46922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Destruction anal lesion(s)","code_information":[{"code":"46924","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of anal fissure","code_information":[{"code":"46940","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove by ligat int hem grp","code_information":[{"code":"46945","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove by ligat int hem grps","code_information":[{"code":"46946","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Hemorrhoidopexy by stapling","code_information":[{"code":"46947","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Int hrhc tranal dartlzj 2+","code_information":[{"code":"46948","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Rpr intst excl anrect fist","code_information":[{"code":"C9796","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2898.56,"maximum":5292.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2956.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5292.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3098.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.39,"additional_payer_notes":"APC"}]}]},{"description":"Exc rectal tumor endoscopic","code_information":[{"code":"0184T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6339.71,"maximum":11576.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6593.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6339.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6529.9,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6783.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6466.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11576.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6720.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6777.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7100.48,"additional_payer_notes":"APC"}]}]},{"description":"Esphgsc flx 1st tndsc dilat","code_information":[{"code":"0884T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6339.71,"maximum":11576.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6593.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6339.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6529.9,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6783.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6466.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11576.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6720.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6777.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7100.48,"additional_payer_notes":"APC"}]}]},{"description":"Colsc flx 1st tndsc dilat","code_information":[{"code":"0885T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6339.71,"maximum":11576.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6593.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6339.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6529.9,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6783.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6466.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11576.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6720.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6777.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7100.48,"additional_payer_notes":"APC"}]}]},{"description":"Sgmdsc flx 1st tndsc dilat","code_information":[{"code":"0886T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6339.71,"maximum":11576.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6593.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6339.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6529.9,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6783.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6466.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11576.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6720.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6777.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7100.48,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscop stent placement","code_information":[{"code":"43212","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6339.71,"maximum":11576.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6593.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6339.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6529.9,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6783.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6466.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11576.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6720.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6777.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7100.48,"additional_payer_notes":"APC"}]}]},{"description":"Egd w/transmural drain cyst","code_information":[{"code":"43240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6339.71,"maximum":11576.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6593.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6339.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6529.9,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6783.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6466.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11576.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6720.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6777.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7100.48,"additional_payer_notes":"APC"}]}]},{"description":"Ercp lithotripsy calculi","code_information":[{"code":"43265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6339.71,"maximum":11576.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6593.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6339.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6529.9,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6783.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6466.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11576.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6720.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6777.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7100.48,"additional_payer_notes":"APC"}]}]},{"description":"Egd endoscopic stent place","code_information":[{"code":"43266","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6339.71,"maximum":11576.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6593.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6339.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6529.9,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6783.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6466.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11576.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6720.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6777.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7100.48,"additional_payer_notes":"APC"}]}]},{"description":"Ercp duct stent placement","code_information":[{"code":"43274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6339.71,"maximum":11576.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6593.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6339.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6529.9,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6783.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6466.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11576.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6720.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6777.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7100.48,"additional_payer_notes":"APC"}]}]},{"description":"Ercp stent exchange w/dilate","code_information":[{"code":"43276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6339.71,"maximum":11576.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6593.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6339.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6529.9,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6783.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6466.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11576.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6720.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6777.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7100.48,"additional_payer_notes":"APC"}]}]},{"description":"Transorl lwr esophgl myotomy","code_information":[{"code":"43497","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6339.71,"maximum":11576.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6593.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6339.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6529.9,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6783.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6466.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11576.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6720.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6777.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7100.48,"additional_payer_notes":"APC"}]}]},{"description":"Small Bowel Endoscopy/Stent","code_information":[{"code":"44370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6339.71,"maximum":11576.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6593.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6339.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6529.9,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6783.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6466.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11576.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6720.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6777.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7100.48,"additional_payer_notes":"APC"}]}]},{"description":"S Bowel Endoscope W/Stent","code_information":[{"code":"44379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6339.71,"maximum":11576.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6593.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6339.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6529.9,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6783.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6466.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11576.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6720.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6777.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7100.48,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/stent plcmt","code_information":[{"code":"44402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6339.71,"maximum":11576.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6593.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6339.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6529.9,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6783.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6466.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11576.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6720.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6777.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7100.48,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy W/Stent","code_information":[{"code":"45327","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6339.71,"maximum":11576.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6593.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6339.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6529.9,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6783.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6466.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11576.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6720.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6777.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7100.48,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy w/plcmt stent","code_information":[{"code":"45347","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6339.71,"maximum":11576.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6593.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6339.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6529.9,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6783.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6466.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11576.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6720.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6777.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7100.48,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/stent plcmt","code_information":[{"code":"45389","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6339.71,"maximum":11576.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6593.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6339.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6529.9,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6783.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6466.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11576.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6720.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6777.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7100.48,"additional_payer_notes":"APC"}]}]},{"description":"Rplcmt ndwllg bldr&prtl cath","code_information":[{"code":"0872T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3738.94,"maximum":6827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3813.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6827.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3996.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.61,"additional_payer_notes":"APC"}]}]},{"description":"Revj subq prtl asct pmp sys","code_information":[{"code":"0873T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3738.94,"maximum":6827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3813.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6827.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3996.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.61,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl pertl ascites pmp sys","code_information":[{"code":"0874T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3738.94,"maximum":6827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3813.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6827.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3996.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.61,"additional_payer_notes":"APC"}]}]},{"description":"Insert pleural cath","code_information":[{"code":"32550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3738.94,"maximum":6827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3813.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6827.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3996.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.61,"additional_payer_notes":"APC"}]}]},{"description":"Incision of gallbladder","code_information":[{"code":"47490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3738.94,"maximum":6827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3813.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6827.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3996.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.61,"additional_payer_notes":"APC"}]}]},{"description":"Injection for cholangiogram","code_information":[{"code":"47531","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3738.94,"maximum":6827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3813.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6827.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3996.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.61,"additional_payer_notes":"APC"}]}]},{"description":"Injection for cholangiogram","code_information":[{"code":"47532","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3738.94,"maximum":6827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3813.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6827.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3996.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.61,"additional_payer_notes":"APC"}]}]},{"description":"Plmt biliary drainage cath","code_information":[{"code":"47533","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3738.94,"maximum":6827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3813.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6827.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3996.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.61,"additional_payer_notes":"APC"}]}]},{"description":"Plmt biliary drainage cath","code_information":[{"code":"47534","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3738.94,"maximum":6827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3813.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6827.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3996.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.61,"additional_payer_notes":"APC"}]}]},{"description":"Conversion ext bil drg cath","code_information":[{"code":"47535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3738.94,"maximum":6827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3813.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6827.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3996.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.61,"additional_payer_notes":"APC"}]}]},{"description":"Exchange biliary drg cath","code_information":[{"code":"47536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3738.94,"maximum":6827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3813.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6827.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3996.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.61,"additional_payer_notes":"APC"}]}]},{"description":"Excision of umbilicus","code_information":[{"code":"49250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3738.94,"maximum":6827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3813.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6827.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3996.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.61,"additional_payer_notes":"APC"}]}]},{"description":"Remove foreign body adbomen","code_information":[{"code":"49402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3738.94,"maximum":6827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3813.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6827.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3996.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.61,"additional_payer_notes":"APC"}]}]},{"description":"Insert tun ip cath perc","code_information":[{"code":"49418","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3738.94,"maximum":6827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3813.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6827.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3996.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.61,"additional_payer_notes":"APC"}]}]},{"description":"Ins tun ip cath for dial opn","code_information":[{"code":"49421","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3738.94,"maximum":6827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3813.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6827.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3996.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.61,"additional_payer_notes":"APC"}]}]},{"description":"Revise abdomen-venous shunt","code_information":[{"code":"49426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3738.94,"maximum":6827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3813.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6827.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3996.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.61,"additional_payer_notes":"APC"}]}]},{"description":"Rpr ing hern premie blocked","code_information":[{"code":"49492","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3738.94,"maximum":6827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3813.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6827.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3996.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.61,"additional_payer_notes":"APC"}]}]},{"description":"Rpr ing hernia baby reduc","code_information":[{"code":"49495","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3738.94,"maximum":6827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3813.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6827.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3996.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.61,"additional_payer_notes":"APC"}]}]},{"description":"Rpr ing hernia baby blocked","code_information":[{"code":"49496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3738.94,"maximum":6827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3813.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6827.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3996.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.61,"additional_payer_notes":"APC"}]}]},{"description":"Rpr ing hernia init blocked","code_information":[{"code":"49501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3738.94,"maximum":6827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3813.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6827.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3996.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.61,"additional_payer_notes":"APC"}]}]},{"description":"Prp i/hern init reduc >5 yr","code_information":[{"code":"49505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3738.94,"maximum":6827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3813.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6827.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3996.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.61,"additional_payer_notes":"APC"}]}]},{"description":"Prp i/hern init block >5 yr","code_information":[{"code":"49507","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3738.94,"maximum":6827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3813.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6827.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3996.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.61,"additional_payer_notes":"APC"}]}]},{"description":"Rerepair ing hernia reduce","code_information":[{"code":"49520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3738.94,"maximum":6827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3813.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6827.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3996.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.61,"additional_payer_notes":"APC"}]}]},{"description":"Repair ing hernia sliding","code_information":[{"code":"49525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3738.94,"maximum":6827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3813.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6827.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3996.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.61,"additional_payer_notes":"APC"}]}]},{"description":"Rpr rem hernia init reduce","code_information":[{"code":"49550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3738.94,"maximum":6827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3813.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6827.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3996.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.61,"additional_payer_notes":"APC"}]}]},{"description":"Rpr fem hernia init blocked","code_information":[{"code":"49553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3738.94,"maximum":6827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3813.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6827.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3996.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.61,"additional_payer_notes":"APC"}]}]},{"description":"Rerepair fem hernia reduce","code_information":[{"code":"49555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3738.94,"maximum":6827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3813.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6827.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3996.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.61,"additional_payer_notes":"APC"}]}]},{"description":"Rerepair fem hernia blocked","code_information":[{"code":"49557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3738.94,"maximum":6827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3813.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6827.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3996.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.61,"additional_payer_notes":"APC"}]}]},{"description":"Rpr aa hrn 1st < 3 cm rdc","code_information":[{"code":"49591","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3738.94,"maximum":6827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3813.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6827.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3996.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.61,"additional_payer_notes":"APC"}]}]},{"description":"Repair umbilical lesion","code_information":[{"code":"49600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3738.94,"maximum":6827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3813.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6827.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3996.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.61,"additional_payer_notes":"APC"}]}]},{"description":"Rpr aa hrn rcr < 3 rdc","code_information":[{"code":"49613","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3738.94,"maximum":6827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3813.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6827.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3996.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.61,"additional_payer_notes":"APC"}]}]},{"description":"Removal of testis","code_information":[{"code":"54530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3738.94,"maximum":6827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3813.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6827.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3996.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.61,"additional_payer_notes":"APC"}]}]},{"description":"Exploration for testis","code_information":[{"code":"54550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3738.94,"maximum":6827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3813.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6827.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3996.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.61,"additional_payer_notes":"APC"}]}]},{"description":"Suspension of testis","code_information":[{"code":"54640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3738.94,"maximum":6827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3813.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6827.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3996.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.61,"additional_payer_notes":"APC"}]}]},{"description":"Orchiopexy (Fowler-Stephens)","code_information":[{"code":"54650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3738.94,"maximum":6827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3813.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6827.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3996.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.61,"additional_payer_notes":"APC"}]}]},{"description":"Removal of hydrocele","code_information":[{"code":"55040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3738.94,"maximum":6827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3813.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6827.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3996.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.61,"additional_payer_notes":"APC"}]}]},{"description":"Removal of hydroceles","code_information":[{"code":"55041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3738.94,"maximum":6827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3813.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6827.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3996.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.61,"additional_payer_notes":"APC"}]}]},{"description":"Revise hernia & sperm veins","code_information":[{"code":"55540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3738.94,"maximum":6827.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3813.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6827.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3996.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4187.61,"additional_payer_notes":"APC"}]}]},{"description":"Appendectomy","code_information":[{"code":"44950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6760.47,"maximum":12344.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7030.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6760.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6963.29,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7233.71,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6895.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12344.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7166.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7226.95,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7571.73,"additional_payer_notes":"APC"}]}]},{"description":"Plmt access bil tree sm bwl","code_information":[{"code":"47541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6760.47,"maximum":12344.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7030.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6760.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6963.29,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7233.71,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6895.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12344.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7166.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7226.95,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7571.73,"additional_payer_notes":"APC"}]}]},{"description":"Biliary endo perq dx w/speci","code_information":[{"code":"47552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6760.47,"maximum":12344.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7030.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6760.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6963.29,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7233.71,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6895.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12344.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7166.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7226.95,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7571.73,"additional_payer_notes":"APC"}]}]},{"description":"Biliary endoscopy thru skin","code_information":[{"code":"47553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6760.47,"maximum":12344.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7030.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6760.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6963.29,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7233.71,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6895.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12344.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7166.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7226.95,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7571.73,"additional_payer_notes":"APC"}]}]},{"description":"Biliary endoscopy thru skin","code_information":[{"code":"47555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6760.47,"maximum":12344.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7030.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6760.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6963.29,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7233.71,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6895.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12344.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7166.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7226.95,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7571.73,"additional_payer_notes":"APC"}]}]},{"description":"Exploration behind abdomen","code_information":[{"code":"49010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6760.47,"maximum":12344.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7030.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6760.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6963.29,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7233.71,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6895.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12344.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7166.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7226.95,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7571.73,"additional_payer_notes":"APC"}]}]},{"description":"Removal of omentum","code_information":[{"code":"49255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6760.47,"maximum":12344.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7030.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6760.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6963.29,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7233.71,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6895.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12344.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7166.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7226.95,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7571.73,"additional_payer_notes":"APC"}]}]},{"description":"Rpr ing hernia init reduce","code_information":[{"code":"49500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6760.47,"maximum":12344.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7030.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6760.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6963.29,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7233.71,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6895.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12344.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7166.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7226.95,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7571.73,"additional_payer_notes":"APC"}]}]},{"description":"Rerepair ing hernia blocked","code_information":[{"code":"49521","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6760.47,"maximum":12344.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7030.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6760.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6963.29,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7233.71,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6895.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12344.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7166.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7226.95,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7571.73,"additional_payer_notes":"APC"}]}]},{"description":"Rpr aa hrn 1st 3-10 rdc","code_information":[{"code":"49593","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6760.47,"maximum":12344.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7030.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6760.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6963.29,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7233.71,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6895.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12344.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7166.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7226.95,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7571.73,"additional_payer_notes":"APC"}]}]},{"description":"Rpr aa hrn 1st > 10 rdc","code_information":[{"code":"49595","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6760.47,"maximum":12344.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7030.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6760.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6963.29,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7233.71,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6895.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12344.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7166.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7226.95,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7571.73,"additional_payer_notes":"APC"}]}]},{"description":"Rpr aa hrn rcr 3-10 rdc","code_information":[{"code":"49615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6760.47,"maximum":12344.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7030.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6760.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6963.29,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7233.71,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6895.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12344.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7166.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7226.95,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7571.73,"additional_payer_notes":"APC"}]}]},{"description":"Revise spermatic cord veins","code_information":[{"code":"55535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6760.47,"maximum":12344.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7030.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6760.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6963.29,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7233.71,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6895.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12344.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7166.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7226.95,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7571.73,"additional_payer_notes":"APC"}]}]},{"description":"Inst pleu-perit shnt w pump","code_information":[{"code":"C8006","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6760.47,"maximum":12344.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7030.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6760.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6963.29,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7233.71,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6895.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12344.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7166.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7226.95,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7571.73,"additional_payer_notes":"APC"}]}]},{"description":"Thoracoscopy diagnostic","code_information":[{"code":"32601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Thoracoscopy w/bx med space","code_information":[{"code":"32606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Thoracoscopy w/bx pleura","code_information":[{"code":"32609","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Perq rf ablate tx pul tumor","code_information":[{"code":"32998","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc spleen","code_information":[{"code":"38129","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Explore deep node(s) neck","code_information":[{"code":"38542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy lymph node biop","code_information":[{"code":"38570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc lymphatic","code_information":[{"code":"38589","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Remove armpit lymph nodes","code_information":[{"code":"38740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Remove armpit lymph nodes","code_information":[{"code":"38745","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Mediastinoscpy w/medstnl bx","code_information":[{"code":"39401","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Mediastinoscpy w/lmph nod bx","code_information":[{"code":"39402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl esophgl sphnctr dev","code_information":[{"code":"43285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc esoph","code_information":[{"code":"43289","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy vagus nerve","code_information":[{"code":"43651","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy vagus nerve","code_information":[{"code":"43652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy gastrostomy","code_information":[{"code":"43653","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc stom","code_information":[{"code":"43659","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Lap replace gastr adj device","code_information":[{"code":"43773","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Lap enterolysis","code_information":[{"code":"44180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Lap jejunostomy","code_information":[{"code":"44186","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc intestine","code_information":[{"code":"44238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy appendectomy","code_information":[{"code":"44970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc app","code_information":[{"code":"44979","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc rectum","code_information":[{"code":"45499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope procedure liver","code_information":[{"code":"47379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Percut ablate liver rf","code_information":[{"code":"47382","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Perq plmt bile duct stent","code_information":[{"code":"47538","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Perq plmt bile duct stent","code_information":[{"code":"47539","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Perq plmt bile duct stent","code_information":[{"code":"47540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopic cholecystectomy","code_information":[{"code":"47562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparo cholecystectomy/graph","code_information":[{"code":"47563","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc biliary","code_information":[{"code":"47579","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Diag laparo separate proc","code_information":[{"code":"49320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy biopsy","code_information":[{"code":"49321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy aspiration","code_information":[{"code":"49322","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparo drain lymphocele","code_information":[{"code":"49323","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Lap insert tunnel ip cath","code_information":[{"code":"49324","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Lap Revision Perm IP Cath","code_information":[{"code":"49325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparo proc abdm/per/oment","code_information":[{"code":"49329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Rpr hern preemie reduc","code_information":[{"code":"49491","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Repair lumbar hernia","code_information":[{"code":"49540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Rpr aa hrn 1st < 3 ncr/strn","code_information":[{"code":"49592","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Rpr aa hrn 1st 3-10 ncr/strn","code_information":[{"code":"49594","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Rpr aa hrn rcr < 3 ncr/strn","code_information":[{"code":"49614","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Lap ing hernia repair init","code_information":[{"code":"49650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Lap ing hernia repair recur","code_information":[{"code":"49651","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparo proc hernia repair","code_information":[{"code":"49659","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc renal","code_information":[{"code":"50549","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Perc rf ablate renal tumor","code_information":[{"code":"50592","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy ureterolithotomy","code_information":[{"code":"50945","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc ureter","code_information":[{"code":"50949","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Removal of bladder cyst","code_information":[{"code":"51500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparo urethral suspension","code_information":[{"code":"51990","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparo sling operation","code_information":[{"code":"51992","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc bla","code_information":[{"code":"51999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy orchiectomy","code_information":[{"code":"54690","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy orchiopexy","code_information":[{"code":"54692","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc testis","code_information":[{"code":"54699","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparo ligate spermatic vein","code_information":[{"code":"55550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparo proc spermatic cord","code_information":[{"code":"55559","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopic myomectomy","code_information":[{"code":"58545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparo-asst vag hysterectomy","code_information":[{"code":"58550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparo proc uterus","code_information":[{"code":"58578","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy lysis","code_information":[{"code":"58660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy remove adnexa","code_information":[{"code":"58661","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy excise lesions","code_information":[{"code":"58662","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy tubal cautery","code_information":[{"code":"58670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy tubal block","code_information":[{"code":"58671","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy fimbrioplasty","code_information":[{"code":"58672","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparo proc oviduct-ovary","code_information":[{"code":"58679","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Treat ectopic pregnancy","code_information":[{"code":"59150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Treat ectopic pregnancy","code_information":[{"code":"59151","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparo proc ob care/deliver","code_information":[{"code":"59898","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Remove thyroid lesion","code_information":[{"code":"60200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Partial thyroid excision","code_information":[{"code":"60210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Partial thyroid excision","code_information":[{"code":"60212","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of thyroid","code_information":[{"code":"60220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of thyroid","code_information":[{"code":"60225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Removal of thyroid","code_information":[{"code":"60240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Remove thyroid duct lesion","code_information":[{"code":"60280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Remove thyroid duct lesion","code_information":[{"code":"60281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Laparo proc endocrine","code_information":[{"code":"60659","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Endocrine surgery procedure","code_information":[{"code":"60699","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6313.22,"maximum":11527.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6439.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11527.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6748.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7070.8,"additional_payer_notes":"APC"}]}]},{"description":"Ire abltj 1+tum organ perq","code_information":[{"code":"0600T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Ire abltj 1+tumors open","code_information":[{"code":"0601T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Laps repos lead isdss 1st ld","code_information":[{"code":"0677T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Laps rmvl lead isdss","code_information":[{"code":"0679T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Thoracoscopy wbx sac","code_information":[{"code":"32604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Thoracoscopy w/bx infiltrate","code_information":[{"code":"32607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Thoracoscopy w/bx nodule","code_information":[{"code":"32608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Ablate pulm tumor perq crybl","code_information":[{"code":"32994","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy splenectomy","code_information":[{"code":"38120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy lymphadenectomy","code_information":[{"code":"38571","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy lymphadenectomy","code_information":[{"code":"38572","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Laps pelvic lymphadec","code_information":[{"code":"38573","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Egd esophagogastrc fndoplsty","code_information":[{"code":"43210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy fundoplasty","code_information":[{"code":"43280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Lap paraesophag hern repair","code_information":[{"code":"43281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Lap paraesoph her rpr w/mesh","code_information":[{"code":"43282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Laps esophgl sphnctr agmntj","code_information":[{"code":"43284","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Lap revise/remv eltrd antrum","code_information":[{"code":"43648","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Lap place gastr adj device","code_information":[{"code":"43770","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Gstr rstcv px trnsorl esg","code_information":[{"code":"43889","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Laparo ablate liver tumor rf","code_information":[{"code":"47370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Laparo ablate liver cryosurg","code_information":[{"code":"47371","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Perq abltj lvr cryoablation","code_information":[{"code":"47383","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Abltj ire liver 1+ tum perq","code_information":[{"code":"47384","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Biliary endoscopy thru skin","code_information":[{"code":"47554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Biliary endoscopy thru skin","code_information":[{"code":"47556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Laparo cholecystectomy/explr","code_information":[{"code":"47564","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Laparo ablate renal cyst","code_information":[{"code":"50541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Laparo ablate renal mass","code_information":[{"code":"50542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Laparo partial nephrectomy","code_information":[{"code":"50543","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy pyeloplasty","code_information":[{"code":"50544","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Perc cryo ablate renal tum","code_information":[{"code":"50593","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Laparo New Ureter/Bladder","code_information":[{"code":"50947","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Laparo New Ureter/Bladder","code_information":[{"code":"50948","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Laparo radical prostatectomy","code_information":[{"code":"55866","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Laps surg prst8ect smpl stot","code_information":[{"code":"55867","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Lap srg prst8ct lymph nod bx","code_information":[{"code":"55868","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Lap srg prst8ct bi pl lmphad","code_information":[{"code":"55869","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Abltj ire prst8 1+ tum perq","code_information":[{"code":"55877","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Repair paravag defect lap","code_information":[{"code":"57423","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy surg colpopexy","code_information":[{"code":"57425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Lsh uterus 250 g or less","code_information":[{"code":"58541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Lsh w/t/o ut 250 g or less","code_information":[{"code":"58542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"LSH Uterus Above 250 g","code_information":[{"code":"58543","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"LSH w/t/o Uterus Above 250 g","code_information":[{"code":"58544","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Laparo-myomectomy complex","code_information":[{"code":"58546","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Laparo-vag hyst incl t/o","code_information":[{"code":"58552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Laparo-vag hyst complex","code_information":[{"code":"58553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Laparo-vag hyst w/t/o compl","code_information":[{"code":"58554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Tlh uterus 250 g or less","code_information":[{"code":"58570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Tlh w/t/o 250 g or less","code_information":[{"code":"58571","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Tlh uterus over 250 g","code_information":[{"code":"58572","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Tlh w/t/o uterus over 250 g","code_information":[{"code":"58573","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy salpingostomy","code_information":[{"code":"58673","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Laps abltj uterine fibroids","code_information":[{"code":"58674","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Endo outlet restrict w/tube","code_information":[{"code":"C9785","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Endo defect closure GI tract","code_information":[{"code":"C9901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11100.51,"maximum":20269.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11544.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11433.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11877.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11322.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20269.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11766.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11866.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12432.57,"additional_payer_notes":"APC"}]}]},{"description":"Temp fml iu vlv-pmp 1st insj","code_information":[{"code":"0596T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":728.17,"maximum":1329.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":757.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":728.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":750.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":779.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":742.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1329.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":771.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":778.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":815.55,"additional_payer_notes":"APC"}]}]},{"description":"Temp fml iu valve-pmp rplcmt","code_information":[{"code":"0597T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":728.17,"maximum":1329.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":757.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":728.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":750.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":779.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":742.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1329.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":771.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":778.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":815.55,"additional_payer_notes":"APC"}]}]},{"description":"Remove renal tube w/fluoro","code_information":[{"code":"50389","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":728.17,"maximum":1329.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":757.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":728.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":750.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":779.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":742.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1329.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":771.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":778.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":815.55,"additional_payer_notes":"APC"}]}]},{"description":"Measure kidney pressure","code_information":[{"code":"50396","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":728.17,"maximum":1329.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":757.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":728.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":750.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":779.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":742.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1329.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":771.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":778.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":815.55,"additional_payer_notes":"APC"}]}]},{"description":"Njx px nfrosgrm &/urtrgrm","code_information":[{"code":"50430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":728.17,"maximum":1329.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":757.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":728.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":750.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":779.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":742.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1329.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":771.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":778.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":815.55,"additional_payer_notes":"APC"}]}]},{"description":"Njx px nfrosgrm &/urtrgrm","code_information":[{"code":"50431","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":728.17,"maximum":1329.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":757.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":728.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":750.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":779.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":742.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1329.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":771.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":778.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":815.55,"additional_payer_notes":"APC"}]}]},{"description":"Kidney endoscopy","code_information":[{"code":"50572","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":728.17,"maximum":1329.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":757.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":728.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":750.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":779.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":742.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1329.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":771.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":778.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":815.55,"additional_payer_notes":"APC"}]}]},{"description":"Change of bladder tube","code_information":[{"code":"51710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":728.17,"maximum":1329.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":757.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":728.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":750.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":779.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":742.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1329.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":771.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":778.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":815.55,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of bladder lesion","code_information":[{"code":"51720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":728.17,"maximum":1329.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":757.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":728.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":750.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":779.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":742.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1329.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":771.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":778.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":815.55,"additional_payer_notes":"APC"}]}]},{"description":"Cystometrogram w/up","code_information":[{"code":"51727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":728.17,"maximum":1329.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":757.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":728.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":750.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":779.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":742.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1329.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":771.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":778.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":815.55,"additional_payer_notes":"APC"}]}]},{"description":"Cystometrogram w/vp","code_information":[{"code":"51728","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":728.17,"maximum":1329.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":757.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":728.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":750.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":779.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":742.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1329.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":771.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":778.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":815.55,"additional_payer_notes":"APC"}]}]},{"description":"Cystometrogram w/vp&up","code_information":[{"code":"51729","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":728.17,"maximum":1329.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":757.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":728.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":750.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":779.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":742.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1329.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":771.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":778.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":815.55,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy","code_information":[{"code":"52000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":728.17,"maximum":1329.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":757.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":728.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":750.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":779.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":742.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1329.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":771.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":778.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":815.55,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy & duct catheter","code_information":[{"code":"52010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":728.17,"maximum":1329.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":757.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":728.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":750.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":779.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":742.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1329.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":771.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":778.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":815.55,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":728.17,"maximum":1329.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":757.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":728.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":750.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":779.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":742.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1329.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":771.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":778.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":815.55,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of urinary leakage","code_information":[{"code":"53080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":728.17,"maximum":1329.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":757.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":728.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":750.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":779.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":742.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1329.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":771.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":778.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":815.55,"additional_payer_notes":"APC"}]}]},{"description":"Dilate urethra stricture","code_information":[{"code":"53620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":728.17,"maximum":1329.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":757.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":728.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":750.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":779.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":742.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1329.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":771.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":778.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":815.55,"additional_payer_notes":"APC"}]}]},{"description":"Circumcision neonate","code_information":[{"code":"54160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":728.17,"maximum":1329.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":757.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":728.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":750.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":779.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":742.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1329.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":771.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":778.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":815.55,"additional_payer_notes":"APC"}]}]},{"description":"Cysto flx rmvl urtl scaffold","code_information":[{"code":"0943T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Renal abscess open drain","code_information":[{"code":"50020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Change ureter stent percut","code_information":[{"code":"50382","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Remove ureter stent percut","code_information":[{"code":"50384","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Change stent via transureth","code_information":[{"code":"50385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Remove stent via transureth","code_information":[{"code":"50386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Change nephroureteral cath","code_information":[{"code":"50387","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Plmt nephrostomy catheter","code_information":[{"code":"50432","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Convert nephrostomy catheter","code_information":[{"code":"50434","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Exchange nephrostomy cath","code_information":[{"code":"50435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Change of ureter tube/stent","code_information":[{"code":"50688","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Incise & drain bladder","code_information":[{"code":"51040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Incise bladder/drain ureter","code_information":[{"code":"51045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Removal of ureter stone","code_information":[{"code":"51060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Drain bl w/cath insertion","code_information":[{"code":"51102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy & ureter catheter","code_information":[{"code":"52005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy w/biopsy(s)","code_information":[{"code":"52204","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy & revise urethra","code_information":[{"code":"52270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy & revise urethra","code_information":[{"code":"52275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy chemodenervation","code_information":[{"code":"52287","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Incision of urethra","code_information":[{"code":"53000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Incision of urethra","code_information":[{"code":"53020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Incision of urethra","code_information":[{"code":"53025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of urethra abscess","code_information":[{"code":"53060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of urinary leakage","code_information":[{"code":"53085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of urethra","code_information":[{"code":"53200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of urethra lesion","code_information":[{"code":"53265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Dilation of urethra","code_information":[{"code":"53665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Insert prost urethral stent","code_information":[{"code":"53855","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Transurethral rf treatment","code_information":[{"code":"53860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Slitting of prepuce","code_information":[{"code":"54001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Circumcision w/regionl block","code_information":[{"code":"54150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Circum 28 days or older","code_information":[{"code":"54161","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Lysis penil circumic lesion","code_information":[{"code":"54162","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Repair of circumcision","code_information":[{"code":"54163","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Frenulotomy of penis","code_information":[{"code":"54164","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Repair penis","code_information":[{"code":"54380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Repair penis","code_information":[{"code":"54385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Exploration for testis","code_information":[{"code":"54560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of scrotum","code_information":[{"code":"54700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Remove epididymis lesion","code_information":[{"code":"54840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of spermatic ducts","code_information":[{"code":"54900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Removal of scrotum lesion","code_information":[{"code":"55120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Removal of sperm duct(s)","code_information":[{"code":"55250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Incise sperm duct pouch","code_information":[{"code":"55600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2182.94,"maximum":3986.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2226.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3986.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2333.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2444.9,"additional_payer_notes":"APC"}]}]},{"description":"Penile venous occlusion","code_information":[{"code":"37790","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Plmt nephroureteral catheter","code_information":[{"code":"50433","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Dilat xst trc ndurlgc px","code_information":[{"code":"50436","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Dilat xst trc new access rcs","code_information":[{"code":"50437","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Kidney endoscopy","code_information":[{"code":"50570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Kidney endoscopy & biopsy","code_information":[{"code":"50574","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Fragmenting of kidney stone","code_information":[{"code":"50590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Plmt ureteral stent prq","code_information":[{"code":"50693","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Plmt ureteral stent prq","code_information":[{"code":"50694","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Plmt ureteral stent prq","code_information":[{"code":"50695","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Revise ureter","code_information":[{"code":"50727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Endoscopy of ureter","code_information":[{"code":"50951","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Endoscopy of ureter","code_information":[{"code":"50953","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Ureter endoscopy","code_information":[{"code":"50970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Ureter endoscopy & catheter","code_information":[{"code":"50972","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Incise & treat bladder","code_information":[{"code":"51020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Remove ureter calculus","code_information":[{"code":"51065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Removal of bladder lesion","code_information":[{"code":"51520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Repair of ureter lesion","code_information":[{"code":"51535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Endoscopic injection/implant","code_information":[{"code":"51715","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Repair of bladder opening","code_information":[{"code":"51880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy removal of clots","code_information":[{"code":"52001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and biopsy","code_information":[{"code":"52007","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52214","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52224","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52234","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and radiotracer","code_information":[{"code":"52250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52277","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy implant stent","code_information":[{"code":"52282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Remove bladder stone","code_information":[{"code":"52317","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Remove bladder stone","code_information":[{"code":"52318","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Create passage to kidney","code_information":[{"code":"52334","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Cysto W/Ureter Stricture Tx","code_information":[{"code":"52341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Cysto W/Up Stricture Tx","code_information":[{"code":"52342","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Cysto W/Renal Stricture Tx","code_information":[{"code":"52343","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Cysto/uretero stricture tx","code_information":[{"code":"52344","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Cysto/Uretero W/Up Stricture","code_information":[{"code":"52345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Cystouretero & or pyeloscope","code_information":[{"code":"52351","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Cystouretero w/stone remove","code_information":[{"code":"52352","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Cystouretero W/Congen Repr","code_information":[{"code":"52400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Cystourethro cut ejacul duct","code_information":[{"code":"52402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Incision of prostate","code_information":[{"code":"52450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Revision of bladder neck","code_information":[{"code":"52500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Relieve bladder contracture","code_information":[{"code":"52640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of prostate abscess","code_information":[{"code":"52700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of urethra abscess","code_information":[{"code":"53040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Removal of urethra","code_information":[{"code":"53210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of urethra lesion","code_information":[{"code":"53220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Surgery for urethra pouch","code_information":[{"code":"53240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Removal of urethra gland","code_information":[{"code":"53250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of urethra lesion","code_information":[{"code":"53260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Removal of urethra gland","code_information":[{"code":"53270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Repair of urethra defect","code_information":[{"code":"53275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Revision of urethra","code_information":[{"code":"53450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Tprnl balo cntnc dev rmvl ea","code_information":[{"code":"53453","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Revision of urethra","code_information":[{"code":"53460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Urethrlys transvag w/ scope","code_information":[{"code":"53500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Repair of urethra injury","code_information":[{"code":"53502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Dilate urethra stricture","code_information":[{"code":"53605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Prostatic microwave thermotx","code_information":[{"code":"53850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Prostatic rf thermotx","code_information":[{"code":"53852","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Trurl dstrj prst8 tiss rf wv","code_information":[{"code":"53854","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Slitting of prepuce","code_information":[{"code":"54000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of penis lesion","code_information":[{"code":"54110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of penis","code_information":[{"code":"54120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Revision of penis","code_information":[{"code":"54300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Revision of penis","code_information":[{"code":"54304","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of urethra","code_information":[{"code":"54312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of urethra","code_information":[{"code":"54318","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of urethra","code_information":[{"code":"54322","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of urethra","code_information":[{"code":"54324","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of urethra","code_information":[{"code":"54326","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Revise penis/urethra","code_information":[{"code":"54328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Revise penis/urethra","code_information":[{"code":"54332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Revise penis/urethra","code_information":[{"code":"54336","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Secondary urethral surgery","code_information":[{"code":"54340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Penis plastic surgery","code_information":[{"code":"54360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Remove muti-comp penis pros","code_information":[{"code":"54406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Remove self-contd penis pros","code_information":[{"code":"54415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Revision of penis","code_information":[{"code":"54420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Revision of penis","code_information":[{"code":"54435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Repair corporeal tear","code_information":[{"code":"54437","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Repair of penis","code_information":[{"code":"54440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of testis","code_information":[{"code":"54505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Excise Lesion Testis","code_information":[{"code":"54512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Removal of testis","code_information":[{"code":"54520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Orchiectomy partial","code_information":[{"code":"54522","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Extensive testis surgery","code_information":[{"code":"54535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Reduce testis torsion","code_information":[{"code":"54600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Suspension of testis","code_information":[{"code":"54620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Repair testis injury","code_information":[{"code":"54670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Relocation of testis(es)","code_information":[{"code":"54680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Remove epididymis lesion","code_information":[{"code":"54830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Removal of epididymis","code_information":[{"code":"54860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Removal of epididymis","code_information":[{"code":"54861","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Explore Epididymis","code_information":[{"code":"54865","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of spermatic ducts","code_information":[{"code":"54901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Repair of hydrocele","code_information":[{"code":"55060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Explore scrotum","code_information":[{"code":"55110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Removal of scrotum","code_information":[{"code":"55150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Revision of scrotum","code_information":[{"code":"55175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Incision of sperm duct","code_information":[{"code":"55200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Repair of sperm duct","code_information":[{"code":"55400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Removal of hydrocele","code_information":[{"code":"55500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Removal of sperm cord lesion","code_information":[{"code":"55520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Revise spermatic cord veins","code_information":[{"code":"55530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Remove sperm pouch lesion","code_information":[{"code":"55680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of prostate","code_information":[{"code":"55705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Prostate saturation sampling","code_information":[{"code":"55706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Bx prst8 trct us guided","code_information":[{"code":"55707","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Bx prst8 trct us w/mri fus 1","code_information":[{"code":"55708","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Bx prst8 tprnl us guided","code_information":[{"code":"55709","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Bx prst8 tprn us w/mri fus 1","code_information":[{"code":"55710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Bx prst8 trct mri-us 1st","code_information":[{"code":"55711","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Bx prst8 tprnl mri-us 1st","code_information":[{"code":"55712","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of prostate abscess","code_information":[{"code":"55720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of prostate abscess","code_information":[{"code":"55725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Sex transformation f to m","code_information":[{"code":"55980","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3681.06,"maximum":6721.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3828.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3791.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3938.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3754.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6721.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3901.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3935.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4122.79,"additional_payer_notes":"APC"}]}]},{"description":"Tprnl focal abltj mal prst8","code_information":[{"code":"0655T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Tprnl lsr ablt b9 prst8 hypr","code_information":[{"code":"0714T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Tpla b9 prst8 hyprplsa>=50ml","code_information":[{"code":"0867T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Kidney endoscopy","code_information":[{"code":"50551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Kidney endoscopy","code_information":[{"code":"50553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Kidney endoscopy & treatment","code_information":[{"code":"50561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Kidney endoscopy","code_information":[{"code":"50575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Kidney endoscopy & treatment","code_information":[{"code":"50580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Ureter endoscopy & biopsy","code_information":[{"code":"50955","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Ureter endoscopy & treatment","code_information":[{"code":"50957","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Ureter endoscopy & treatment","code_information":[{"code":"50961","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Ureter endoscopy & biopsy","code_information":[{"code":"50974","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Ureter endoscopy & treatment","code_information":[{"code":"50976","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Ureter endoscopy & treatment","code_information":[{"code":"50980","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Removal of bladder stone","code_information":[{"code":"51050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Cysto rx balo cath urtl strx","code_information":[{"code":"52284","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy stone removal","code_information":[{"code":"52325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy inject material","code_information":[{"code":"52327","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Cystouretero W/Renal Strict","code_information":[{"code":"52346","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Cystouretero W/Lithotripsy","code_information":[{"code":"52353","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Cystouretero W/Biopsy","code_information":[{"code":"52354","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Cystouretero W/Excise Tumor","code_information":[{"code":"52355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Cysto/uretero w/lithotripsy","code_information":[{"code":"52356","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Prostatectomy (TURP)","code_information":[{"code":"52601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Remove prostate regrowth","code_information":[{"code":"52630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Laser surgery of prostate","code_information":[{"code":"52648","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Prostate laser enucleation","code_information":[{"code":"52649","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Incision of urethra","code_information":[{"code":"53010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Removal of urethra","code_information":[{"code":"53215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Removal of urethra lesion","code_information":[{"code":"53230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Removal of urethra lesion","code_information":[{"code":"53235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Revise urethra stage 1","code_information":[{"code":"53400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Revise urethra stage 2","code_information":[{"code":"53405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of urethra","code_information":[{"code":"53410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct urethra stage 1","code_information":[{"code":"53420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct urethra stage 2","code_information":[{"code":"53425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of urethra","code_information":[{"code":"53430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct urethra/bladder","code_information":[{"code":"53431","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Remove/revise male sling","code_information":[{"code":"53442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Remove uro sphincter","code_information":[{"code":"53446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Repair of urethra injury","code_information":[{"code":"53505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Repair of urethra injury","code_information":[{"code":"53510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Repair of urethra injury","code_information":[{"code":"53515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Repair of urethra defect","code_information":[{"code":"53520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Treat penis lesion graft","code_information":[{"code":"54111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of penis lesion","code_information":[{"code":"54205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of urethra","code_information":[{"code":"54308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Secondary urethral surgery","code_information":[{"code":"54348","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct urethra/penis","code_information":[{"code":"54352","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Repair multi-comp penis pros","code_information":[{"code":"54408","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Revision of testis","code_information":[{"code":"54660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Revision of scrotum","code_information":[{"code":"55180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Bx prst8 in-bore ct/mri bx 1","code_information":[{"code":"55713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Bx prst8 in-bore ct/mri 1","code_information":[{"code":"55714","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Surgical exposure prostate","code_information":[{"code":"55860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Tprnl plmt biodegrdabl matrl","code_information":[{"code":"55874","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Transperi needle place pros","code_information":[{"code":"55875","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Cysto, litho, w suct sheath","code_information":[{"code":"C8014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Cystoscopy prostatic imp 1-3","code_information":[{"code":"C9739","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5599.21,"maximum":10224.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5823.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5767.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5991.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5711.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10224.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5935.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5985.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6271.12,"additional_payer_notes":"APC"}]}]},{"description":"Cysto flx ins&xpns urtl scaf","code_information":[{"code":"0941T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9885.63,"maximum":18051.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10281.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9885.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10182.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10577.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10083.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18051.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10478.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10567.74,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11071.9,"additional_payer_notes":"APC"}]}]},{"description":"Cysto flx rmv&rplc urtl scaf","code_information":[{"code":"0942T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9885.63,"maximum":18051.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10281.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9885.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10182.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10577.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10083.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18051.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10478.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10567.74,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11071.9,"additional_payer_notes":"APC"}]}]},{"description":"Abltj b9 prst8 tissue hifu","code_information":[{"code":"0950T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9885.63,"maximum":18051.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10281.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9885.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10182.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10577.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10083.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18051.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10478.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10567.74,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11071.9,"additional_payer_notes":"APC"}]}]},{"description":"Cysto lo-nrg lithtrp&mcrsphr","code_information":[{"code":"0991T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9885.63,"maximum":18051.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10281.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9885.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10182.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10577.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10083.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18051.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10478.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10567.74,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11071.9,"additional_payer_notes":"APC"}]}]},{"description":"Removal of kidney stone","code_information":[{"code":"50080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9885.63,"maximum":18051.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10281.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9885.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10182.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10577.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10083.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18051.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10478.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10567.74,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11071.9,"additional_payer_notes":"APC"}]}]},{"description":"Removal of kidney stone","code_information":[{"code":"50081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9885.63,"maximum":18051.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10281.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9885.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10182.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10577.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10083.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18051.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10478.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10567.74,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11071.9,"additional_payer_notes":"APC"}]}]},{"description":"Kidney endoscopy & biopsy","code_information":[{"code":"50555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9885.63,"maximum":18051.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10281.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9885.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10182.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10577.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10083.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18051.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10478.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10567.74,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11071.9,"additional_payer_notes":"APC"}]}]},{"description":"Kidney endoscopy & treatment","code_information":[{"code":"50557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9885.63,"maximum":18051.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10281.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9885.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10182.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10577.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10083.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18051.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10478.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10567.74,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11071.9,"additional_payer_notes":"APC"}]}]},{"description":"Renal scope w/tumor resect","code_information":[{"code":"50562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9885.63,"maximum":18051.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10281.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9885.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10182.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10577.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10083.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18051.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10478.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10567.74,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11071.9,"additional_payer_notes":"APC"}]}]},{"description":"Kidney endoscopy & treatment","code_information":[{"code":"50576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9885.63,"maximum":18051.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10281.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9885.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10182.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10577.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10083.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18051.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10478.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10567.74,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11071.9,"additional_payer_notes":"APC"}]}]},{"description":"Repair of bladder wound","code_information":[{"code":"51860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9885.63,"maximum":18051.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10281.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9885.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10182.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10577.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10083.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18051.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10478.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10567.74,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11071.9,"additional_payer_notes":"APC"}]}]},{"description":"Cysto 1st trurl prst8 comis","code_information":[{"code":"52443","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9885.63,"maximum":18051.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10281.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9885.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10182.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10577.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10083.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18051.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10478.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10567.74,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11071.9,"additional_payer_notes":"APC"}]}]},{"description":"Trurl rbtc wtrjt rescj prst8","code_information":[{"code":"52597","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9885.63,"maximum":18051.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10281.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9885.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10182.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10577.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10083.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18051.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10478.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10567.74,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11071.9,"additional_payer_notes":"APC"}]}]},{"description":"Repair uro sphincter","code_information":[{"code":"53449","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9885.63,"maximum":18051.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10281.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9885.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10182.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10577.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10083.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18051.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10478.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10567.74,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11071.9,"additional_payer_notes":"APC"}]}]},{"description":"Tprnl balo cntnc dev uni","code_information":[{"code":"53452","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9885.63,"maximum":18051.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10281.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9885.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10182.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10577.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10083.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18051.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10478.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10567.74,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11071.9,"additional_payer_notes":"APC"}]}]},{"description":"Cysto insj dev ischmc rmdlg","code_information":[{"code":"53865","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9885.63,"maximum":18051.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10281.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9885.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10182.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10577.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10083.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18051.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10478.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10567.74,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11071.9,"additional_payer_notes":"APC"}]}]},{"description":"Treat penis lesion graft","code_information":[{"code":"54112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9885.63,"maximum":18051.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10281.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9885.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10182.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10577.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10083.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18051.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10478.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10567.74,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11071.9,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of urethra","code_information":[{"code":"54316","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9885.63,"maximum":18051.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10281.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9885.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10182.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10577.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10083.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18051.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10478.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10567.74,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11071.9,"additional_payer_notes":"APC"}]}]},{"description":"Secondary urethral surgery","code_information":[{"code":"54344","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9885.63,"maximum":18051.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10281.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9885.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10182.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10577.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10083.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18051.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10478.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10567.74,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11071.9,"additional_payer_notes":"APC"}]}]},{"description":"Cryoablate Prostate","code_information":[{"code":"55873","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9885.63,"maximum":18051.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10281.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9885.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10182.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10577.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10083.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18051.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10478.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10567.74,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11071.9,"additional_payer_notes":"APC"}]}]},{"description":"Abltj mal prst8 tiss hifu","code_information":[{"code":"55880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9885.63,"maximum":18051.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10281.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9885.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10182.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10577.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10083.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18051.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10478.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10567.74,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11071.9,"additional_payer_notes":"APC"}]}]},{"description":"Cysto impl 4 or more","code_information":[{"code":"C9740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9885.63,"maximum":18051.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10281.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9885.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10182.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10577.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10083.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18051.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10478.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10567.74,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11071.9,"additional_payer_notes":"APC"}]}]},{"description":"Cysto, litho, vacuum kidney","code_information":[{"code":"C9761","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9885.63,"maximum":18051.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10281.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9885.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10182.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10577.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10083.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18051.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10478.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10567.74,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11071.9,"additional_payer_notes":"APC"}]}]},{"description":"Hemodialysis one evaluation","code_information":[{"code":"90935","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":716.7,"maximum":1308.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":745.37,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":716.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":738.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":766.87,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":731.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1308.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":759.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":766.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.71,"additional_payer_notes":"APC"}]}]},{"description":"Unsched dialysis ESRD pt hos","code_information":[{"code":"G0257","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":716.7,"maximum":1308.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":745.37,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":716.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":738.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":766.87,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":731.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1308.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":759.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":766.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.71,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of gland abscess","code_information":[{"code":"56420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":211.12,"maximum":385.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":219.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211.12,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":217.46,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":225.9,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":385.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":223.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":225.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":236.46,"additional_payer_notes":"APC"}]}]},{"description":"Exam of vulva w/scope","code_information":[{"code":"56820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":211.12,"maximum":385.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":219.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211.12,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":217.46,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":225.9,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":385.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":223.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":225.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":236.46,"additional_payer_notes":"APC"}]}]},{"description":"Insert pessary/other device","code_information":[{"code":"57160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":211.12,"maximum":385.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":219.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211.12,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":217.46,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":225.9,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":385.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":223.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":225.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":236.46,"additional_payer_notes":"APC"}]}]},{"description":"Fitting of diaphragm/cap","code_information":[{"code":"57170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":211.12,"maximum":385.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":219.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211.12,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":217.46,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":225.9,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":385.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":223.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":225.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":236.46,"additional_payer_notes":"APC"}]}]},{"description":"Treat vaginal bleeding","code_information":[{"code":"57180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":211.12,"maximum":385.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":219.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211.12,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":217.46,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":225.9,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":385.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":223.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":225.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":236.46,"additional_payer_notes":"APC"}]}]},{"description":"Exam of cervix w/scope","code_information":[{"code":"57452","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":211.12,"maximum":385.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":219.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211.12,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":217.46,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":225.9,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":385.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":223.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":225.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":236.46,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of uterus lining","code_information":[{"code":"58100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":211.12,"maximum":385.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":219.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211.12,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":217.46,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":225.9,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":385.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":223.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":225.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":236.46,"additional_payer_notes":"APC"}]}]},{"description":"Artificial insemination","code_information":[{"code":"58322","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":211.12,"maximum":385.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":219.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211.12,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":217.46,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":225.9,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":385.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":223.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":225.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":236.46,"additional_payer_notes":"APC"}]}]},{"description":"Sperm washing","code_information":[{"code":"58323","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":211.12,"maximum":385.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":219.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211.12,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":217.46,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":225.9,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":385.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":223.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":225.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":236.46,"additional_payer_notes":"APC"}]}]},{"description":"Hysteroscope procedure","code_information":[{"code":"58579","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":211.12,"maximum":385.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":219.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211.12,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":217.46,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":225.9,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":385.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":223.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":225.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":236.46,"additional_payer_notes":"APC"}]}]},{"description":"Genital surgery procedure","code_information":[{"code":"58999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":211.12,"maximum":385.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":219.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211.12,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":217.46,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":225.9,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":385.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":223.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":225.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":236.46,"additional_payer_notes":"APC"}]}]},{"description":"Fetal contract stress test","code_information":[{"code":"59020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":211.12,"maximum":385.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":219.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211.12,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":217.46,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":225.9,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":385.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":223.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":225.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":236.46,"additional_payer_notes":"APC"}]}]},{"description":"Fetal non-stress test","code_information":[{"code":"59025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":211.12,"maximum":385.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":219.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211.12,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":217.46,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":225.9,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":385.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":223.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":225.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":236.46,"additional_payer_notes":"APC"}]}]},{"description":"Fetal invas px w/us","code_information":[{"code":"59897","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":211.12,"maximum":385.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":219.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211.12,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":217.46,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":225.9,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":385.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":223.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":225.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":236.46,"additional_payer_notes":"APC"}]}]},{"description":"Maternity care procedure","code_information":[{"code":"59899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":211.12,"maximum":385.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":219.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211.12,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":217.46,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":225.9,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":385.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":223.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":225.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":236.46,"additional_payer_notes":"APC"}]}]},{"description":"Anogenital exam child w imag","code_information":[{"code":"99170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":211.12,"maximum":385.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":219.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211.12,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":217.46,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":225.9,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":385.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":223.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":225.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":236.46,"additional_payer_notes":"APC"}]}]},{"description":"I & D of vulva/perineum","code_information":[{"code":"56405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":318.22,"maximum":581.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":330.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":327.77,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":324.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":581.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":337.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.18,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":356.41,"additional_payer_notes":"APC"}]}]},{"description":"Exam/biopsy of vulva w/scope","code_information":[{"code":"56821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":318.22,"maximum":581.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":330.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":327.77,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":324.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":581.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":337.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.18,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":356.41,"additional_payer_notes":"APC"}]}]},{"description":"Ins vag brachytx device","code_information":[{"code":"57156","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":318.22,"maximum":581.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":330.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":327.77,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":324.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":581.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":337.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.18,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":356.41,"additional_payer_notes":"APC"}]}]},{"description":"Exam of vagina w/scope","code_information":[{"code":"57420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":318.22,"maximum":581.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":330.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":327.77,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":324.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":581.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":337.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.18,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":356.41,"additional_payer_notes":"APC"}]}]},{"description":"Bx/curett of cervix w/scope","code_information":[{"code":"57454","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":318.22,"maximum":581.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":330.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":327.77,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":324.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":581.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":337.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.18,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":356.41,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of cervix w/scope","code_information":[{"code":"57455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":318.22,"maximum":581.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":330.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":327.77,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":324.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":581.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":337.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.18,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":356.41,"additional_payer_notes":"APC"}]}]},{"description":"Endocerv curettage w/scope","code_information":[{"code":"57456","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":318.22,"maximum":581.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":330.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":327.77,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":324.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":581.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":337.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.18,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":356.41,"additional_payer_notes":"APC"}]}]},{"description":"Cryocautery of cervix","code_information":[{"code":"57511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":318.22,"maximum":581.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":330.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":327.77,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":324.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":581.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":337.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.18,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":356.41,"additional_payer_notes":"APC"}]}]},{"description":"Remove intrauterine device","code_information":[{"code":"58301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":318.22,"maximum":581.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":330.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":327.77,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":324.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":581.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":337.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.18,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":356.41,"additional_payer_notes":"APC"}]}]},{"description":"Artificial insemination","code_information":[{"code":"58321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":318.22,"maximum":581.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":330.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":327.77,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":324.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":581.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":337.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.18,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":356.41,"additional_payer_notes":"APC"}]}]},{"description":"Transfer of embryo","code_information":[{"code":"58976","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":318.22,"maximum":581.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":330.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":327.77,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":324.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":581.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":337.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.18,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":356.41,"additional_payer_notes":"APC"}]}]},{"description":"Amniocentesis therapeutic","code_information":[{"code":"59001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":318.22,"maximum":581.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":330.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":327.77,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":324.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":581.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":337.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.18,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":356.41,"additional_payer_notes":"APC"}]}]},{"description":"Fetal cord puncture prenatal","code_information":[{"code":"59012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":318.22,"maximum":581.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":330.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":327.77,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":324.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":581.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":337.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.18,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":356.41,"additional_payer_notes":"APC"}]}]},{"description":"Fetal scalp blood sample","code_information":[{"code":"59030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":318.22,"maximum":581.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":330.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":327.77,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":324.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":581.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":337.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.18,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":356.41,"additional_payer_notes":"APC"}]}]},{"description":"Transabdom amnioinfus w/us","code_information":[{"code":"59070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":318.22,"maximum":581.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":330.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":327.77,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":324.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":581.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":337.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.18,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":356.41,"additional_payer_notes":"APC"}]}]},{"description":"Umbilical cord occlud w/us","code_information":[{"code":"59072","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":318.22,"maximum":581.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":330.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":327.77,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":324.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":581.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":337.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.18,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":356.41,"additional_payer_notes":"APC"}]}]},{"description":"Fetal fluid drainage w/us","code_information":[{"code":"59074","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":318.22,"maximum":581.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":330.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":327.77,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":324.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":581.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":337.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.18,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":356.41,"additional_payer_notes":"APC"}]}]},{"description":"Fetal shunt placement w/us","code_information":[{"code":"59076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":318.22,"maximum":581.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":330.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":327.77,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":324.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":581.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":337.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.18,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":356.41,"additional_payer_notes":"APC"}]}]},{"description":"Insert cervical dilator","code_information":[{"code":"59200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":318.22,"maximum":581.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":330.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":327.77,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":324.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":581.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":337.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.18,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":356.41,"additional_payer_notes":"APC"}]}]},{"description":"Abortion (mpr)","code_information":[{"code":"59866","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":318.22,"maximum":581.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":330.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":318.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":327.77,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":324.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":581.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":337.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":340.18,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":356.41,"additional_payer_notes":"APC"}]}]},{"description":"Us leiomyomata ablate <200","code_information":[{"code":"0071T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Us leiomyomata ablate >200","code_information":[{"code":"0072T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Surgery for vulva lesion","code_information":[{"code":"56440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Lysis of labial lesion(s)","code_information":[{"code":"56441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Hymenotomy","code_information":[{"code":"56442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of vulva","code_information":[{"code":"56620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Complete removal of vulva","code_information":[{"code":"56625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of hymen","code_information":[{"code":"56700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Remove vagina gland lesion","code_information":[{"code":"56740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Repair of vagina","code_information":[{"code":"56800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Repair clitoris","code_information":[{"code":"56805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Repair of perineum","code_information":[{"code":"56810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of vagina","code_information":[{"code":"57000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of pelvic abscess","code_information":[{"code":"57010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Destroy vag lesions simple","code_information":[{"code":"57061","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Destroy vag lesions complex","code_information":[{"code":"57065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of vagina","code_information":[{"code":"57105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Remove vagina wall partial","code_information":[{"code":"57106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Remove vagina tissue part","code_information":[{"code":"57107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Vaginectomy partial w/nodes","code_information":[{"code":"57109","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Remove vagina lesion","code_information":[{"code":"57130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Remove vagina lesion","code_information":[{"code":"57135","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Repair of vagina","code_information":[{"code":"57200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Repair vagina/perineum","code_information":[{"code":"57210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Repair of urethral lesion","code_information":[{"code":"57230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Revise/Remove Sling Repair","code_information":[{"code":"57287","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Revise vag graft via vagina","code_information":[{"code":"57295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Repair rectum-vagina fistula","code_information":[{"code":"57300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Dilation of vagina","code_information":[{"code":"57400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Pelvic examination","code_information":[{"code":"57410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Remove vaginal foreign body","code_information":[{"code":"57415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Bx of cervix w/scope leep","code_information":[{"code":"57460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Conz of cervix w/scope leep","code_information":[{"code":"57461","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Cauterization of cervix","code_information":[{"code":"57510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Laser surgery of cervix","code_information":[{"code":"57513","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Conization of cervix","code_information":[{"code":"57520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Conization of cervix","code_information":[{"code":"57522","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"D&C oF Cervical Stump","code_information":[{"code":"57558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Revision of cervix","code_information":[{"code":"57700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Revision of cervix","code_information":[{"code":"57720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Dilation of cervical canal","code_information":[{"code":"57800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Dilation and curettage","code_information":[{"code":"58120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Myomectomy vag method","code_information":[{"code":"58145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Reopen fallopian tube","code_information":[{"code":"58345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Hysteroscopy dx sep proc","code_information":[{"code":"58555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Hysteroscopy biopsy","code_information":[{"code":"58558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Hysteroscopy remove fb","code_information":[{"code":"58562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Division of fallopian tube","code_information":[{"code":"58600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Occlude fallopian tube(s)","code_information":[{"code":"58615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Create new tubal opening","code_information":[{"code":"58770","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of ovarian cyst(s)","code_information":[{"code":"58800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of ovarian cyst(s)","code_information":[{"code":"58805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Drain ovary abscess open","code_information":[{"code":"58820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of ovary(s)","code_information":[{"code":"58900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"D & c after delivery","code_information":[{"code":"59160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Episiotomy or vaginal repair","code_information":[{"code":"59300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Revision of cervix","code_information":[{"code":"59320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Obstetrical care","code_information":[{"code":"59409","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Antepartum manipulation","code_information":[{"code":"59412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Deliver placenta","code_information":[{"code":"59414","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Vbac delivery only","code_information":[{"code":"59612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of miscarriage","code_information":[{"code":"59812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Care of miscarriage","code_information":[{"code":"59820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of miscarriage","code_information":[{"code":"59821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Abortion","code_information":[{"code":"59840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Abortion","code_information":[{"code":"59841","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Evacuate mole of uterus","code_information":[{"code":"59870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Remove cerclage suture","code_information":[{"code":"59871","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3380.46,"maximum":6172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3380.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3481.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3617.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3448.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6172.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3583.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3613.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3786.12,"additional_payer_notes":"APC"}]}]},{"description":"Attach bladder/urethra","code_information":[{"code":"51840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Repair bladder neck","code_information":[{"code":"51845","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Place needles pelvic for rt","code_information":[{"code":"55920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Sex transformation m to f","code_information":[{"code":"55970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Extensive vulva surgery","code_information":[{"code":"56630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of pelvic fluid","code_information":[{"code":"57020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Closure of vagina","code_information":[{"code":"57120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Insert uteri tandem/ovoids","code_information":[{"code":"57155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Revision of urethra","code_information":[{"code":"57220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Repair bladder & vagina","code_information":[{"code":"57240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Repair rectum & vagina","code_information":[{"code":"57250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Repair of vagina","code_information":[{"code":"57260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Extensive repair of vagina","code_information":[{"code":"57265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Repair of bowel bulge","code_information":[{"code":"57268","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Repair paravag defect open","code_information":[{"code":"57284","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Repair bladder defect","code_information":[{"code":"57288","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Construction of vagina","code_information":[{"code":"57291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Construct vagina with graft","code_information":[{"code":"57292","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Repair bladder-vagina lesion","code_information":[{"code":"57320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Repair vagina","code_information":[{"code":"57335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Removal of cervix","code_information":[{"code":"57530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Removal of residual cervix","code_information":[{"code":"57550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Remove cervix/repair vagina","code_information":[{"code":"57555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Remove cervix repair bowel","code_information":[{"code":"57556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Vaginal hysterectomy","code_information":[{"code":"58260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Vag hyst including t/o","code_information":[{"code":"58262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Vag hyst w/t/o & vag repair","code_information":[{"code":"58263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Vag hyst w/enterocele repair","code_information":[{"code":"58270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Vag hyst incl t/o complex","code_information":[{"code":"58291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Vag hyst w/enterocele compl","code_information":[{"code":"58294","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Insert heyman uteri capsule","code_information":[{"code":"58346","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Reopen fallopian tube","code_information":[{"code":"58350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Endometr ablate thermal","code_information":[{"code":"58353","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Endometrial cryoablation","code_information":[{"code":"58356","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Hysteroscopy lysis","code_information":[{"code":"58559","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Hysteroscopy resect septum","code_information":[{"code":"58560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Hysteroscopy remove myoma","code_information":[{"code":"58561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Hysteroscopy ablation","code_information":[{"code":"58563","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Hysteroscopy sterilization","code_information":[{"code":"58565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Removal of ovarian cyst(s)","code_information":[{"code":"58925","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Remove uterus lesion","code_information":[{"code":"59100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Colpopexy, min/inv, ex-perit","code_information":[{"code":"C9778","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5223.95,"maximum":9538.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5328.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9538.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5584.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5850.83,"additional_payer_notes":"APC"}]}]},{"description":"Colpopexy extraperitoneal","code_information":[{"code":"57282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7743.78,"maximum":14140.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8053.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7743.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7976.1,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8285.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7898.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14140.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8208.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8278.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8673.04,"additional_payer_notes":"APC"}]}]},{"description":"Colpopexy intraperitoneal","code_information":[{"code":"57283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7743.78,"maximum":14140.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8053.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7743.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7976.1,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8285.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7898.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14140.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8208.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8278.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8673.04,"additional_payer_notes":"APC"}]}]},{"description":"Repair paravag defect vag","code_information":[{"code":"57285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7743.78,"maximum":14140.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8053.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7743.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7976.1,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8285.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7898.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14140.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8208.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8278.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8673.04,"additional_payer_notes":"APC"}]}]},{"description":"Repair bladder & vagina","code_information":[{"code":"57289","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7743.78,"maximum":14140.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8053.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7743.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7976.1,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8285.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7898.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14140.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8208.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8278.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8673.04,"additional_payer_notes":"APC"}]}]},{"description":"Repair urethrovaginal lesion","code_information":[{"code":"57310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7743.78,"maximum":14140.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8053.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7743.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7976.1,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8285.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7898.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14140.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8208.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8278.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8673.04,"additional_payer_notes":"APC"}]}]},{"description":"Repair bladder-vagina lesion","code_information":[{"code":"57330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7743.78,"maximum":14140.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8053.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7743.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7976.1,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8285.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7898.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14140.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8208.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8278.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8673.04,"additional_payer_notes":"APC"}]}]},{"description":"Revise prosth vag graft lap","code_information":[{"code":"57426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7743.78,"maximum":14140.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8053.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7743.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7976.1,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8285.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7898.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14140.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8208.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8278.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8673.04,"additional_payer_notes":"APC"}]}]},{"description":"Vag hyst complex","code_information":[{"code":"58290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7743.78,"maximum":14140.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8053.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7743.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7976.1,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8285.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7898.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14140.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8208.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8278.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8673.04,"additional_payer_notes":"APC"}]}]},{"description":"Vag hyst t/o & repair compl","code_information":[{"code":"58292","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7743.78,"maximum":14140.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8053.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7743.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7976.1,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8285.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7898.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14140.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8208.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8278.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8673.04,"additional_payer_notes":"APC"}]}]},{"description":"Transcrv abltj utrn fibrd rf","code_information":[{"code":"58580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7743.78,"maximum":14140.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8053.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7743.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7976.1,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8285.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7898.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14140.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8208.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8278.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8673.04,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of ovary(s)","code_information":[{"code":"58920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7743.78,"maximum":14140.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8053.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7743.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7976.1,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8285.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7898.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14140.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8208.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8278.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8673.04,"additional_payer_notes":"APC"}]}]},{"description":"Abltj perc uxtr/perph nrv","code_information":[{"code":"0440T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Abltj perc lxtr/perph nrv","code_information":[{"code":"0441T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Neurectomy hamstring","code_information":[{"code":"27325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Neurectomy popliteal","code_information":[{"code":"27326","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of tibia nerve","code_information":[{"code":"28035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Neurectomy foot","code_information":[{"code":"28055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Treat trigeminal nerve","code_information":[{"code":"61790","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Treat trigeminal tract","code_information":[{"code":"61791","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Replace/irrigate catheter","code_information":[{"code":"62194","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Percutaneous diskectomy","code_information":[{"code":"62287","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Injection into disk lesion","code_information":[{"code":"62292","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Remove spinal canal catheter","code_information":[{"code":"62355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Remove spinal cord lesion","code_information":[{"code":"63600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Stimulation of spinal cord","code_information":[{"code":"63610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine eltrd perq aray","code_information":[{"code":"63661","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Removal of spinal shunt","code_information":[{"code":"63746","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Injection treatment of nerve","code_information":[{"code":"64605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Injection treatment of nerve","code_information":[{"code":"64610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Dstrj nulyt agt gnclr nrv","code_information":[{"code":"64624","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Rf abltj nrv nrvtg si jt","code_information":[{"code":"64625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Destroy cerv/thor facet jnt","code_information":[{"code":"64633","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Destroy lumb/sac facet jnt","code_information":[{"code":"64635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Revise finger/toe nerve","code_information":[{"code":"64702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Revise hand/foot nerve","code_information":[{"code":"64704","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Revise arm/leg nerve","code_information":[{"code":"64708","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Revision of sciatic nerve","code_information":[{"code":"64712","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Revision of arm nerve(s)","code_information":[{"code":"64713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Revise low back nerve(s)","code_information":[{"code":"64714","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Revision of cranial nerve","code_information":[{"code":"64716","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Revise ulnar nerve at elbow","code_information":[{"code":"64718","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Revise ulnar nerve at wrist","code_information":[{"code":"64719","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Carpal tunnel surgery","code_information":[{"code":"64721","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Relieve pressure on nerve(s)","code_information":[{"code":"64722","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Release foot/toe nerve","code_information":[{"code":"64726","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Dcmprn median nrv carpl tunl","code_information":[{"code":"64728","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Incision of brow nerve","code_information":[{"code":"64732","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Incision of cheek nerve","code_information":[{"code":"64734","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Incision of chin nerve","code_information":[{"code":"64736","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Incision of jaw nerve","code_information":[{"code":"64738","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Incision of tongue nerve","code_information":[{"code":"64740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Incision of facial nerve","code_information":[{"code":"64742","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Incise nerve back of head","code_information":[{"code":"64744","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Incise diaphragm nerve","code_information":[{"code":"64746","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Incise hip/thigh nerve","code_information":[{"code":"64763","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Incise hip/thigh nerve","code_information":[{"code":"64766","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Sever cranial nerve","code_information":[{"code":"64771","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Incision of spinal nerve","code_information":[{"code":"64772","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Remove skin nerve lesion","code_information":[{"code":"64774","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Remove digit nerve lesion","code_information":[{"code":"64776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Remove limb nerve lesion","code_information":[{"code":"64782","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Remove nerve lesion","code_information":[{"code":"64784","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Remove skin nerve lesion","code_information":[{"code":"64788","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Removal of nerve lesion","code_information":[{"code":"64790","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of nerve","code_information":[{"code":"64795","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Sympathectomy cervical","code_information":[{"code":"64802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Remove sympathetic nerves","code_information":[{"code":"64804","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Sympathectomy digital artery","code_information":[{"code":"64820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Repair of digit nerve","code_information":[{"code":"64831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Repair sciatic nerve","code_information":[{"code":"64858","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Repair of arm nerves","code_information":[{"code":"64861","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2039.19,"maximum":3723.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2079.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3723.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2179.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2283.89,"additional_payer_notes":"APC"}]}]},{"description":"Ther injection carp tunnel","code_information":[{"code":"20526","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.54,"maximum":585.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":333.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":320.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":330.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":326.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":585.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":339.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":359.01,"additional_payer_notes":"APC"}]}]},{"description":"Inj dupuytren cord w/enzyme","code_information":[{"code":"20527","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.54,"maximum":585.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":333.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":320.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":330.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":326.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":585.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":339.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":359.01,"additional_payer_notes":"APC"}]}]},{"description":"Inj tendon sheath/ligament","code_information":[{"code":"20550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.54,"maximum":585.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":333.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":320.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":330.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":326.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":585.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":339.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":359.01,"additional_payer_notes":"APC"}]}]},{"description":"Inj tendon origin/insertion","code_information":[{"code":"20551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.54,"maximum":585.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":333.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":320.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":330.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":326.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":585.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":339.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":359.01,"additional_payer_notes":"APC"}]}]},{"description":"Inj trigger point 1/2 muscl","code_information":[{"code":"20552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.54,"maximum":585.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":333.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":320.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":330.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":326.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":585.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":339.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":359.01,"additional_payer_notes":"APC"}]}]},{"description":"Inject trigger points 3/>","code_information":[{"code":"20553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.54,"maximum":585.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":333.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":320.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":330.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":326.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":585.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":339.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":359.01,"additional_payer_notes":"APC"}]}]},{"description":"Drain/inj joint/bursa w/o us","code_information":[{"code":"20600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.54,"maximum":585.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":333.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":320.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":330.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":326.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":585.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":339.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":359.01,"additional_payer_notes":"APC"}]}]},{"description":"Drain/inj joint/bursa w/us","code_information":[{"code":"20604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.54,"maximum":585.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":333.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":320.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":330.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":326.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":585.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":339.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":359.01,"additional_payer_notes":"APC"}]}]},{"description":"Drain/inj joint/bursa w/o us","code_information":[{"code":"20605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.54,"maximum":585.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":333.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":320.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":330.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":326.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":585.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":339.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":359.01,"additional_payer_notes":"APC"}]}]},{"description":"Drain/inj joint/bursa w/o us","code_information":[{"code":"20610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.54,"maximum":585.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":333.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":320.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":330.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":326.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":585.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":339.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":359.01,"additional_payer_notes":"APC"}]}]},{"description":"Drain/inj joint/bursa w/us","code_information":[{"code":"20611","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.54,"maximum":585.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":333.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":320.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":330.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":326.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":585.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":339.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":359.01,"additional_payer_notes":"APC"}]}]},{"description":"Aspirate/inj ganglion cyst","code_information":[{"code":"20612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.54,"maximum":585.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":333.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":320.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":330.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":326.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":585.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":339.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":359.01,"additional_payer_notes":"APC"}]}]},{"description":"Remove brain canal fluid","code_information":[{"code":"61050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.54,"maximum":585.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":333.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":320.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":330.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":326.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":585.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":339.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":359.01,"additional_payer_notes":"APC"}]}]},{"description":"Injection into brain canal","code_information":[{"code":"61055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.54,"maximum":585.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":333.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":320.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":330.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":326.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":585.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":339.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":359.01,"additional_payer_notes":"APC"}]}]},{"description":"N block inj trigeminal","code_information":[{"code":"64400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.54,"maximum":585.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":333.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":320.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":330.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":326.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":585.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":339.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":359.01,"additional_payer_notes":"APC"}]}]},{"description":"N block inj occipital","code_information":[{"code":"64405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.54,"maximum":585.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":333.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":320.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":330.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":326.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":585.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":339.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":359.01,"additional_payer_notes":"APC"}]}]},{"description":"N block inj vagus","code_information":[{"code":"64408","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.54,"maximum":585.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":333.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":320.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":330.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":326.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":585.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":339.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":359.01,"additional_payer_notes":"APC"}]}]},{"description":"N block inj plantar digit","code_information":[{"code":"64455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.54,"maximum":585.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":333.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":320.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":330.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":326.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":585.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":339.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":359.01,"additional_payer_notes":"APC"}]}]},{"description":"N block spenopalatine gangl","code_information":[{"code":"64505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.54,"maximum":585.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":333.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":320.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":330.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":326.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":585.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":339.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":359.01,"additional_payer_notes":"APC"}]}]},{"description":"Neuroeltrd stim post tibial","code_information":[{"code":"64566","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.54,"maximum":585.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":333.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":320.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":330.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":326.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":585.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":339.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":359.01,"additional_payer_notes":"APC"}]}]},{"description":"Chemodenerv saliv glands","code_information":[{"code":"64611","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.54,"maximum":585.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":333.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":320.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":330.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":326.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":585.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":339.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":359.01,"additional_payer_notes":"APC"}]}]},{"description":"Destroy nerve face muscle","code_information":[{"code":"64612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.54,"maximum":585.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":333.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":320.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":330.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":326.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":585.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":339.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":359.01,"additional_payer_notes":"APC"}]}]},{"description":"Chemodenerv musc migraine","code_information":[{"code":"64615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.54,"maximum":585.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":333.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":320.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":330.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":326.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":585.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":339.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":359.01,"additional_payer_notes":"APC"}]}]},{"description":"Chemodenerv musc neck dyston","code_information":[{"code":"64616","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.54,"maximum":585.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":333.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":320.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":330.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":326.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":585.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":339.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":359.01,"additional_payer_notes":"APC"}]}]},{"description":"N block inj common digit","code_information":[{"code":"64632","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.54,"maximum":585.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":333.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":320.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":330.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":326.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":585.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":339.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":359.01,"additional_payer_notes":"APC"}]}]},{"description":"Chemodenerv eccrine glands","code_information":[{"code":"64650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.54,"maximum":585.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":333.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":320.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":330.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":326.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":585.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":339.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":359.01,"additional_payer_notes":"APC"}]}]},{"description":"Chemodenerv eccrine glands","code_information":[{"code":"64653","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.54,"maximum":585.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":333.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":320.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":330.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":326.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":585.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":339.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":359.01,"additional_payer_notes":"APC"}]}]},{"description":"Nervous system surgery","code_information":[{"code":"64999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.54,"maximum":585.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":333.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":320.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":330.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":326.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":585.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":339.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":359.01,"additional_payer_notes":"APC"}]}]},{"description":"Spin/brain pump refil & main","code_information":[{"code":"95991","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.54,"maximum":585.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":333.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":320.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":330.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":326.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":585.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":339.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":359.01,"additional_payer_notes":"APC"}]}]},{"description":"Drain/inj joint/bursa w/us","code_information":[{"code":"20606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":737.14,"maximum":1346.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":751.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1346.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.59,"additional_payer_notes":"APC"}]}]},{"description":"Remove cranial cavity fluid","code_information":[{"code":"61000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":737.14,"maximum":1346.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":751.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1346.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.59,"additional_payer_notes":"APC"}]}]},{"description":"Remove cranial cavity fluid","code_information":[{"code":"61001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":737.14,"maximum":1346.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":751.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1346.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.59,"additional_payer_notes":"APC"}]}]},{"description":"Injection into brain canal","code_information":[{"code":"61026","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":737.14,"maximum":1346.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":751.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1346.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.59,"additional_payer_notes":"APC"}]}]},{"description":"Brain canal shunt procedure","code_information":[{"code":"61070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":737.14,"maximum":1346.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":751.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1346.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.59,"additional_payer_notes":"APC"}]}]},{"description":"Spinal fluid tap diagnostic","code_information":[{"code":"62270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":737.14,"maximum":1346.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":751.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1346.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.59,"additional_payer_notes":"APC"}]}]},{"description":"Drain cerebro spinal fluid","code_information":[{"code":"62272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":737.14,"maximum":1346.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":751.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1346.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.59,"additional_payer_notes":"APC"}]}]},{"description":"Inject epidural patch","code_information":[{"code":"62273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":737.14,"maximum":1346.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":751.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1346.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.59,"additional_payer_notes":"APC"}]}]},{"description":"Njx interlaminar crv/thrc","code_information":[{"code":"62320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":737.14,"maximum":1346.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":751.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1346.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.59,"additional_payer_notes":"APC"}]}]},{"description":"Njx interlaminar crv/thrc","code_information":[{"code":"62321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":737.14,"maximum":1346.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":751.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1346.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.59,"additional_payer_notes":"APC"}]}]},{"description":"Njx interlaminar lmbr/sac","code_information":[{"code":"62323","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":737.14,"maximum":1346.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":751.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1346.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.59,"additional_payer_notes":"APC"}]}]},{"description":"Dx lmbr spi pnxr w/fluor/ct","code_information":[{"code":"62328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":737.14,"maximum":1346.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":751.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1346.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.59,"additional_payer_notes":"APC"}]}]},{"description":"Ther spi pnxr csf fluor/ct","code_information":[{"code":"62329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":737.14,"maximum":1346.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":751.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1346.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.59,"additional_payer_notes":"APC"}]}]},{"description":"N block inj suprascapular","code_information":[{"code":"64418","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":737.14,"maximum":1346.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":751.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1346.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.59,"additional_payer_notes":"APC"}]}]},{"description":"N block inj intercost sng","code_information":[{"code":"64420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":737.14,"maximum":1346.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":751.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1346.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.59,"additional_payer_notes":"APC"}]}]},{"description":"N block inj ilio-ing/hypogi","code_information":[{"code":"64425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":737.14,"maximum":1346.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":751.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1346.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.59,"additional_payer_notes":"APC"}]}]},{"description":"N block inj paracervical","code_information":[{"code":"64435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":737.14,"maximum":1346.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":751.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1346.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.59,"additional_payer_notes":"APC"}]}]},{"description":"N block inj sciatic sng","code_information":[{"code":"64445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":737.14,"maximum":1346.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":751.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1346.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.59,"additional_payer_notes":"APC"}]}]},{"description":"N block inj fem single","code_information":[{"code":"64447","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":737.14,"maximum":1346.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":751.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1346.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.59,"additional_payer_notes":"APC"}]}]},{"description":"N block other peripheral","code_information":[{"code":"64450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":737.14,"maximum":1346.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":751.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1346.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.59,"additional_payer_notes":"APC"}]}]},{"description":"Njx aa&/strd nrv nrvtg si jt","code_information":[{"code":"64451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":737.14,"maximum":1346.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":751.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1346.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.59,"additional_payer_notes":"APC"}]}]},{"description":"Njx aa&/strd gnclr nrv brnch","code_information":[{"code":"64454","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":737.14,"maximum":1346.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":751.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1346.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.59,"additional_payer_notes":"APC"}]}]},{"description":"Pvb thoracic single inj site","code_information":[{"code":"64461","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":737.14,"maximum":1346.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":751.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1346.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.59,"additional_payer_notes":"APC"}]}]},{"description":"Pvb thoracic cont infusion","code_information":[{"code":"64463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":737.14,"maximum":1346.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":751.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1346.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.59,"additional_payer_notes":"APC"}]}]},{"description":"Chemodener muscle larynx emg","code_information":[{"code":"64617","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":737.14,"maximum":1346.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":751.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1346.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.59,"additional_payer_notes":"APC"}]}]},{"description":"Chemodenerv 1 extremity 1-4","code_information":[{"code":"64642","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":737.14,"maximum":1346.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":751.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1346.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.59,"additional_payer_notes":"APC"}]}]},{"description":"Chemodenerv 1 extrem 5/> mus","code_information":[{"code":"64644","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":737.14,"maximum":1346.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":751.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1346.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.59,"additional_payer_notes":"APC"}]}]},{"description":"Chemodenerv trunk musc 1-5","code_information":[{"code":"64646","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":737.14,"maximum":1346.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":751.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1346.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.59,"additional_payer_notes":"APC"}]}]},{"description":"Chemodenerv trunk musc 6/>","code_information":[{"code":"64647","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":737.14,"maximum":1346.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":751.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1346.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.59,"additional_payer_notes":"APC"}]}]},{"description":"Inj for sacroiliac jt anesth","code_information":[{"code":"G0260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":737.14,"maximum":1346.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":751.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1346.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.59,"additional_payer_notes":"APC"}]}]},{"description":"Njx paravert w/us cer/thor","code_information":[{"code":"0213T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.64,"maximum":1686.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":960.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":951.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":942.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1686.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":979.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":987.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1034.47,"additional_payer_notes":"APC"}]}]},{"description":"Njx paravert w/us lumb/sac","code_information":[{"code":"0216T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.64,"maximum":1686.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":960.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":951.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":942.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1686.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":979.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":987.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1034.47,"additional_payer_notes":"APC"}]}]},{"description":"Remove brain cavity fluid","code_information":[{"code":"61020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.64,"maximum":1686.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":960.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":951.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":942.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1686.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":979.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":987.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1034.47,"additional_payer_notes":"APC"}]}]},{"description":"Epidural lysis mult sessions","code_information":[{"code":"62263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.64,"maximum":1686.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":960.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":951.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":942.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1686.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":979.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":987.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1034.47,"additional_payer_notes":"APC"}]}]},{"description":"Epidural lysis on single day","code_information":[{"code":"62264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.64,"maximum":1686.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":960.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":951.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":942.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1686.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":979.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":987.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1034.47,"additional_payer_notes":"APC"}]}]},{"description":"Drain spinal cord cyst","code_information":[{"code":"62268","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.64,"maximum":1686.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":960.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":951.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":942.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1686.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":979.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":987.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1034.47,"additional_payer_notes":"APC"}]}]},{"description":"Treat spinal cord lesion","code_information":[{"code":"62280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.64,"maximum":1686.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":960.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":951.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":942.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1686.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":979.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":987.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1034.47,"additional_payer_notes":"APC"}]}]},{"description":"Treat spinal cord lesion","code_information":[{"code":"62281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.64,"maximum":1686.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":960.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":951.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":942.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1686.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":979.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":987.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1034.47,"additional_payer_notes":"APC"}]}]},{"description":"Treat spinal canal lesion","code_information":[{"code":"62282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.64,"maximum":1686.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":960.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":951.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":942.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1686.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":979.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":987.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1034.47,"additional_payer_notes":"APC"}]}]},{"description":"Injection into spinal artery","code_information":[{"code":"62294","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.64,"maximum":1686.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":960.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":951.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":942.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1686.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":979.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":987.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1034.47,"additional_payer_notes":"APC"}]}]},{"description":"Njx interlaminar lmbr/sac","code_information":[{"code":"62322","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.64,"maximum":1686.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":960.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":951.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":942.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1686.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":979.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":987.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1034.47,"additional_payer_notes":"APC"}]}]},{"description":"Njx interlaminar crv/thrc","code_information":[{"code":"62324","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.64,"maximum":1686.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":960.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":951.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":942.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1686.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":979.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":987.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1034.47,"additional_payer_notes":"APC"}]}]},{"description":"Njx interlaminar crv/thrc","code_information":[{"code":"62325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.64,"maximum":1686.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":960.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":951.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":942.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1686.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":979.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":987.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1034.47,"additional_payer_notes":"APC"}]}]},{"description":"Njx interlaminar lmbr/sac","code_information":[{"code":"62326","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.64,"maximum":1686.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":960.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":951.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":942.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1686.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":979.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":987.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1034.47,"additional_payer_notes":"APC"}]}]},{"description":"Njx interlaminar lmbr/sac","code_information":[{"code":"62327","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.64,"maximum":1686.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":960.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":951.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":942.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1686.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":979.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":987.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1034.47,"additional_payer_notes":"APC"}]}]},{"description":"N block inj brachial plexus","code_information":[{"code":"64415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.64,"maximum":1686.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":960.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":951.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":942.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1686.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":979.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":987.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1034.47,"additional_payer_notes":"APC"}]}]},{"description":"N block cont infuse b plex","code_information":[{"code":"64416","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.64,"maximum":1686.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":960.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":951.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":942.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1686.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":979.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":987.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1034.47,"additional_payer_notes":"APC"}]}]},{"description":"N block inj axillary","code_information":[{"code":"64417","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.64,"maximum":1686.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":960.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":951.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":942.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1686.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":979.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":987.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1034.47,"additional_payer_notes":"APC"}]}]},{"description":"N block inj intercost mlt","code_information":[{"code":"64421","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.64,"maximum":1686.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":960.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":951.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":942.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1686.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":979.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":987.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1034.47,"additional_payer_notes":"APC"}]}]},{"description":"N block inj pudendal","code_information":[{"code":"64430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.64,"maximum":1686.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":960.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":951.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":942.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1686.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":979.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":987.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1034.47,"additional_payer_notes":"APC"}]}]},{"description":"N blk inj sciatic cont inf","code_information":[{"code":"64446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.64,"maximum":1686.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":960.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":951.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":942.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1686.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":979.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":987.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1034.47,"additional_payer_notes":"APC"}]}]},{"description":"N block inj fem cont inf","code_information":[{"code":"64448","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.64,"maximum":1686.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":960.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":951.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":942.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1686.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":979.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":987.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1034.47,"additional_payer_notes":"APC"}]}]},{"description":"N block inj lumbar plexus","code_information":[{"code":"64449","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.64,"maximum":1686.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":960.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":951.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":942.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1686.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":979.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":987.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1034.47,"additional_payer_notes":"APC"}]}]},{"description":"Inj foramen epidural c/t","code_information":[{"code":"64479","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.64,"maximum":1686.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":960.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":951.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":942.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1686.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":979.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":987.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1034.47,"additional_payer_notes":"APC"}]}]},{"description":"Inj foramen epidural l/s","code_information":[{"code":"64483","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.64,"maximum":1686.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":960.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":951.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":942.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1686.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":979.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":987.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1034.47,"additional_payer_notes":"APC"}]}]},{"description":"Inj paravert f jnt c/t 1 lev","code_information":[{"code":"64490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.64,"maximum":1686.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":960.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":951.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":942.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1686.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":979.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":987.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1034.47,"additional_payer_notes":"APC"}]}]},{"description":"Inj paravert f jnt l/s 1 lev","code_information":[{"code":"64493","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.64,"maximum":1686.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":960.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":951.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":942.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1686.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":979.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":987.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1034.47,"additional_payer_notes":"APC"}]}]},{"description":"N block stellate ganglion","code_information":[{"code":"64510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.64,"maximum":1686.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":960.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":951.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":942.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1686.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":979.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":987.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1034.47,"additional_payer_notes":"APC"}]}]},{"description":"N block inj hypogas plxs","code_information":[{"code":"64517","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.64,"maximum":1686.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":960.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":951.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":942.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1686.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":979.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":987.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1034.47,"additional_payer_notes":"APC"}]}]},{"description":"N block lumbar/thoracic","code_information":[{"code":"64520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.64,"maximum":1686.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":960.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":951.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":942.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1686.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":979.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":987.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1034.47,"additional_payer_notes":"APC"}]}]},{"description":"N block inj celiac pelus","code_information":[{"code":"64530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.64,"maximum":1686.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":960.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":951.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":942.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1686.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":979.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":987.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1034.47,"additional_payer_notes":"APC"}]}]},{"description":"Injection treatment of nerve","code_information":[{"code":"64600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.64,"maximum":1686.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":960.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":951.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":942.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1686.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":979.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":987.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1034.47,"additional_payer_notes":"APC"}]}]},{"description":"Injection treatment of nerve","code_information":[{"code":"64620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.64,"maximum":1686.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":960.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":951.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":942.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1686.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":979.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":987.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1034.47,"additional_payer_notes":"APC"}]}]},{"description":"Injection treatment of nerve","code_information":[{"code":"64630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.64,"maximum":1686.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":960.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":951.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":942.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1686.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":979.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":987.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1034.47,"additional_payer_notes":"APC"}]}]},{"description":"Injection treatment of nerve","code_information":[{"code":"64640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.64,"maximum":1686.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":960.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":951.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":942.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1686.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":979.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":987.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1034.47,"additional_payer_notes":"APC"}]}]},{"description":"Injection treatment of nerve","code_information":[{"code":"64680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.64,"maximum":1686.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":960.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":951.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":942.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1686.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":979.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":987.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1034.47,"additional_payer_notes":"APC"}]}]},{"description":"Injection treatment of nerve","code_information":[{"code":"64681","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":923.64,"maximum":1686.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":960.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":923.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":951.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":942.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1686.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":979.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":987.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1034.47,"additional_payer_notes":"APC"}]}]},{"description":"Revision/removal isdns ptn","code_information":[{"code":"0588T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3650.91,"maximum":6666.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3723.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6666.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3902.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4089.02,"additional_payer_notes":"APC"}]}]},{"description":"Rlcj pulse gen only isdss","code_information":[{"code":"0681T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3650.91,"maximum":6666.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3723.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6666.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3902.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4089.02,"additional_payer_notes":"APC"}]}]},{"description":"Removal pulse gen only isdss","code_information":[{"code":"0682T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3650.91,"maximum":6666.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3723.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6666.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3902.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4089.02,"additional_payer_notes":"APC"}]}]},{"description":"Revj/rmvl nea spi w/nstim","code_information":[{"code":"0785T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3650.91,"maximum":6666.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3723.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6666.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3902.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4089.02,"additional_payer_notes":"APC"}]}]},{"description":"Revj/rmvl nea sac w/nstim","code_information":[{"code":"0787T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3650.91,"maximum":6666.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3723.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6666.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3902.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4089.02,"additional_payer_notes":"APC"}]}]},{"description":"Revj/rmvl ins ptn subq","code_information":[{"code":"0818T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3650.91,"maximum":6666.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3723.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6666.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3902.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4089.02,"additional_payer_notes":"APC"}]}]},{"description":"Revj/rmvl ins ptn subf","code_information":[{"code":"0819T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3650.91,"maximum":6666.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3723.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6666.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3902.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4089.02,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl int nstim sys vagus nrv","code_information":[{"code":"0910T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3650.91,"maximum":6666.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3723.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6666.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3902.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4089.02,"additional_payer_notes":"APC"}]}]},{"description":"Revj/rmvl ins ptn subq&subf","code_information":[{"code":"0989T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3650.91,"maximum":6666.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3723.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6666.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3902.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4089.02,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl phrnc nrv stim sys","code_information":[{"code":"33278","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3650.91,"maximum":6666.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3723.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6666.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3902.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4089.02,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl phrnc nrv stim transvns","code_information":[{"code":"33279","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3650.91,"maximum":6666.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3723.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6666.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3902.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4089.02,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl phrnc nrv stim pg only","code_information":[{"code":"33280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3650.91,"maximum":6666.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3723.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6666.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3902.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4089.02,"additional_payer_notes":"APC"}]}]},{"description":"Reposg phrnc nrv stim trnsvn","code_information":[{"code":"33281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3650.91,"maximum":6666.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3723.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6666.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3902.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4089.02,"additional_payer_notes":"APC"}]}]},{"description":"Revise/remove neuroelectrode","code_information":[{"code":"61880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3650.91,"maximum":6666.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3723.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6666.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3902.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4089.02,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine eltrd plate","code_information":[{"code":"63662","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3650.91,"maximum":6666.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3723.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6666.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3902.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4089.02,"additional_payer_notes":"APC"}]}]},{"description":"Revise/remove neuroreceiver","code_information":[{"code":"63688","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3650.91,"maximum":6666.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3723.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6666.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3902.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4089.02,"additional_payer_notes":"APC"}]}]},{"description":"Revise/remove neuroelectrode","code_information":[{"code":"64585","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3650.91,"maximum":6666.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3723.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6666.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3902.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4089.02,"additional_payer_notes":"APC"}]}]},{"description":"Revise/rmv pn/gastr stimul","code_information":[{"code":"64595","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3650.91,"maximum":6666.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3723.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6666.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3902.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4089.02,"additional_payer_notes":"APC"}]}]},{"description":"Revj/rmvl nea pn w/int nstim","code_information":[{"code":"64598","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3650.91,"maximum":6666.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3723.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6666.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3902.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4089.02,"additional_payer_notes":"APC"}]}]},{"description":"Revj/rplcmt bat mod sys lead","code_information":[{"code":"64655","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3650.91,"maximum":6666.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3723.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6666.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3902.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4089.02,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl bat modul sys lead only","code_information":[{"code":"64658","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3650.91,"maximum":6666.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3723.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6666.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3902.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4089.02,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl bat modulj sys pg only","code_information":[{"code":"64659","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3650.91,"maximum":6666.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3723.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6666.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3902.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4089.02,"additional_payer_notes":"APC"}]}]},{"description":"Perq impltj/rplcmt isdns ptn","code_information":[{"code":"0587T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6655.18,"maximum":12152.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6921.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6655.18,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6854.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7121.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6788.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12152.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7054.5,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7114.39,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7453.81,"additional_payer_notes":"APC"}]}]},{"description":"Implant neuroelectrodes","code_information":[{"code":"63650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6655.18,"maximum":12152.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6921.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6655.18,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6854.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7121.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6788.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12152.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7054.5,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7114.39,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7453.81,"additional_payer_notes":"APC"}]}]},{"description":"Revise spine eltrd perq aray","code_information":[{"code":"63663","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6655.18,"maximum":12152.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6921.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6655.18,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6854.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7121.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6788.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12152.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7054.5,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7114.39,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7453.81,"additional_payer_notes":"APC"}]}]},{"description":"Implant neuroelectrodes","code_information":[{"code":"64555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6655.18,"maximum":12152.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6921.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6655.18,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6854.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7121.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6788.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12152.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7054.5,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7114.39,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7453.81,"additional_payer_notes":"APC"}]}]},{"description":"Implant neuroelectrodes","code_information":[{"code":"64561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6655.18,"maximum":12152.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6921.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6655.18,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6854.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7121.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6788.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12152.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7054.5,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7114.39,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7453.81,"additional_payer_notes":"APC"}]}]},{"description":"Implant neuroelectrodes","code_information":[{"code":"64581","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6655.18,"maximum":12152.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6921.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6655.18,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6854.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7121.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6788.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12152.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7054.5,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7114.39,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7453.81,"additional_payer_notes":"APC"}]}]},{"description":"Intraoral periapical first","code_information":[{"code":"D0220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Intraoral occlusal film","code_information":[{"code":"D0240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Extraoral 2d project image","code_information":[{"code":"D0250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Extraoral posterior image","code_information":[{"code":"D0251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Dental bitewing single image","code_information":[{"code":"D0270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Dental bitewings two images","code_information":[{"code":"D0272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Other tmj images by report","code_information":[{"code":"D0321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"2d cephalometric image","code_information":[{"code":"D0340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Oral/facial photo images","code_information":[{"code":"D0350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Sialoendoscopy capt & interp","code_information":[{"code":"D0371","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Trtmnt simulation 3d image","code_information":[{"code":"D0393","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Digital sub 2 or more images","code_information":[{"code":"D0394","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Fusion 2 or more 3d images","code_information":[{"code":"D0395","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Fracture of lower extremity M >=61.50","code_information":[{"code":"D0701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Fracture of lower extremity M >=52.50 and M <61.50","code_information":[{"code":"D0702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Fracture of lower extremity M >=41.50 and M <52.50","code_information":[{"code":"D0703","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Extra oral post radio image","code_information":[{"code":"D0705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Intraoral occlus radio image","code_information":[{"code":"D0706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Intraoral periap radio image","code_information":[{"code":"D0707","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Intraoral bite radio image","code_information":[{"code":"D0708","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Intraoral cmplt radio images","code_information":[{"code":"D0709","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Software meas of cardiac vol","code_information":[{"code":"G0183","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.88,"maximum":165.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":165.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"}]}]},{"description":"Extracranial uni/ltd study","code_information":[{"code":"93882","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Intracranial limited study","code_information":[{"code":"93888","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Tcd emboli detect w/o inj","code_information":[{"code":"93892","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Tcd emboli detect w/inj","code_information":[{"code":"93893","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Lower extremity study","code_information":[{"code":"93926","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Upper extremity study","code_information":[{"code":"93931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Extremity study","code_information":[{"code":"93971","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Vascular study","code_information":[{"code":"93976","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Vascular study","code_information":[{"code":"93979","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Penile vascular study","code_information":[{"code":"93980","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Penile vascular study","code_information":[{"code":"93981","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Dup-scan hemo compl uni std","code_information":[{"code":"93986","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Doppler flow testing","code_information":[{"code":"93990","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Dental tomographic survey","code_information":[{"code":"D0322","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct capt & interp","code_information":[{"code":"D0364","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct interprete man","code_information":[{"code":"D0365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct interprete max","code_information":[{"code":"D0366","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct interp both jaw","code_information":[{"code":"D0367","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct interprete TMJ","code_information":[{"code":"D0368","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Max MRI capture & interprete","code_information":[{"code":"D0369","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Max ultrasound capt & interp","code_information":[{"code":"D0370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct capture limited","code_information":[{"code":"D0380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct capt mandible","code_information":[{"code":"D0381","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct capt maxilla","code_information":[{"code":"D0382","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct both jaws","code_information":[{"code":"D0383","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct capture TMJ","code_information":[{"code":"D0384","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Max MRI image capture","code_information":[{"code":"D0385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"Max ultrasound image capture","code_information":[{"code":"D0386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.17,"maximum":199.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"}]}]},{"description":"N-invas assmt car rsk w/o ct","code_information":[{"code":"0992T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"N-invas assmt car rsk w/ct","code_information":[{"code":"0993T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Fluoro exam of g/colon tube","code_information":[{"code":"49465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Tte w/o doppler complete","code_information":[{"code":"93307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Tte f-up or lmtd","code_information":[{"code":"93308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Extracranial bilat study","code_information":[{"code":"93880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Intracranial complete study","code_information":[{"code":"93886","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Lower extremity study","code_information":[{"code":"93925","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Upper extremity study","code_information":[{"code":"93930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Extremity study","code_information":[{"code":"93970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Vascular study","code_information":[{"code":"93975","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Vascular study","code_information":[{"code":"93978","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Dup-scan hemo compl bi std","code_information":[{"code":"93985","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Intraor complete film series","code_information":[{"code":"D0210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Bitewings - three images","code_information":[{"code":"D0273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Bitewings four images","code_information":[{"code":"D0274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Vert bitewings 7 to 8 images","code_information":[{"code":"D0277","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Dental saliography","code_information":[{"code":"D0310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Dental tmj arthrogram incl i","code_information":[{"code":"D0320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Panoramic image","code_information":[{"code":"D0330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.17,"maximum":454.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":454.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.07,"additional_payer_notes":"APC"}]}]},{"description":"Echo transthoracic","code_information":[{"code":"93303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":570.61,"maximum":1041.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":582.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1041.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":609.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":639.08,"additional_payer_notes":"APC"}]}]},{"description":"Echo transthoracic","code_information":[{"code":"93304","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":570.61,"maximum":1041.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":582.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1041.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":609.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":639.08,"additional_payer_notes":"APC"}]}]},{"description":"Tte w/doppler complete","code_information":[{"code":"93306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":570.61,"maximum":1041.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":582.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1041.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":609.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":639.08,"additional_payer_notes":"APC"}]}]},{"description":"Echo transesophageal","code_information":[{"code":"93312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":570.61,"maximum":1041.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":582.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1041.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":609.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":639.08,"additional_payer_notes":"APC"}]}]},{"description":"Echo transesophageal","code_information":[{"code":"93313","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":570.61,"maximum":1041.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":582.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1041.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":609.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":639.08,"additional_payer_notes":"APC"}]}]},{"description":"Echo transesophageal","code_information":[{"code":"93315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":570.61,"maximum":1041.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":582.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1041.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":609.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":639.08,"additional_payer_notes":"APC"}]}]},{"description":"Echo transesophageal","code_information":[{"code":"93316","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":570.61,"maximum":1041.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":582.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1041.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":609.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":639.08,"additional_payer_notes":"APC"}]}]},{"description":"Echo Transesophageal Intraop","code_information":[{"code":"93318","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":570.61,"maximum":1041.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":582.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1041.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":609.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":639.08,"additional_payer_notes":"APC"}]}]},{"description":"Stress tte only","code_information":[{"code":"93350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":570.61,"maximum":1041.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":582.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1041.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":609.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":639.08,"additional_payer_notes":"APC"}]}]},{"description":"Stress tte complete","code_information":[{"code":"93351","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":570.61,"maximum":1041.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":582.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1041.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":609.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":639.08,"additional_payer_notes":"APC"}]}]},{"description":"2d tte w or w/o fol w/con,fu","code_information":[{"code":"C8924","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.32,"maximum":665.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":371.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":665.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.46,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"}]}]},{"description":"Ra tracer id of sentinl node","code_information":[{"code":"38792","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":417.47,"maximum":762.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":762.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":446.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":467.57,"additional_payer_notes":"APC"}]}]},{"description":"Path clin consltj sf 5-20","code_information":[{"code":"80503","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.42,"maximum":99.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":99.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60.95,"additional_payer_notes":"APC"}]}]},{"description":"Phys blood bank serv authrj","code_information":[{"code":"86079","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.42,"maximum":99.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":99.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60.95,"additional_payer_notes":"APC"}]}]},{"description":"RBC antibody screen","code_information":[{"code":"86850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.42,"maximum":99.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":99.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60.95,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath cell enhance tech","code_information":[{"code":"88112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.42,"maximum":99.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":99.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60.95,"additional_payer_notes":"APC"}]}]},{"description":"Forensic cytopathology","code_information":[{"code":"88125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.42,"maximum":99.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":99.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60.95,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath smear other source","code_information":[{"code":"88162","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.42,"maximum":99.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":99.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60.95,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath eval fna report","code_information":[{"code":"88173","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.42,"maximum":99.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":99.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60.95,"additional_payer_notes":"APC"}]}]},{"description":"Cell marker study","code_information":[{"code":"88182","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.42,"maximum":99.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":99.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60.95,"additional_payer_notes":"APC"}]}]},{"description":"Cytopathology procedure","code_information":[{"code":"88199","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.42,"maximum":99.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":99.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60.95,"additional_payer_notes":"APC"}]}]},{"description":"Cytogenetic study","code_information":[{"code":"88299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.42,"maximum":99.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":99.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60.95,"additional_payer_notes":"APC"}]}]},{"description":"Tissue exam by pathologist","code_information":[{"code":"88304","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.42,"maximum":99.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":99.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60.95,"additional_payer_notes":"APC"}]}]},{"description":"Tissue exam by pathologist","code_information":[{"code":"88305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.42,"maximum":99.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":99.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60.95,"additional_payer_notes":"APC"}]}]},{"description":"Special stains group 1","code_information":[{"code":"88312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.42,"maximum":99.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":99.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60.95,"additional_payer_notes":"APC"}]}]},{"description":"Microslide consultation","code_information":[{"code":"88323","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.42,"maximum":99.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":99.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60.95,"additional_payer_notes":"APC"}]}]},{"description":"Analysis nerve","code_information":[{"code":"88356","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.42,"maximum":99.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":99.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60.95,"additional_payer_notes":"APC"}]}]},{"description":"Surgical pathology procedure","code_information":[{"code":"88399","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.42,"maximum":99.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":99.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60.95,"additional_payer_notes":"APC"}]}]},{"description":"Collect sweat for test","code_information":[{"code":"89230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.42,"maximum":99.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":99.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60.95,"additional_payer_notes":"APC"}]}]},{"description":"Pathology lab procedure","code_information":[{"code":"89240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.42,"maximum":99.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":99.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60.95,"additional_payer_notes":"APC"}]}]},{"description":"Prepare embryo for transfer","code_information":[{"code":"89255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.42,"maximum":99.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":99.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60.95,"additional_payer_notes":"APC"}]}]},{"description":"Sperm identification","code_information":[{"code":"89257","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.42,"maximum":99.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":99.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60.95,"additional_payer_notes":"APC"}]}]},{"description":"Sperm isolation simple","code_information":[{"code":"89260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.42,"maximum":99.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":99.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60.95,"additional_payer_notes":"APC"}]}]},{"description":"Sperm isolation complex","code_information":[{"code":"89261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.42,"maximum":99.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":99.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60.95,"additional_payer_notes":"APC"}]}]},{"description":"Identify sperm tissue","code_information":[{"code":"89264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.42,"maximum":99.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":99.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60.95,"additional_payer_notes":"APC"}]}]},{"description":"Cryopreserve testicular tiss","code_information":[{"code":"89335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.42,"maximum":99.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":99.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60.95,"additional_payer_notes":"APC"}]}]},{"description":"Thawing cryopresrved sperm","code_information":[{"code":"89353","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.42,"maximum":99.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":99.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60.95,"additional_payer_notes":"APC"}]}]},{"description":"Unlisted reprod med lab proc","code_information":[{"code":"89398","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.42,"maximum":99.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":99.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60.95,"additional_payer_notes":"APC"}]}]},{"description":"Path clin consltj mod 21-40","code_information":[{"code":"80504","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Path clin consltj high 41-60","code_information":[{"code":"80505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Phys blood bank serv reactj","code_information":[{"code":"86078","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"RBC antibody elution","code_information":[{"code":"86860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Coombs test indirect qual","code_information":[{"code":"86885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Coombs test indirect titer","code_information":[{"code":"86886","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Autologous blood process","code_information":[{"code":"86890","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Compatibility test spin","code_information":[{"code":"86920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Compatibility test incubate","code_information":[{"code":"86921","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Compatibility test antiglob","code_information":[{"code":"86922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Compatibility test electric","code_information":[{"code":"86923","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Plasma fresh frozen","code_information":[{"code":"86927","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Frozen blood prep","code_information":[{"code":"86930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Frozen blood thaw","code_information":[{"code":"86931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Leukacyte transfusion","code_information":[{"code":"86950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Vol reduction of blood/prod","code_information":[{"code":"86960","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Pooling blood platelets","code_information":[{"code":"86965","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Rbc pretx incubatj w/enzymes","code_information":[{"code":"86971","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Rbc pretx incubatj w/density","code_information":[{"code":"86972","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Rbc serum pretx incubj/inhib","code_information":[{"code":"86977","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Split blood or products","code_information":[{"code":"86985","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Cytp urne 3-5 probes ea spec","code_information":[{"code":"88120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Cytp urine 3-5 probes cmptr","code_information":[{"code":"88121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Cytp dx eval fna 1st ea site","code_information":[{"code":"88172","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Comprehensive review of data","code_information":[{"code":"88325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Path consult intraop 1 bloc","code_information":[{"code":"88331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Immunohisto antb 1st stain","code_information":[{"code":"88342","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Immunofluor antb 1st stain","code_information":[{"code":"88346","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Analysis skeletal muscle","code_information":[{"code":"88355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Analysis tumor","code_information":[{"code":"88358","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Tumor immunohistochem/manual","code_information":[{"code":"88360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Insitu hybridization (fish)","code_information":[{"code":"88365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Insitu hybridization (fish)","code_information":[{"code":"88366","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"M/phmtrc alys ishquant/semiq","code_information":[{"code":"88374","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"M/phmtrc alys ishquant/semiq","code_information":[{"code":"88377","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Chct for mal hyperthermia","code_information":[{"code":"89049","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Sputum specimen collection","code_information":[{"code":"89220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Cultr oocyte/embryo <4 days","code_information":[{"code":"89250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Cultr oocyte/embryo <4 days","code_information":[{"code":"89251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Embryo hatching","code_information":[{"code":"89253","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Oocyte identification","code_information":[{"code":"89254","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Cryopreservation sperm","code_information":[{"code":"89259","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Insemination of oocytes","code_information":[{"code":"89268","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Assist oocyte fertilization","code_information":[{"code":"89281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy oocyte polar body","code_information":[{"code":"89290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy oocyte polar body","code_information":[{"code":"89291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Cryopreservation oocyte(s)","code_information":[{"code":"89337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Storage/year embryo(s)","code_information":[{"code":"89342","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Storage/year sperm/semen","code_information":[{"code":"89343","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Storage/year reprod tissue","code_information":[{"code":"89344","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Storage/year oocyte(s)","code_information":[{"code":"89346","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Thawing cryopresrved embryo","code_information":[{"code":"89352","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Thaw cryoprsvrd reprod tiss","code_information":[{"code":"89354","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"Thawing cryopresrved oocyte","code_information":[{"code":"89356","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.91,"maximum":324.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.26,"additional_payer_notes":"APC"}]}]},{"description":"RBC antibody identification","code_information":[{"code":"86870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":374.32,"maximum":683.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":374.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":385.55,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":400.52,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":381.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":683.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":396.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":400.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":419.24,"additional_payer_notes":"APC"}]}]},{"description":"Blood type antigen donor ea","code_information":[{"code":"86902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":374.32,"maximum":683.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":374.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":385.55,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":400.52,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":381.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":683.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":396.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":400.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":419.24,"additional_payer_notes":"APC"}]}]},{"description":"Blood typing rbc antigens","code_information":[{"code":"86905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":374.32,"maximum":683.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":374.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":385.55,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":400.52,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":381.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":683.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":396.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":400.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":419.24,"additional_payer_notes":"APC"}]}]},{"description":"Flowcytometry/ tc 1 marker","code_information":[{"code":"88184","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":374.32,"maximum":683.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":374.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":385.55,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":400.52,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":381.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":683.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":396.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":400.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":419.24,"additional_payer_notes":"APC"}]}]},{"description":"Tissue exam by pathologist","code_information":[{"code":"88307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":374.32,"maximum":683.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":374.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":385.55,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":400.52,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":381.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":683.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":396.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":400.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":419.24,"additional_payer_notes":"APC"}]}]},{"description":"Immunohisto antibody slide","code_information":[{"code":"88344","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":374.32,"maximum":683.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":374.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":385.55,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":400.52,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":381.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":683.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":396.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":400.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":419.24,"additional_payer_notes":"APC"}]}]},{"description":"Tumor immunohistochem/comput","code_information":[{"code":"88361","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":374.32,"maximum":683.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":374.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":385.55,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":400.52,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":381.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":683.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":396.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":400.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":419.24,"additional_payer_notes":"APC"}]}]},{"description":"Insitu hybridization auto","code_information":[{"code":"88367","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":374.32,"maximum":683.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":374.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":385.55,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":400.52,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":381.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":683.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":396.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":400.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":419.24,"additional_payer_notes":"APC"}]}]},{"description":"Insitu hybridization manual","code_information":[{"code":"88368","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":374.32,"maximum":683.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":374.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":385.55,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":400.52,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":381.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":683.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":396.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":400.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":419.24,"additional_payer_notes":"APC"}]}]},{"description":"Prostate biopsy, any mthd","code_information":[{"code":"G0416","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":374.32,"maximum":683.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":389.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":374.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":385.55,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":400.52,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":381.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":683.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":396.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":400.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":419.24,"additional_payer_notes":"APC"}]}]},{"description":"Bone marrow interpretation","code_information":[{"code":"85097","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":841.35,"maximum":1536.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":875.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":841.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":866.59,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":900.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":858.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1536.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":891.84,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":899.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":942.32,"additional_payer_notes":"APC"}]}]},{"description":"Autologous blood op salvage","code_information":[{"code":"86891","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":841.35,"maximum":1536.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":875.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":841.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":866.59,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":900.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":858.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1536.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":891.84,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":899.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":942.32,"additional_payer_notes":"APC"}]}]},{"description":"Tissue exam by pathologist","code_information":[{"code":"88309","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":841.35,"maximum":1536.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":875.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":841.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":866.59,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":900.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":858.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1536.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":891.84,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":899.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":942.32,"additional_payer_notes":"APC"}]}]},{"description":"Enzyme histochemistry","code_information":[{"code":"88319","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":841.35,"maximum":1536.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":875.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":841.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":866.59,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":900.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":858.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1536.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":891.84,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":899.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":942.32,"additional_payer_notes":"APC"}]}]},{"description":"Intraop cyto path consult 1","code_information":[{"code":"88333","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":841.35,"maximum":1536.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":875.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":841.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":866.59,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":900.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":858.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1536.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":891.84,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":899.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":942.32,"additional_payer_notes":"APC"}]}]},{"description":"Electron microscopy","code_information":[{"code":"88348","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":841.35,"maximum":1536.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":875.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":841.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":866.59,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":900.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":858.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1536.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":891.84,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":899.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":942.32,"additional_payer_notes":"APC"}]}]},{"description":"Nerve teasing preparations","code_information":[{"code":"88362","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":841.35,"maximum":1536.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":875.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":841.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":866.59,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":900.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":858.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1536.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":891.84,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":899.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":942.32,"additional_payer_notes":"APC"}]}]},{"description":"Cryopreservation embryo(s)","code_information":[{"code":"89258","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":841.35,"maximum":1536.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":875.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":841.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":866.59,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":900.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":858.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1536.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":891.84,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":899.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":942.32,"additional_payer_notes":"APC"}]}]},{"description":"Extended culture of oocytes","code_information":[{"code":"89272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":841.35,"maximum":1536.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":875.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":841.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":866.59,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":900.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":858.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1536.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":891.84,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":899.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":942.32,"additional_payer_notes":"APC"}]}]},{"description":"Assist oocyte fertilization","code_information":[{"code":"89280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":841.35,"maximum":1536.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":875.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":841.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":866.59,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":900.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":858.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1536.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":891.84,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":899.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":942.32,"additional_payer_notes":"APC"}]}]},{"description":"Immunotherapy one injection","code_information":[{"code":"95115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.9,"maximum":89.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":50.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":49.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":89.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":51.83,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.27,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.77,"additional_payer_notes":"APC"}]}]},{"description":"Immunotherapy injections","code_information":[{"code":"95117","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.9,"maximum":89.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":50.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":49.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":89.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":51.83,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.27,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.77,"additional_payer_notes":"APC"}]}]},{"description":"Antigen therapy services","code_information":[{"code":"95144","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.9,"maximum":89.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":50.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":49.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":89.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":51.83,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.27,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.77,"additional_payer_notes":"APC"}]}]},{"description":"Antigen therapy services","code_information":[{"code":"95145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.9,"maximum":89.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":50.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":49.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":89.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":51.83,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.27,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.77,"additional_payer_notes":"APC"}]}]},{"description":"Antigen therapy services","code_information":[{"code":"95146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.9,"maximum":89.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":50.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":49.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":89.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":51.83,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.27,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.77,"additional_payer_notes":"APC"}]}]},{"description":"Antigen therapy services","code_information":[{"code":"95165","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.9,"maximum":89.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":50.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":49.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":89.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":51.83,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.27,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.77,"additional_payer_notes":"APC"}]}]},{"description":"Antigen therapy services","code_information":[{"code":"95170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.9,"maximum":89.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":50.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":49.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":89.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":51.83,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.27,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.77,"additional_payer_notes":"APC"}]}]},{"description":"Hydrate iv infusion add-on","code_information":[{"code":"96361","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.9,"maximum":89.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":50.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":49.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":89.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":51.83,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.27,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.77,"additional_payer_notes":"APC"}]}]},{"description":"Ther/proph/diag iv inf addon","code_information":[{"code":"96366","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.9,"maximum":89.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":50.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":49.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":89.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":51.83,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.27,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.77,"additional_payer_notes":"APC"}]}]},{"description":"Sc ther infusion addl hr","code_information":[{"code":"96370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.9,"maximum":89.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":50.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":49.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":89.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":51.83,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.27,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.77,"additional_payer_notes":"APC"}]}]},{"description":"Tx/pro/dx inj new drug addon","code_information":[{"code":"96375","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.9,"maximum":89.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":50.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":49.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":89.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":51.83,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.27,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.77,"additional_payer_notes":"APC"}]}]},{"description":"Applicaton on-body injector","code_information":[{"code":"96377","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.9,"maximum":89.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":50.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":49.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":89.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":51.83,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.27,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.77,"additional_payer_notes":"APC"}]}]},{"description":"Ther/prop/diag inj/inf proc","code_information":[{"code":"96379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.9,"maximum":89.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":50.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":49.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":89.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":51.83,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.27,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.77,"additional_payer_notes":"APC"}]}]},{"description":"Chemo ia infuse each addl hr","code_information":[{"code":"96423","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.9,"maximum":89.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":50.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":49.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":89.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":51.83,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.27,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.77,"additional_payer_notes":"APC"}]}]},{"description":"Chemotherapy unspecified","code_information":[{"code":"96549","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.9,"maximum":89.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":50.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":49.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":89.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":51.83,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.27,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.77,"additional_payer_notes":"APC"}]}]},{"description":"Admin influenza virus vac","code_information":[{"code":"G0008","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.9,"maximum":89.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":50.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":49.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":89.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":51.83,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.27,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.77,"additional_payer_notes":"APC"}]}]},{"description":"Admin pneumococcal vaccine","code_information":[{"code":"G0009","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.9,"maximum":89.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":50.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":49.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":89.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":51.83,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.27,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.77,"additional_payer_notes":"APC"}]}]},{"description":"Admin hepatitis b vaccine","code_information":[{"code":"G0010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.9,"maximum":89.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":50.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":49.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":89.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":51.83,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.27,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.77,"additional_payer_notes":"APC"}]}]},{"description":"Immunization admin","code_information":[{"code":"90471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":75.19,"maximum":137.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":78.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":77.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":76.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":137.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":79.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":84.21,"additional_payer_notes":"APC"}]}]},{"description":"Immune admin oral/nasal","code_information":[{"code":"90473","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":75.19,"maximum":137.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":78.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":77.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":76.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":137.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":79.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":84.21,"additional_payer_notes":"APC"}]}]},{"description":"Antigen therapy services","code_information":[{"code":"95147","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":75.19,"maximum":137.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":78.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":77.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":76.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":137.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":79.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":84.21,"additional_payer_notes":"APC"}]}]},{"description":"Antigen therapy services","code_information":[{"code":"95148","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":75.19,"maximum":137.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":78.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":77.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":76.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":137.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":79.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":84.21,"additional_payer_notes":"APC"}]}]},{"description":"Antigen therapy services","code_information":[{"code":"95149","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":75.19,"maximum":137.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":78.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":77.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":76.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":137.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":79.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":84.21,"additional_payer_notes":"APC"}]}]},{"description":"Tx/proph/dg addl seq iv inf","code_information":[{"code":"96367","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":75.19,"maximum":137.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":78.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":77.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":76.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":137.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":79.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":84.21,"additional_payer_notes":"APC"}]}]},{"description":"Sc ther infusion reset pump","code_information":[{"code":"96371","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":75.19,"maximum":137.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":78.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":77.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":76.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":137.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":79.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":84.21,"additional_payer_notes":"APC"}]}]},{"description":"Ther/proph/diag inj sc/im","code_information":[{"code":"96372","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":75.19,"maximum":137.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":78.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":77.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":76.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":137.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":79.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":84.21,"additional_payer_notes":"APC"}]}]},{"description":"Chemo anti-neopl sq/im","code_information":[{"code":"96401","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":75.19,"maximum":137.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":78.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":77.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":76.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":137.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":79.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":84.21,"additional_payer_notes":"APC"}]}]},{"description":"Chemo hormon antineopl sq/im","code_information":[{"code":"96402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":75.19,"maximum":137.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":78.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":77.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":76.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":137.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":79.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":84.21,"additional_payer_notes":"APC"}]}]},{"description":"Chemo intralesional up to 7","code_information":[{"code":"96405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":75.19,"maximum":137.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":78.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":77.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":76.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":137.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":79.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":84.21,"additional_payer_notes":"APC"}]}]},{"description":"Chemo iv push addl drug","code_information":[{"code":"96411","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":75.19,"maximum":137.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":78.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":77.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":76.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":137.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":79.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":84.21,"additional_payer_notes":"APC"}]}]},{"description":"Chemo iv infusion addl hr","code_information":[{"code":"96415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":75.19,"maximum":137.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":78.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":77.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":76.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":137.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":79.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":84.21,"additional_payer_notes":"APC"}]}]},{"description":"Chemo iv infus each addl seq","code_information":[{"code":"96417","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":75.19,"maximum":137.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":78.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":77.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":76.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":137.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":79.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":84.21,"additional_payer_notes":"APC"}]}]},{"description":"Injection of hiv prep drug","code_information":[{"code":"G0012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":75.19,"maximum":137.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":78.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":77.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":76.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":137.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":79.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":84.21,"additional_payer_notes":"APC"}]}]},{"description":"Inj w/fluor eval cv device","code_information":[{"code":"36598","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":222.12,"maximum":405.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":231.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":222.12,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":228.78,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":237.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":226.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":405.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":235.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":237.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":248.78,"additional_payer_notes":"APC"}]}]},{"description":"Hydration iv infusion init","code_information":[{"code":"96360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":222.12,"maximum":405.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":231.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":222.12,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":228.78,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":237.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":226.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":405.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":235.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":237.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":248.78,"additional_payer_notes":"APC"}]}]},{"description":"Ther/proph/diag iv inf init","code_information":[{"code":"96365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":222.12,"maximum":405.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":231.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":222.12,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":228.78,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":237.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":226.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":405.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":235.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":237.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":248.78,"additional_payer_notes":"APC"}]}]},{"description":"Sc ther infusion up to 1 hr","code_information":[{"code":"96369","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":222.12,"maximum":405.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":231.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":222.12,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":228.78,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":237.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":226.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":405.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":235.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":237.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":248.78,"additional_payer_notes":"APC"}]}]},{"description":"Ther/proph/diag inj ia","code_information":[{"code":"96373","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":222.12,"maximum":405.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":231.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":222.12,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":228.78,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":237.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":226.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":405.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":235.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":237.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":248.78,"additional_payer_notes":"APC"}]}]},{"description":"Ther/proph/diag inj iv push","code_information":[{"code":"96374","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":222.12,"maximum":405.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":231.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":222.12,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":228.78,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":237.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":226.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":405.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":235.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":237.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":248.78,"additional_payer_notes":"APC"}]}]},{"description":"Chemo intralesional over 7","code_information":[{"code":"96406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":222.12,"maximum":405.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":231.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":222.12,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":228.78,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":237.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":226.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":405.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":235.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":237.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":248.78,"additional_payer_notes":"APC"}]}]},{"description":"Refill/maint portable pump","code_information":[{"code":"96521","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":222.12,"maximum":405.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":231.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":222.12,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":228.78,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":237.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":226.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":405.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":235.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":237.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":248.78,"additional_payer_notes":"APC"}]}]},{"description":"Refill/maint pump/resvr syst","code_information":[{"code":"96522","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":222.12,"maximum":405.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":231.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":222.12,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":228.78,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":237.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":226.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":405.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":235.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":237.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":248.78,"additional_payer_notes":"APC"}]}]},{"description":"Prolonged iv inf, req pump","code_information":[{"code":"C8957","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":222.12,"maximum":405.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":231.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":222.12,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":228.78,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":237.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":226.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":405.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":235.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":237.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":248.78,"additional_payer_notes":"APC"}]}]},{"description":"Compre audiometry evaluation","code_information":[{"code":"0212T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Tempr","code_information":[{"code":"0278T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Visual ep test for glaucoma","code_information":[{"code":"0464T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Colonic lavage 35+l water","code_information":[{"code":"0736T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Tc auriculr neurostimulation","code_information":[{"code":"0783T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Rem mlt day uroflow dev sply","code_information":[{"code":"0812T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Crtj dig 3d mdl surf mesh 1","code_information":[{"code":"1030T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Crtj dig 3d mdl mesh&sim 1","code_information":[{"code":"1032T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Crt dig 3d mdl msh sim&aly 1","code_information":[{"code":"1034T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Dx gastr intub w/asp specs","code_information":[{"code":"43755","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Measure ureter pressure","code_information":[{"code":"50686","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Insert bladder cath complex","code_information":[{"code":"51703","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Anal/urinary muscle study","code_information":[{"code":"51784","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Dilation of urethra","code_information":[{"code":"53660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Gastroenterology procedure","code_information":[{"code":"91299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Multifocal erg w/i&r","code_information":[{"code":"92274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Vemp test i&r cervical","code_information":[{"code":"92517","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Vemp test i&r ocular","code_information":[{"code":"92518","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Caloric vstblr test w/rec","code_information":[{"code":"92537","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Optokinetic nystagmus test","code_information":[{"code":"92544","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Sinusoidal rotational test","code_information":[{"code":"92546","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Audiometry air & bone","code_information":[{"code":"92553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Comprehensive hearing test","code_information":[{"code":"92557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Acoustic immitance testing","code_information":[{"code":"92570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Staggered spondaic word test","code_information":[{"code":"92572","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Conditioning play audiometry","code_information":[{"code":"92582","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Electrocochleography","code_information":[{"code":"92584","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Cochlear implt f/up exam <7","code_information":[{"code":"92601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Reprogram cochlear implt 7/>","code_information":[{"code":"92602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Cochlear implt f/up exam 7/>","code_information":[{"code":"92603","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Reprogram cochlear implt 7/>","code_information":[{"code":"92604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Auditory function 60 min","code_information":[{"code":"92620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Dx aly aud oi snd prcsr 1st","code_information":[{"code":"92622","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Tinnitus assessment","code_information":[{"code":"92625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Eval aud rehab status","code_information":[{"code":"92626","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Aud brainstem implt programg","code_information":[{"code":"92640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Microvolt t-wave assess","code_information":[{"code":"93025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Interrog crtd sins bat ip wo","code_information":[{"code":"93145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Interrog crtd sins bat ip w/","code_information":[{"code":"93146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Bis xtracell fluid analysis","code_information":[{"code":"93702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Temperature gradient studies","code_information":[{"code":"93740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Cardiovascular procedure","code_information":[{"code":"93799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Spirometry up to 2 yrs old","code_information":[{"code":"94011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Vital capacity test","code_information":[{"code":"94150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Hypoxia response curve","code_information":[{"code":"94450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Exhaled air analysis o2","code_information":[{"code":"94680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Pulm funct test oscillometry","code_information":[{"code":"94728","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Measure blood oxygen level","code_information":[{"code":"94762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Ped home apnea rec hk-up","code_information":[{"code":"94775","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Ped home apnea rec downld","code_information":[{"code":"94776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Pulmonary service/procedure","code_information":[{"code":"94799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test 3 limbs","code_information":[{"code":"95863","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test 4 limbs","code_information":[{"code":"95864","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test hemidiaphragm","code_information":[{"code":"95866","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Limb exercise test","code_information":[{"code":"95875","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Autonomic nrv parasym inervj","code_information":[{"code":"95921","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Neuromuscular junction test","code_information":[{"code":"95937","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Neurological procedure","code_information":[{"code":"95999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Devel tst phys/qhp 1st hr","code_information":[{"code":"96112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.37,"maximum":245.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.49,"additional_payer_notes":"APC"}]}]},{"description":"Pattern erg w/i&r","code_information":[{"code":"0509T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"N-nvs artl plaq alys quan","code_information":[{"code":"0712T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Tc mag stimj pn 1st tx 1nrv","code_information":[{"code":"0766T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Tx gastro intub w/asp","code_information":[{"code":"43753","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Dx gastr intub w/asp spec","code_information":[{"code":"43754","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Electro-uroflowmetry first","code_information":[{"code":"51741","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Penis study","code_information":[{"code":"54240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Tcranial magn stim tx plan","code_information":[{"code":"90867","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Tcranial magn stim tx deli","code_information":[{"code":"90868","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Tcran magn stim redetemine","code_information":[{"code":"90869","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Esoph imped function test","code_information":[{"code":"91037","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Breath hydrogen/methane test","code_information":[{"code":"91065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Colon motility 6 hr study","code_information":[{"code":"91117","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Rct snsatn tone&cmplianc std","code_information":[{"code":"91124","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Electrogastrography","code_information":[{"code":"91132","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Fluorescein angrph uni/bi","code_information":[{"code":"92235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Icg angiography uni/bi","code_information":[{"code":"92240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Fluorescein icg angiography","code_information":[{"code":"92242","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Full field erg w/i&r","code_information":[{"code":"92273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Nasal function studies","code_information":[{"code":"92512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Facial nerve function test","code_information":[{"code":"92516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Vemp tst i&r cervical&ocular","code_information":[{"code":"92519","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Caloric vstblr test w/rec","code_information":[{"code":"92538","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Basic vestibular evaluation","code_information":[{"code":"92540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Oscillating tracking test","code_information":[{"code":"92545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Tympanometry & reflex thresh","code_information":[{"code":"92550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Loudness balance test","code_information":[{"code":"92562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Visual audiometry (vra)","code_information":[{"code":"92579","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Evoked auditory test limited","code_information":[{"code":"92587","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Aep hearing status deter i&r","code_information":[{"code":"92651","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Aep thrshld est mlt freq i&r","code_information":[{"code":"92652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Aep neurodiagnostic i&r","code_information":[{"code":"92653","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Heart/lung resuscitation cpr","code_information":[{"code":"92950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Cardiovascular stress test","code_information":[{"code":"93017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Upr/lxtr art stdy 3+ lvls","code_information":[{"code":"93923","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Lwr xtr vasc stdy bilat","code_information":[{"code":"93924","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Breathing capacity test","code_information":[{"code":"94010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Spirmtry w/brnchdil inf-2 yr","code_information":[{"code":"94012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Patient recorded spirometry","code_information":[{"code":"94015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Respiratory flow volume loop","code_information":[{"code":"94375","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Pulm function test by gas","code_information":[{"code":"94727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Eeg cont rec w/vid eeg tech","code_information":[{"code":"95700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Eeg w/o vid 2-12 hr unmntr","code_information":[{"code":"95705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Eeg wo vid 2-12hr intmt mntr","code_information":[{"code":"95706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Eeg w/o vid 2-12hr cont mntr","code_information":[{"code":"95707","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Veeg 2-12 hr unmonitored","code_information":[{"code":"95711","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Slp stdy unattended","code_information":[{"code":"95800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Sleep study unatt&resp efft","code_information":[{"code":"95806","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Eeg 41-60 minutes","code_information":[{"code":"95812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Eeg over 1 hour","code_information":[{"code":"95813","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Eeg awake and drowsy","code_information":[{"code":"95816","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Eeg awake and asleep","code_information":[{"code":"95819","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Eeg coma or sleep only","code_information":[{"code":"95822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Cholinesterase challenge","code_information":[{"code":"95857","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test cran nerv unilat","code_information":[{"code":"95867","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test cran nerve bilat","code_information":[{"code":"95868","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test thor paraspinal","code_information":[{"code":"95869","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test one fiber","code_information":[{"code":"95872","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Nvr cndj tst 1-2 studies","code_information":[{"code":"95907","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Nrv cndj tst 3-4 studies","code_information":[{"code":"95908","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Nrv cndj tst 5-6 studies","code_information":[{"code":"95909","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Ans parasymp & symp w/tilt","code_information":[{"code":"95924","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Somatosensory testing","code_information":[{"code":"95925","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Somatosensory testing","code_information":[{"code":"95926","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Somatosensory testing","code_information":[{"code":"95927","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Visual evoked potential test","code_information":[{"code":"95930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Dynamic surface emg","code_information":[{"code":"96002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Neurobehavioral status exam","code_information":[{"code":"96116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Psycl tst eval phys/qhp 1st","code_information":[{"code":"96130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Pre-op service LVRS 10-15dos","code_information":[{"code":"G0303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Home sleep test/type 2 porta","code_information":[{"code":"G0398","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Home sleep test/type 3 porta","code_information":[{"code":"G0399","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Home sleep test/type 4 porta","code_information":[{"code":"G0400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.48,"maximum":411.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":229.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":411.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":241.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":252.54,"additional_payer_notes":"APC"}]}]},{"description":"Myocardial imaging mcg","code_information":[{"code":"0541T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Gi myoelectrical actv study","code_information":[{"code":"0779T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Ext trnscranl mag stimj meas","code_information":[{"code":"0858T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Hi-res gastric ep mapping","code_information":[{"code":"0868T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Esophagus motility study","code_information":[{"code":"91010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Gastric motility studies","code_information":[{"code":"91020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Duodenal motility study","code_information":[{"code":"91022","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Acid perfusion of esophagus","code_information":[{"code":"91030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Gastroesophageal reflux test","code_information":[{"code":"91034","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Esoph imped funct test > 1hr","code_information":[{"code":"91038","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Esoph balloon distension tst","code_information":[{"code":"91040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Anrct mano rct snsatn&balo","code_information":[{"code":"91125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Eye exam with photos","code_information":[{"code":"92230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Stenger test speech","code_information":[{"code":"92577","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Evoked auditory tst complete","code_information":[{"code":"92588","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Remote 30 day ecg tech supp","code_information":[{"code":"93229","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Tilt table evaluation","code_information":[{"code":"93660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Meas lung vol thru 2 yrs","code_information":[{"code":"94013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Evaluation of wheezing","code_information":[{"code":"94060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Evaluation of wheezing","code_information":[{"code":"94070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Pulm stress test/complex","code_information":[{"code":"94621","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Exhaled air analysis o2/co2","code_information":[{"code":"94681","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Pulm funct tst plethysmograp","code_information":[{"code":"94726","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Breath recording infant","code_information":[{"code":"94772","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Bronchial allergy tests","code_information":[{"code":"95070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Ingest challenge ini 120 min","code_information":[{"code":"95076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Eeg wo vid ea 12-26hr unmntr","code_information":[{"code":"95708","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Eeg w/o vid ea 12-26hr intmt","code_information":[{"code":"95709","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Eeg w/o vid ea 12-26hr cont","code_information":[{"code":"95710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Veeg 2-12 hr intmt mntr","code_information":[{"code":"95712","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Veeg 2-12 hr cont mntr","code_information":[{"code":"95713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Veeg ea 12-26 hr unmntr","code_information":[{"code":"95714","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Veeg ea 12-26hr intmt mntr","code_information":[{"code":"95715","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Sleep study attended","code_information":[{"code":"95807","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Eeg cerebral death only","code_information":[{"code":"95824","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Nrv cndj test 7-8 studies","code_information":[{"code":"95910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Nrv cndj test 9-10 studies","code_information":[{"code":"95911","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Nrv cndj test 11-12 studies","code_information":[{"code":"95912","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Nrv cndj test 13/> studies","code_information":[{"code":"95913","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"C motor evoked lwr limbs","code_information":[{"code":"95929","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"EEG monitoring/giving drugs","code_information":[{"code":"95954","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Motion analysis video/3d","code_information":[{"code":"96000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Nrpsyc tst eval phys/qhp 1st","code_information":[{"code":"96132","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Pre-op service LVRS complete","code_information":[{"code":"G0302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Pre-op service LVRS 1-9 dos","code_information":[{"code":"G0304","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Post op service LVRS min 6","code_information":[{"code":"G0305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"Blinded conv. Tx MDD clin tr","code_information":[{"code":"G2000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.68,"maximum":711.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":711.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":416.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":436.44,"additional_payer_notes":"APC"}]}]},{"description":"BIA whole body","code_information":[{"code":"0358T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.2,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"Interrog dev eval wcs ip","code_information":[{"code":"0521T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.2,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"Air displacmnt plethysmograp","code_information":[{"code":"1002T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.2,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"Ndl insj w/o njx 1 or 2 musc","code_information":[{"code":"20560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.2,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"Ndl insj w/o njx 3+ musc","code_information":[{"code":"20561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.2,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"Us bone stimulation","code_information":[{"code":"20979","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.2,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"Phys blood bank serv xmatch","code_information":[{"code":"86077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.2,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"Skin test candida","code_information":[{"code":"86485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.2,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"Skin test nos antigen","code_information":[{"code":"86486","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.2,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"TB intradermal test","code_information":[{"code":"86580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.2,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"Rbc serum pretx id dilution","code_information":[{"code":"86976","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.2,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"Transfusion procedure","code_information":[{"code":"86999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.2,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath fl nongyn filter","code_information":[{"code":"88106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.2,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath smear other source","code_information":[{"code":"88160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.2,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath smear other source","code_information":[{"code":"88161","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.2,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"Surgical path gross","code_information":[{"code":"88300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.2,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"Xm archive tissue molec anal","code_information":[{"code":"88363","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.2,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"Eye service or procedure","code_information":[{"code":"92499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.2,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"Ent procedure/service","code_information":[{"code":"92700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.2,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"Art pressure waveform analys","code_information":[{"code":"93050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.2,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"Ilr device interrogate","code_information":[{"code":"93291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.2,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"Noninvas vasc dx study proc","code_information":[{"code":"93998","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.2,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"Perq & icut allg test venoms","code_information":[{"code":"95017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.2,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"Icut allergy titrate-airborn","code_information":[{"code":"95027","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.2,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"Allergy immunology services","code_information":[{"code":"95199","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.2,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"Psycl/nrpsyc tst auto result","code_information":[{"code":"96146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.2,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"Acupunct w/o stimul 15 min","code_information":[{"code":"97810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.2,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"Acupunct w/stimul 15 min","code_information":[{"code":"97813","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.2,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"Self-meas bp pt educaj/train","code_information":[{"code":"99473","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.2,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"Glaucoma scrn hgh risk direc","code_information":[{"code":"G0117","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.2,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"Therapeutic procd strg endur","code_information":[{"code":"G0237","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.2,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"Oth resp proc, indiv","code_information":[{"code":"G0238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.2,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"EKG tracing for initial prev","code_information":[{"code":"G0404","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.2,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"No pt prsnt train initial 30","code_information":[{"code":"G0541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.2,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"Group train w/o patient","code_information":[{"code":"G0543","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.2,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"Alcohol/sub abuse assess","code_information":[{"code":"G2011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.2,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"Obtaining screen pap smear","code_information":[{"code":"Q0091","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.2,"maximum":55.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.83,"additional_payer_notes":"APC"}]}]},{"description":"Touch Quant Sensory Test","code_information":[{"code":"0106T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Vibrate Quant Sensory Test","code_information":[{"code":"0107T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Heat Quant Sensory Test","code_information":[{"code":"0109T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Audiometry air only","code_information":[{"code":"0208T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Audiometry air & bone","code_information":[{"code":"0209T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Speech audiometry threshold","code_information":[{"code":"0210T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Speech audiom thresh & recog","code_information":[{"code":"0211T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Tear film img uni/bi w/i&r","code_information":[{"code":"0330T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Vis field assmnt tech suppt","code_information":[{"code":"0379T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Oct mid ear i&r unilateral","code_information":[{"code":"0485T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Oct mid ear i&r bilateral","code_information":[{"code":"0486T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Ncntc nr ifr spctrsc wnd","code_information":[{"code":"0640T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Surf radj ther tx planning","code_information":[{"code":"77436","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Histoplasmosis skin test","code_information":[{"code":"86510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Blood typing serologic rh(d)","code_information":[{"code":"86901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Bld typing serologic rh phnt","code_information":[{"code":"86906","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Frozen blood freeze/thaw","code_information":[{"code":"86932","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Blood product/irradiation","code_information":[{"code":"86945","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath fl nongyn smears","code_information":[{"code":"88104","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath concentrate tech","code_information":[{"code":"88108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Tissue exam by pathologist","code_information":[{"code":"88302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Microslide consultation","code_information":[{"code":"88321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Remote retinal imaging mgmt","code_information":[{"code":"92228","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Ophthalmoscopy/dynamometry","code_information":[{"code":"92260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Eye photography","code_information":[{"code":"92285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Rx corneoscleral cntact lens","code_information":[{"code":"92317","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Fit spectacles single system","code_information":[{"code":"92354","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Fit spectacles compound lens","code_information":[{"code":"92355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Tone decay hearing test","code_information":[{"code":"92563","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Tympanometry","code_information":[{"code":"92567","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Acoustic refl threshold tst","code_information":[{"code":"92568","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Filtered speech hearing test","code_information":[{"code":"92571","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Sensorineural acuity test","code_information":[{"code":"92575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Synthetic sentence test","code_information":[{"code":"92576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Ear protector evaluation","code_information":[{"code":"92596","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Ext ecg>48hr<7d recording","code_information":[{"code":"93242","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Ext ecg>7d<15d recording","code_information":[{"code":"93246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Car seat/bed test 60 min","code_information":[{"code":"94780","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Exhaled Nitric Oxide Meas","code_information":[{"code":"95012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Perq&ic allg test drugs/biol","code_information":[{"code":"95018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Icut allergy test-delayed","code_information":[{"code":"95028","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Nose allergy test","code_information":[{"code":"95065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Brief emotional/behav assmt","code_information":[{"code":"96127","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Ultraviolet light therapy","code_information":[{"code":"96900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Appl modality 1+lllt po pain","code_information":[{"code":"97037","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Glaucoma scrn hgh risk direc","code_information":[{"code":"G0118","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Oth resp proc, group","code_information":[{"code":"G0239","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Non-cov surg proc,clin trial","code_information":[{"code":"G0293","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Non-cov proc, clinical trial","code_information":[{"code":"G0294","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Cardiokymography","code_information":[{"code":"Q0035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.69,"additional_payer_notes":"APC"}]}]},{"description":"Cool Quant Sensory Test","code_information":[{"code":"0108T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Ins bone device for rsa","code_information":[{"code":"0347T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Mac pgmt opt dns meas hfp","code_information":[{"code":"0506T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Near ifr 2img mibmn glnd i&r","code_information":[{"code":"0507T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Evac meibomian glnd heat bi","code_information":[{"code":"0563T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Car acous wavfrm rec cad rsk","code_information":[{"code":"0716T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Augmnt ai-based fcl phnt a/r","code_information":[{"code":"0731T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Rem auton alg nsln cal setup","code_information":[{"code":"0740T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Pt spec alg rx-onc tx option","code_information":[{"code":"0794T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Ecg alg 12 ld rdcd trcg only","code_information":[{"code":"0904T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Elec aly nstm sys vgs nrv wo","code_information":[{"code":"0911T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Trim nail(s) any number","code_information":[{"code":"11719","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Debride nail 1-5","code_information":[{"code":"11720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Debride nail 6 or more","code_information":[{"code":"11721","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Cryotherapy of skin","code_information":[{"code":"17340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Application of finger splint","code_information":[{"code":"29131","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Strapping of elbow or wrist","code_information":[{"code":"29260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Strapping of hand or finger","code_information":[{"code":"29280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Strapping of toes","code_information":[{"code":"29550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Urinary reflex study","code_information":[{"code":"51792","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Us urine capacity measure","code_information":[{"code":"51798","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Treat vagina infection","code_information":[{"code":"57150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Remove impacted ear wax uni","code_information":[{"code":"69209","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Remove impacted ear wax uni","code_information":[{"code":"69210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Coombs test direct","code_information":[{"code":"86880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Blood typing patient serum","code_information":[{"code":"86904","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Rbc pretx incubatj w/chemicl","code_information":[{"code":"86970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Rbc pretreatment serum","code_information":[{"code":"86978","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Path consult introp","code_information":[{"code":"88329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Corneal Topography","code_information":[{"code":"92025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Special eye evaluation","code_information":[{"code":"92060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Orthop traing supvj phys/qhp","code_information":[{"code":"92066","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Visual field examination(s)","code_information":[{"code":"92081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Visual field examination(s)","code_information":[{"code":"92082","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Cmptr ophth dx img ant segmt","code_information":[{"code":"92132","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Cmptr ophth img optic nerve","code_information":[{"code":"92133","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Cptr ophth dx img post segmt","code_information":[{"code":"92134","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Corneal hysteresis deter","code_information":[{"code":"92145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Opscpy extnd rta draw uni/bi","code_information":[{"code":"92201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Opscpy extnd on/mac draw","code_information":[{"code":"92202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Remote dx retinal imaging","code_information":[{"code":"92227","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Img rta detc/mntr ds poc aly","code_information":[{"code":"92229","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Eye muscle evaluation","code_information":[{"code":"92265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Color vision examination","code_information":[{"code":"92283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Replacement of contact lens","code_information":[{"code":"92326","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Fit aphakia spectcl monofocl","code_information":[{"code":"92352","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Fit aphakia spectcl multifoc","code_information":[{"code":"92353","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Aphakia prosth service temp","code_information":[{"code":"92358","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Repair & adjust spectacles","code_information":[{"code":"92371","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Speech threshold audiometry","code_information":[{"code":"92555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Speech audiometry complete","code_information":[{"code":"92556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Stenger test pure tone","code_information":[{"code":"92565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Select picture audiometry","code_information":[{"code":"92583","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Electrocardiogram tracing","code_information":[{"code":"93005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Rhythm ecg tracing","code_information":[{"code":"93041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Ecg monit/reprt up to 48 hrs","code_information":[{"code":"93226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"ECG/signal-averaged","code_information":[{"code":"93278","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Peripheral Vascular Rehab","code_information":[{"code":"93668","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Lung function test (MBC/MVV)","code_information":[{"code":"94200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Exercise tst brncspsm wo ecg","code_information":[{"code":"94619","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Phy/qhp op pulm rhb w/o mntr","code_information":[{"code":"94625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Phy/qhp op pulm rhb w/mntr","code_information":[{"code":"94626","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Exhaled air analysis","code_information":[{"code":"94690","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Icut allergy test drug/bug","code_information":[{"code":"95024","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Photo patch test","code_information":[{"code":"95052","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Cont gluc mntr pt prov eqp","code_information":[{"code":"95249","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Slp stdy unatnd w/anal","code_information":[{"code":"95801","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Actigraphy testing","code_information":[{"code":"95803","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Blink reflex test","code_information":[{"code":"95933","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Io anal gast n-stim subsq","code_information":[{"code":"95981","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Irrig drug delivery device","code_information":[{"code":"96523","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Photochemotherapy with UV-B","code_information":[{"code":"96910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Photochemotherapy with UV-A","code_information":[{"code":"96912","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Trim nail(s)","code_information":[{"code":"G0127","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Pathogen test for platelets","code_information":[{"code":"P9100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.6,"maximum":112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.0,"additional_payer_notes":"APC"}]}]},{"description":"Nos Quant Sensory Test","code_information":[{"code":"0110T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Ocular blood flow measure","code_information":[{"code":"0198T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Clear eyelid gland w/heat","code_information":[{"code":"0207T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Eye mvmt alys w/o calbrj i&r","code_information":[{"code":"0615T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Asstv alg ecg rsk asmt cncrt","code_information":[{"code":"0764T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Asstv alg ecg rsk asmt prev","code_information":[{"code":"0765T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Instlj fecal microbiota ssp","code_information":[{"code":"0780T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"N-invas assmt bld oxygnation","code_information":[{"code":"0893T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Qtc ntrvl augmnt alg aly ecg","code_information":[{"code":"0902T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Asstv alg alys acous&ecg rec","code_information":[{"code":"0962T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Elec alys s-scl eeg wo prgrm","code_information":[{"code":"1004T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Cptr oph alys monoc eye mvmt","code_information":[{"code":"1010T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Augmnt alg alys enceph wvfrm","code_information":[{"code":"1041T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Drain blood from under nail","code_information":[{"code":"11740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Insert drug implant device","code_information":[{"code":"11981","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Apply forearm splint","code_information":[{"code":"29125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Apply forearm splint","code_information":[{"code":"29126","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Application of finger splint","code_information":[{"code":"29130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Strapping of shoulder","code_information":[{"code":"29240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Strapping of hip","code_information":[{"code":"29520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Strapping of knee","code_information":[{"code":"29530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Remove nasal foreign body","code_information":[{"code":"30300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Control of nosebleed","code_information":[{"code":"30901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Control of nosebleed","code_information":[{"code":"30903","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Control of nosebleed","code_information":[{"code":"30905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Vein access cutdown < 1 yr","code_information":[{"code":"36420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Draw blood off venous device","code_information":[{"code":"36591","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Collect blood from picc","code_information":[{"code":"36592","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Withdrawal of arterial blood","code_information":[{"code":"36600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of gum lesion","code_information":[{"code":"41800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Diagnostic anoscopy spx","code_information":[{"code":"46600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Insert bladder catheter","code_information":[{"code":"51701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Insert temp bladder cath","code_information":[{"code":"51702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Urine flow measurement","code_information":[{"code":"51736","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Dilate urethra stricture","code_information":[{"code":"53601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Dilation of urethra","code_information":[{"code":"53661","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Remove foreign body from eye","code_information":[{"code":"65205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Remove foreign body from eye","code_information":[{"code":"65222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Revise eyelashes","code_information":[{"code":"67820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Clear outer ear canal","code_information":[{"code":"69200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Blood typing serologic abo","code_information":[{"code":"86900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Special stains group 2","code_information":[{"code":"88313","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Electrogastrography W/Test","code_information":[{"code":"91133","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Special eye evaluation","code_information":[{"code":"92020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Visual field examination(s)","code_information":[{"code":"92083","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Ophthalmic biometry","code_information":[{"code":"92136","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Eye exam with photos","code_information":[{"code":"92250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Electro-oculography","code_information":[{"code":"92270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Internal eye photography","code_information":[{"code":"92286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Internal eye photography","code_information":[{"code":"92287","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Contact lens fitting","code_information":[{"code":"92312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Contact lens fitting","code_information":[{"code":"92313","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Rx cntact lens aphakia 1 eye","code_information":[{"code":"92315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Rx cntact lens aphakia 2 eye","code_information":[{"code":"92316","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Modification of contact lens","code_information":[{"code":"92325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Laryngeal function studies","code_information":[{"code":"92520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Spontaneous nystagmus test","code_information":[{"code":"92541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Positional nystagmus test","code_information":[{"code":"92542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Posturography","code_information":[{"code":"92548","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Cdp-sot 6 cond w/i&r mct&adt","code_information":[{"code":"92549","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Pure tone audiometry air","code_information":[{"code":"92552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Ecg monit/reprt up to 48 hrs","code_information":[{"code":"93225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Ext ecg>48hr<7d scan a/r","code_information":[{"code":"93243","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Ext ecg>7d<15d scan a/r","code_information":[{"code":"93247","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Bioimpedance cv analysis","code_information":[{"code":"93701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Ambulatory BP recording","code_information":[{"code":"93786","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Ambulatory BP analysis","code_information":[{"code":"93788","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Upr/l xtremity art 2 levels","code_information":[{"code":"93922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Hast w/report","code_information":[{"code":"94452","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Hast w/oxygen titrate","code_information":[{"code":"94453","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Exercise tst brncspsm","code_information":[{"code":"94617","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Pulmonary stress testing","code_information":[{"code":"94618","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Cbt 1st hour","code_information":[{"code":"94644","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Chest wall manipulation","code_information":[{"code":"94667","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Chest wall manipulation","code_information":[{"code":"94668","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Photosensitivity tests","code_information":[{"code":"95056","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Eye allergy tests","code_information":[{"code":"95060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test one limb","code_information":[{"code":"95860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test 2 limbs","code_information":[{"code":"95861","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test larynx","code_information":[{"code":"95865","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test nonparaspinal","code_information":[{"code":"95870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Quan puplmtry phy/qhp uni/bi","code_information":[{"code":"95919","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Autonomic nrv adrenrg inervj","code_information":[{"code":"95922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Autonomic nrv syst funj test","code_information":[{"code":"95923","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Analyze neurostim no prog","code_information":[{"code":"95970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Psycl/nrpsyc tst phy/qhp 1st","code_information":[{"code":"96136","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Phlebotomy","code_information":[{"code":"99195","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Extrnl counterpulse, per tx","code_information":[{"code":"G0166","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":138.94,"maximum":253.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":253.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":155.61,"additional_payer_notes":"APC"}]}]},{"description":"Njx platelet plasma","code_information":[{"code":"0232T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.5,"maximum":851.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":485.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":466.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":480.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":499.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":475.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":851.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":494.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":498.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":522.49,"additional_payer_notes":"APC"}]}]},{"description":"Njx autol wbc concentrate","code_information":[{"code":"0481T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.5,"maximum":851.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":485.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":466.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":480.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":499.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":475.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":851.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":494.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":498.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":522.49,"additional_payer_notes":"APC"}]}]},{"description":"Cryotherapy oral cavity","code_information":[{"code":"0881T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.5,"maximum":851.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":485.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":466.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":480.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":499.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":475.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":851.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":494.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":498.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":522.49,"additional_payer_notes":"APC"}]}]},{"description":"Implant hormone pellet(s)","code_information":[{"code":"11980","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.5,"maximum":851.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":485.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":466.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":480.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":499.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":475.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":851.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":494.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":498.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":522.49,"additional_payer_notes":"APC"}]}]},{"description":"Remove drug implant device","code_information":[{"code":"11982","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.5,"maximum":851.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":485.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":466.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":480.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":499.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":475.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":851.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":494.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":498.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":522.49,"additional_payer_notes":"APC"}]}]},{"description":"Remove/insert drug implant","code_information":[{"code":"11983","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.5,"maximum":851.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":485.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":466.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":480.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":499.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":475.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":851.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":494.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":498.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":522.49,"additional_payer_notes":"APC"}]}]},{"description":"Test for blood flow in graft","code_information":[{"code":"15860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.5,"maximum":851.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":485.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":466.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":480.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":499.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":475.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":851.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":494.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":498.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":522.49,"additional_payer_notes":"APC"}]}]},{"description":"Removal of fixation device","code_information":[{"code":"20665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.5,"maximum":851.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":485.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":466.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":480.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":499.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":475.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":851.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":494.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":498.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":522.49,"additional_payer_notes":"APC"}]}]},{"description":"Vein access cutdown > 1 yr","code_information":[{"code":"36425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.5,"maximum":851.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":485.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":466.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":480.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":499.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":475.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":851.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":494.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":498.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":522.49,"additional_payer_notes":"APC"}]}]},{"description":"Insert needle bone cavity","code_information":[{"code":"36680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.5,"maximum":851.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":485.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":466.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":480.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":499.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":475.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":851.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":494.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":498.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":522.49,"additional_payer_notes":"APC"}]}]},{"description":"Repair tongue laceration","code_information":[{"code":"41250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.5,"maximum":851.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":485.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":466.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":480.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":499.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":475.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":851.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":494.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":498.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":522.49,"additional_payer_notes":"APC"}]}]},{"description":"Remove pharynx foreign body","code_information":[{"code":"42809","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.5,"maximum":851.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":485.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":466.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":480.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":499.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":475.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":851.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":494.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":498.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":522.49,"additional_payer_notes":"APC"}]}]},{"description":"Nasal/orogastric w/tube plmt","code_information":[{"code":"43752","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.5,"maximum":851.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":485.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":466.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":480.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":499.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":475.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":851.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":494.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":498.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":522.49,"additional_payer_notes":"APC"}]}]},{"description":"Diagnostic anoscopy","code_information":[{"code":"46601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.5,"maximum":851.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":485.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":466.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":480.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":499.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":475.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":851.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":494.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":498.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":522.49,"additional_payer_notes":"APC"}]}]},{"description":"Remove foreign body from eye","code_information":[{"code":"65210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.5,"maximum":851.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":485.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":466.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":480.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":499.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":475.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":851.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":494.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":498.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":522.49,"additional_payer_notes":"APC"}]}]},{"description":"Remove foreign body from eye","code_information":[{"code":"65220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.5,"maximum":851.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":485.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":466.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":480.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":499.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":475.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":851.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":494.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":498.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":522.49,"additional_payer_notes":"APC"}]}]},{"description":"Corneal smear","code_information":[{"code":"65430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.5,"maximum":851.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":485.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":466.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":480.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":499.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":475.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":851.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":494.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":498.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":522.49,"additional_payer_notes":"APC"}]}]},{"description":"Treat eyelid by injection","code_information":[{"code":"68200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.5,"maximum":851.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":485.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":466.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":480.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":499.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":475.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":851.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":494.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":498.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":522.49,"additional_payer_notes":"APC"}]}]},{"description":"Dilate tear duct opening","code_information":[{"code":"68801","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.5,"maximum":851.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":485.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":466.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":480.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":499.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":475.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":851.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":494.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":498.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":522.49,"additional_payer_notes":"APC"}]}]},{"description":"Rbc serum pretx incubj drugs","code_information":[{"code":"86975","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.5,"maximum":851.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":485.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":466.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":480.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":499.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":475.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":851.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":494.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":498.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":522.49,"additional_payer_notes":"APC"}]}]},{"description":"Dark adaptation eye exam","code_information":[{"code":"92284","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.5,"maximum":851.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":485.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":466.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":480.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":499.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":475.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":851.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":494.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":498.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":522.49,"additional_payer_notes":"APC"}]}]},{"description":"Contact lens fitting","code_information":[{"code":"92311","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.5,"maximum":851.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":485.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":466.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":480.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":499.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":475.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":851.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":494.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":498.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":522.49,"additional_payer_notes":"APC"}]}]},{"description":"Cardiac drug stress test","code_information":[{"code":"93024","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.5,"maximum":851.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":485.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":466.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":480.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":499.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":475.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":851.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":494.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":498.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":522.49,"additional_payer_notes":"APC"}]}]},{"description":"Patient recorded spirometry","code_information":[{"code":"94014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.5,"maximum":851.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":485.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":466.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":480.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":499.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":475.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":851.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":494.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":498.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":522.49,"additional_payer_notes":"APC"}]}]},{"description":"Rapid desensitization","code_information":[{"code":"95180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.5,"maximum":851.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":485.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":466.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":480.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":499.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":475.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":851.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":494.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":498.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":522.49,"additional_payer_notes":"APC"}]}]},{"description":"Motor &/ sens nrve cndj test","code_information":[{"code":"95905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.5,"maximum":851.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":485.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":466.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":480.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":499.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":475.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":851.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":494.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":498.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":522.49,"additional_payer_notes":"APC"}]}]},{"description":"Psycl/nrpsyc tech 1st","code_information":[{"code":"96138","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.5,"maximum":851.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":485.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":466.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":480.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":499.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":475.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":851.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":494.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":498.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":522.49,"additional_payer_notes":"APC"}]}]},{"description":"Insert drug del implant, >4","code_information":[{"code":"G0516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.5,"maximum":851.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":485.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":466.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":480.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":499.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":475.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":851.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":494.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":498.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":522.49,"additional_payer_notes":"APC"}]}]},{"description":"Remove drug implant","code_information":[{"code":"G0517","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.5,"maximum":851.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":485.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":466.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":480.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":499.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":475.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":851.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":494.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":498.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":522.49,"additional_payer_notes":"APC"}]}]},{"description":"Remove w insert drug implant","code_information":[{"code":"G0518","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.5,"maximum":851.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":485.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":466.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":480.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":499.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":475.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":851.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":494.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":498.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":522.49,"additional_payer_notes":"APC"}]}]},{"description":"Cardiac rehab","code_information":[{"code":"93797","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.62,"maximum":245.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":140.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.62,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.04,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.69,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.9,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.77,"additional_payer_notes":"APC"}]}]},{"description":"Cardiac rehab/monitor","code_information":[{"code":"93798","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.62,"maximum":245.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":140.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.62,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.04,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.69,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.9,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.77,"additional_payer_notes":"APC"}]}]},{"description":"Intens cardiac rehab w/exerc","code_information":[{"code":"G0422","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.62,"maximum":245.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":140.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.62,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.04,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.69,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.9,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.77,"additional_payer_notes":"APC"}]}]},{"description":"Intens cardiac rehab no exer","code_information":[{"code":"G0423","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.62,"maximum":245.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":140.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.62,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.04,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":245.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.69,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.9,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.77,"additional_payer_notes":"APC"}]}]},{"description":"Temporary external pacing","code_information":[{"code":"92953","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":690.21,"maximum":1260.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":717.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":690.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":710.92,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":738.52,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":704.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1260.32,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":731.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":737.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":773.04,"additional_payer_notes":"APC"}]}]},{"description":"Cardioversion electric ext","code_information":[{"code":"92960","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":690.21,"maximum":1260.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":717.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":690.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":710.92,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":738.52,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":704.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1260.32,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":731.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":737.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":773.04,"additional_payer_notes":"APC"}]}]},{"description":"Cardioversion electric int","code_information":[{"code":"92961","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":690.21,"maximum":1260.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":717.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":690.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":710.92,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":738.52,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":704.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1260.32,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":731.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":737.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":773.04,"additional_payer_notes":"APC"}]}]},{"description":"Nb resuscitation","code_information":[{"code":"99465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":690.21,"maximum":1260.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":717.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":690.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":710.92,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":738.52,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":704.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1260.32,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":731.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":737.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":773.04,"additional_payer_notes":"APC"}]}]},{"description":"Clearance of airways","code_information":[{"code":"31720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.67,"maximum":417.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":237.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.67,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":235.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":244.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":233.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":417.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":242.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":244.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":256.11,"additional_payer_notes":"APC"}]}]},{"description":"Surfactant Admin Thru Tube","code_information":[{"code":"94610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.67,"maximum":417.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":237.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.67,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":235.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":244.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":233.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":417.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":242.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":244.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":256.11,"additional_payer_notes":"APC"}]}]},{"description":"Airway inhalation treatment","code_information":[{"code":"94640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.67,"maximum":417.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":237.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.67,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":235.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":244.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":233.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":417.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":242.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":244.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":256.11,"additional_payer_notes":"APC"}]}]},{"description":"Aerosol inhalation treatment","code_information":[{"code":"94642","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.67,"maximum":417.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":237.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.67,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":235.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":244.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":233.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":417.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":242.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":244.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":256.11,"additional_payer_notes":"APC"}]}]},{"description":"Pos airway pressure cpap","code_information":[{"code":"94660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.67,"maximum":417.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":237.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.67,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":235.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":244.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":233.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":417.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":242.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":244.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":256.11,"additional_payer_notes":"APC"}]}]},{"description":"Evaluate pt use of inhaler","code_information":[{"code":"94664","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.67,"maximum":417.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":237.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.67,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":235.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":244.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":233.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":417.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":242.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":244.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":256.11,"additional_payer_notes":"APC"}]}]},{"description":"Mechanical chest wall oscill","code_information":[{"code":"94669","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":228.67,"maximum":417.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":237.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":228.67,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":235.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":244.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":233.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":417.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":242.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":244.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":256.11,"additional_payer_notes":"APC"}]}]},{"description":"Miscellaneous M >=66.50","code_information":[{"code":"A2001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Miscellaneous M >=55.50 and M <66.50","code_information":[{"code":"A2002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Miscellaneous M <46.50 and A <77.50","code_information":[{"code":"A2005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Novosorb synpath per sq cm","code_information":[{"code":"A2006","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Restrata, per sq cm","code_information":[{"code":"A2007","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Theragenesis, per sq cm","code_information":[{"code":"A2008","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Symphony, per sq cm","code_information":[{"code":"A2009","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Apis, per square centimeter","code_information":[{"code":"A2010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Supra sdrm, per sq cm","code_information":[{"code":"A2011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Suprathel, per sq cm","code_information":[{"code":"A2012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Innovamatrix fs, per sq cm","code_information":[{"code":"A2013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Phoenix wnd mtrx, per sq cm","code_information":[{"code":"A2015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Permeaderm b, per sq cm","code_information":[{"code":"A2016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Permeaderm c, per sq cm","code_information":[{"code":"A2018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Kerecis marigen shld sq cm","code_information":[{"code":"A2019","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Neomatrix per sq cm","code_information":[{"code":"A2021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Innovabrn/innovamatx xl sqcm","code_information":[{"code":"A2022","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Resolve matrix per sq cm","code_information":[{"code":"A2024","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Miro3d per cubic cm","code_information":[{"code":"A2025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Matriderm per sq cm","code_information":[{"code":"A2027","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Mirotract matrix sheet","code_information":[{"code":"A2029","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Mirodry, per sq cm","code_information":[{"code":"A2031","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Myriad matrix, per sq cm","code_information":[{"code":"A2032","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Found drs solo, per sq cm","code_information":[{"code":"A2034","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Cohealyx col dml mx pr sq cm","code_information":[{"code":"A2036","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Marigen pacto, per sq cm","code_information":[{"code":"A2038","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Innovamatrix fd, per sq cm","code_information":[{"code":"A2039","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Microlyte painguard pr sq cm","code_information":[{"code":"A2040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Foundation drs+ duo pr sq cm","code_information":[{"code":"A2041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Foundation drs+ solo, sq cm","code_information":[{"code":"A2042","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Biobrane, per sq cm","code_information":[{"code":"A2043","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Novashield/novogen pr sq cm","code_information":[{"code":"A2045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Integra Meshed Bil Wound Mat","code_information":[{"code":"C9363","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Oasis wound matrix","code_information":[{"code":"Q4102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Oasis burn matrix","code_information":[{"code":"Q4103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Integra bmwd","code_information":[{"code":"Q4104","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Graftjacket","code_information":[{"code":"Q4107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Primatrix","code_information":[{"code":"Q4110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Gammagraft","code_information":[{"code":"Q4111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Alloderm","code_information":[{"code":"Q4116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Hyalomatrix","code_information":[{"code":"Q4117","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Dermacell","code_information":[{"code":"Q4122","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Oasis tri-layer wound matrix","code_information":[{"code":"Q4124","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Talymed","code_information":[{"code":"Q4127","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Strattice TM","code_information":[{"code":"Q4130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Mediskin","code_information":[{"code":"Q4135","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"EZderm","code_information":[{"code":"Q4136","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Tensix, 1cm","code_information":[{"code":"Q4146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Marigen 1 square cm","code_information":[{"code":"Q4158","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Bio-connekt per square cm","code_information":[{"code":"Q4161","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Helicoll, per square cm","code_information":[{"code":"Q4164","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Keramatrix, per square cm","code_information":[{"code":"Q4165","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Cytal, per square centimeter","code_information":[{"code":"Q4166","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Miroderm","code_information":[{"code":"Q4175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Puraply 1 sq cm","code_information":[{"code":"Q4195","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Puraply am 1 sq cm","code_information":[{"code":"Q4196","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Puraply xt 1 sq cm","code_information":[{"code":"Q4197","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Genesis amnio membrane 1sqcm","code_information":[{"code":"Q4198","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Matrion 1 sq cm","code_information":[{"code":"Q4201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Derma-gide, 1 sq cm","code_information":[{"code":"Q4203","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Progenamatrix, per sq cm","code_information":[{"code":"Q4222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Amniobind, per sq cm","code_information":[{"code":"Q4225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Corplex, per sq cm","code_information":[{"code":"Q4232","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Orion, per sq cm","code_information":[{"code":"Q4276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Cygnus dual per sq cm","code_information":[{"code":"Q4282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"Emerge matrix, per sq cm","code_information":[{"code":"Q4297","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"510(k) skin subs, nos","code_information":[{"code":"Q4432","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.95,"maximum":237.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":237.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.55,"additional_payer_notes":"APC"}]}]},{"description":"RBC, l/r, cmv-neg, irrad","code_information":[{"code":"P9058","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.4,"maximum":455.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":259.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":249.4,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.86,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":455.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":264.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.33,"additional_payer_notes":"APC"}]}]},{"description":"Platelets, pathogen reduced","code_information":[{"code":"P9073","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":607.43,"maximum":1109.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":631.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":607.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":625.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":649.95,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":619.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1109.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":643.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":649.34,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":680.32,"additional_payer_notes":"APC"}]}]},{"description":"Rbc dna hea 35 ag 11 bld grp","code_information":[{"code":"0001U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":720.0,"maximum":1314.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":748.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":720.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":741.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":770.4,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":734.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1314.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":763.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.68,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":806.4,"additional_payer_notes":"APC"}]}]},{"description":"Liver dis 10 assays w/ash","code_information":[{"code":"0002M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":503.4,"maximum":919.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":523.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":503.4,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":518.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":538.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":513.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":919.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":533.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":538.13,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":563.81,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct 3 ur metab alg plp","code_information":[{"code":"0002U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.0,"maximum":45.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.75,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":45.65,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.5,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.72,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.0,"additional_payer_notes":"APC"}]}]},{"description":"Liver dis 10 assays w/nash","code_information":[{"code":"0003M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":503.4,"maximum":919.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":523.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":503.4,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":518.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":538.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":513.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":919.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":533.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":538.13,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":563.81,"additional_payer_notes":"APC"}]}]},{"description":"Onc ovar 5 prtn ser alg scor","code_information":[{"code":"0003U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":950.0,"maximum":1734.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":950.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":978.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1016.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":969.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1734.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1007.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1015.55,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1064.0,"additional_payer_notes":"APC"}]}]},{"description":"Scoliosis dna alys","code_information":[{"code":"0004M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":79.0,"maximum":144.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":82.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":81.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":84.53,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":80.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":144.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":83.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":84.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":88.48,"additional_payer_notes":"APC"}]}]},{"description":"Onco prst8 3 gene ur alg","code_information":[{"code":"0005U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1387.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1387.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":812.44,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":851.2,"additional_payer_notes":"APC"}]}]},{"description":"Onc hep gene risk classifier","code_information":[{"code":"0006M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":150.0,"maximum":273.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":156.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":150.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":160.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":153.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":273.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":159.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":160.35,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":168.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc gastro 51 gene nomogram","code_information":[{"code":"0007M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":375.0,"maximum":684.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":390.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":375.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":401.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":382.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":684.75,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.5,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":400.88,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":420.0,"additional_payer_notes":"APC"}]}]},{"description":"Rx test prsmv ur w/def conf","code_information":[{"code":"0007U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":114.43,"maximum":208.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":119.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":114.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":117.86,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.44,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":116.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":208.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":121.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.33,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":128.16,"additional_payer_notes":"APC"}]}]},{"description":"Hpylori detcj abx rstnc dna","code_information":[{"code":"0008U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":597.91,"maximum":1091.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":621.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":597.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":615.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":639.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":609.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1091.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":633.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":639.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":669.66,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst ca erbb2 amp/nonamp","code_information":[{"code":"0009U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":107.0,"maximum":195.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":111.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":107.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":110.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":114.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":109.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":195.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":113.42,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":114.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":119.84,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds strn typ whl gen seq","code_information":[{"code":"0010U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":427.26,"maximum":780.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":444.35,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":427.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":440.08,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":457.17,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":435.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":780.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":452.9,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":456.74,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":478.53,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 ca mrna 12 gen alg","code_information":[{"code":"0011M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1387.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1387.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":812.44,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":851.2,"additional_payer_notes":"APC"}]}]},{"description":"Rx mntr lc-ms/ms oral fluid","code_information":[{"code":"0011U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":114.43,"maximum":208.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":119.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":114.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":117.86,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.44,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":116.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":208.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":121.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.33,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":128.16,"additional_payer_notes":"APC"}]}]},{"description":"Adrnl cortcl tum bchm asy 25","code_information":[{"code":"0015M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1305.37,"maximum":2383.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1357.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1305.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1344.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1396.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1331.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2383.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1383.69,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1395.44,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1462.01,"additional_payer_notes":"APC"}]}]},{"description":"Onc bladder mrna 209 gen alg","code_information":[{"code":"0016M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3489.63,"maximum":6372.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3629.22,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3489.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3594.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3733.9,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3559.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6372.06,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3699.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3730.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3908.39,"additional_payer_notes":"APC"}]}]},{"description":"Onc hmtlmf neo rna bcr/abl1","code_information":[{"code":"0016U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":163.96,"maximum":299.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":170.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":163.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":168.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":175.44,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":167.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":299.39,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":173.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":175.27,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":183.64,"additional_payer_notes":"APC"}]}]},{"description":"Onc dlbcl mrna 20 genes alg","code_information":[{"code":"0017M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2510.21,"maximum":4583.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2610.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2510.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2585.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2685.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2560.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":4583.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2660.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2683.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2811.44,"additional_payer_notes":"APC"}]}]},{"description":"Onc hmtlmf neo jak2 mut dna","code_information":[{"code":"0017U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":91.66,"maximum":167.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":95.33,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91.66,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":94.41,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":98.08,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":167.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":97.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":102.66,"additional_payer_notes":"APC"}]}]},{"description":"Trnsplj rnl meas cd154+cll","code_information":[{"code":"0018M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":640.73,"maximum":1169.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":666.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":640.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":659.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":685.58,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":653.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1169.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":679.17,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":684.94,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":717.62,"additional_payer_notes":"APC"}]}]},{"description":"Onc thyr 10 microrna seq alg","code_information":[{"code":"0018U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3002.09,"maximum":5481.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3122.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3002.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3092.15,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3212.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3062.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5481.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3182.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3209.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3362.34,"additional_payer_notes":"APC"}]}]},{"description":"Cv ds plasma alys prtn bmrk","code_information":[{"code":"0019M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":712.4,"maximum":1300.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":740.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":712.4,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":733.77,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":762.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":726.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1300.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":755.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":761.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":797.89,"additional_payer_notes":"APC"}]}]},{"description":"Onc rna tiss predict alg","code_information":[{"code":"0019U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3675.0,"maximum":6710.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3822.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3675.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3785.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3932.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3748.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6710.55,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3895.5,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3928.58,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4116.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 detcj 8 autoantb","code_information":[{"code":"0021U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1387.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1387.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":812.44,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":851.2,"additional_payer_notes":"APC"}]}]},{"description":"Trgt gen seq dna&rna 23 gene","code_information":[{"code":"0022U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1950.0,"maximum":3560.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2028.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1950.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2008.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2086.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1989.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3560.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2067.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.55,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2184.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc aml dna detcj/nondetcj","code_information":[{"code":"0023U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":248.51,"maximum":453.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":258.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":248.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":255.97,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":265.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":253.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":453.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":263.42,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":265.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":278.33,"additional_payer_notes":"APC"}]}]},{"description":"Glyca nuc mr spectrsc quan","code_information":[{"code":"0024U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34.19,"maximum":62.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.22,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.58,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.55,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38.29,"additional_payer_notes":"APC"}]}]},{"description":"Tenofovir liq chrom ur quan","code_information":[{"code":"0025U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":114.43,"maximum":208.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":119.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":114.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":117.86,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.44,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":116.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":208.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":121.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.33,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":128.16,"additional_payer_notes":"APC"}]}]},{"description":"Onc thyr dna&mrna 112 genes","code_information":[{"code":"0026U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3600.0,"maximum":6573.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3744.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3600.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3708.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3852.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3672.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6573.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3816.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4032.0,"additional_payer_notes":"APC"}]}]},{"description":"Jak2 gene trgt seq alys","code_information":[{"code":"0027U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":121.91,"maximum":222.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":126.79,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":121.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":125.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":130.44,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":124.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":222.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":129.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":130.32,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":136.54,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab warf trgt seq alys","code_information":[{"code":"0030U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.13,"maximum":244.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.13,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.15,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.52,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":136.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":244.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.23,"additional_payer_notes":"APC"}]}]},{"description":"Comt gene","code_information":[{"code":"0032U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.81,"maximum":319.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":180.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":178.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":319.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":185.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":186.87,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.79,"additional_payer_notes":"APC"}]}]},{"description":"Tpmt nudt15 genes","code_information":[{"code":"0034U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.17,"maximum":851.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":484.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":466.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":480.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":498.8,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":475.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":851.23,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":494.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":498.34,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":522.11,"additional_payer_notes":"APC"}]}]},{"description":"Neuro csf prion prtn qual","code_information":[{"code":"0035U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":540.99,"maximum":987.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":562.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":540.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":557.22,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":578.86,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":551.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":987.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":573.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":578.32,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":605.91,"additional_payer_notes":"APC"}]}]},{"description":"Xome tum & nml spec seq alys","code_information":[{"code":"0036U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4780.0,"maximum":8728.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4971.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4780.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4923.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5114.6,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4875.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":8728.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5066.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5109.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5353.6,"additional_payer_notes":"APC"}]}]},{"description":"Trgt gen seq dna 324 genes","code_information":[{"code":"0037U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3500.0,"maximum":6391.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3640.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3500.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3605.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3745.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3570.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6391.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3710.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3741.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3920.0,"additional_payer_notes":"APC"}]}]},{"description":"Vitamin d srm microsamp quan","code_information":[{"code":"0038U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.6,"maximum":54.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.49,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":54.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.15,"additional_payer_notes":"APC"}]}]},{"description":"Dna antb 2strand hi avidity","code_information":[{"code":"0039U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.74,"maximum":25.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.74,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.15,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.39,"additional_payer_notes":"APC"}]}]},{"description":"Bcr/abl1 gene major bp quan","code_information":[{"code":"0040U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":409.9,"maximum":748.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":426.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":409.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":422.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":438.59,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":418.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":748.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":434.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":438.18,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":459.09,"additional_payer_notes":"APC"}]}]},{"description":"B brgdrferi antb 5 prtn igm","code_information":[{"code":"0041U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.21,"maximum":31.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.41,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":31.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.28,"additional_payer_notes":"APC"}]}]},{"description":"B brgdrferi antb 12 prtn igg","code_information":[{"code":"0042U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.21,"maximum":31.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.41,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":31.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.28,"additional_payer_notes":"APC"}]}]},{"description":"Tbrf b grp antb 4 prtn igm","code_information":[{"code":"0043U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.86,"maximum":27.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.31,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.9,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.64,"additional_payer_notes":"APC"}]}]},{"description":"Tbrf b grp antb 4 prtn igg","code_information":[{"code":"0044U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.86,"maximum":27.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.31,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.9,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.64,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst dux carc is 12 gene","code_information":[{"code":"0045U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3873.0,"maximum":7072.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4027.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3989.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3950.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7072.1,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4105.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4140.24,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4337.76,"additional_payer_notes":"APC"}]}]},{"description":"Flt3 gene itd variants quan","code_information":[{"code":"0046U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":407.43,"maximum":743.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":423.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":407.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":419.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":435.95,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":415.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":743.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":431.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":435.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":456.32,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 mrna 17 gene alg","code_information":[{"code":"0047U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3873.0,"maximum":7072.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4027.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3989.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3950.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7072.1,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4105.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4140.24,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4337.76,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld org neo dna 468 gene","code_information":[{"code":"0048U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":5331.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3036.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3123.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5331.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3121.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3269.95,"additional_payer_notes":"APC"}]}]},{"description":"Npm1 gene analysis quan","code_information":[{"code":"0049U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":407.43,"maximum":743.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":423.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":407.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":419.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":435.95,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":415.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":743.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":431.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":435.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":456.32,"additional_payer_notes":"APC"}]}]},{"description":"Trgt gen seq dna 194 genes","code_information":[{"code":"0050U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2916.6,"maximum":5325.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3033.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2916.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3004.1,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3120.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2974.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5325.71,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3091.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3117.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3266.59,"additional_payer_notes":"APC"}]}]},{"description":"Rx mntr lc-ms/ms ur 31 pnl","code_information":[{"code":"0051U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":246.92,"maximum":450.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":256.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":246.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":251.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":450.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":261.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":263.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":276.55,"additional_payer_notes":"APC"}]}]},{"description":"Lpoprtn bld w/5 maj classes","code_information":[{"code":"0052U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.86,"maximum":61.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35.21,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":61.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.2,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.92,"additional_payer_notes":"APC"}]}]},{"description":"Rx mntr 14+ drugs & sbsts","code_information":[{"code":"0054U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":198.74,"maximum":362.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":206.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":198.74,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":204.7,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":212.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":202.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":362.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":210.66,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":212.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":222.59,"additional_payer_notes":"APC"}]}]},{"description":"Card hrt trnspl 96 dna seq","code_information":[{"code":"0055U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3240.0,"maximum":5916.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3369.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3240.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3337.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3466.8,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3304.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5916.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3434.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3463.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3628.8,"additional_payer_notes":"APC"}]}]},{"description":"Onc merkel cll carc srm quan","code_information":[{"code":"0058U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":322.96,"maximum":589.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":335.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":322.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":332.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":345.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":329.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":589.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":342.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":345.24,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":361.72,"additional_payer_notes":"APC"}]}]},{"description":"Onc merkel cll carc srm +/-","code_information":[{"code":"0059U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":322.96,"maximum":589.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":335.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":322.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":332.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":345.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":329.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":589.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":342.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":345.24,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":361.72,"additional_payer_notes":"APC"}]}]},{"description":"Twn zyg gen seq alys chrms2","code_information":[{"code":"0060U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":759.05,"maximum":1386.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":789.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":759.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.82,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":812.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":774.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1386.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":804.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":811.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":850.14,"additional_payer_notes":"APC"}]}]},{"description":"Tc meas 5 bmrk sfdi m-s alys","code_information":[{"code":"0061U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.1,"maximum":45.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.1,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.1,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.86,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":45.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.11,"additional_payer_notes":"APC"}]}]},{"description":"Ai sle igg&igm alys 80 bmrk","code_information":[{"code":"0062U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":380.72,"maximum":695.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":395.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":380.72,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":392.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":407.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":388.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":695.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":403.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":406.99,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":426.41,"additional_payer_notes":"APC"}]}]},{"description":"Neuro autism 32 amines alg","code_information":[{"code":"0063U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":750.0,"maximum":1369.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":780.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":750.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":772.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":765.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1369.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":795.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":801.75,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":840.0,"additional_payer_notes":"APC"}]}]},{"description":"Antb tp total&rpr ia qual","code_information":[{"code":"0064U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":31.33,"maximum":57.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.52,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":57.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.49,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"}]}]},{"description":"Syfls tst nontreponemal antb","code_information":[{"code":"0065U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.09,"maximum":33.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.63,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.36,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.34,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.26,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst imhchem prfl 4 bmrk","code_information":[{"code":"0067U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1897.0,"maximum":3463.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1972.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1897.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1953.91,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2029.79,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1934.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3463.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2010.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2027.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2124.64,"additional_payer_notes":"APC"}]}]},{"description":"Candida species pnl amp prb","code_information":[{"code":"0068U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.63,"maximum":260.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":146.91,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":152.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":145.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":260.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":151.19,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":152.47,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":159.75,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct microrna mir-31-3p","code_information":[{"code":"0069U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":380.0,"maximum":693.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":395.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":380.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":391.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":406.6,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":387.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":693.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":402.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":406.22,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":425.6,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2d6 gen com&slct rar vrnt","code_information":[{"code":"0070U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.37,"maximum":1235.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":703.42,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":676.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":696.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":723.72,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":689.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1235.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":716.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":723.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":757.53,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2d6 full gene sequence","code_information":[{"code":"0071U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":600.0,"maximum":1095.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":624.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":600.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":618.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":642.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":612.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1095.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":636.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":641.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":672.0,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2d6 gen cyp2d6-2d7 hybrid","code_information":[{"code":"0072U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":450.91,"maximum":823.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":468.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":450.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":464.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":482.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":459.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":823.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":477.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":482.02,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":505.02,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2d6 gen cyp2d7-2d6 hybrid","code_information":[{"code":"0073U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":450.91,"maximum":823.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":468.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":450.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":464.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":482.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":459.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":823.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":477.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":482.02,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":505.02,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2d6 nonduplicated gene","code_information":[{"code":"0074U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":450.91,"maximum":823.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":468.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":450.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":464.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":482.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":459.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":823.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":477.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":482.02,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":505.02,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2d6 5' gene dup/mlt","code_information":[{"code":"0075U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":450.91,"maximum":823.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":468.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":450.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":464.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":482.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":459.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":823.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":477.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":482.02,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":505.02,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2d6 3' gene dup/mlt","code_information":[{"code":"0076U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":450.91,"maximum":823.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":468.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":450.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":464.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":482.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":459.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":823.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":477.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":482.02,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":505.02,"additional_payer_notes":"APC"}]}]},{"description":"Ig paraprotein qual bld/ur","code_information":[{"code":"0077U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":43.43,"maximum":79.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":79.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":46.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46.43,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48.64,"additional_payer_notes":"APC"}]}]},{"description":"Onc lng 5 clin rsk factr alg","code_information":[{"code":"0080U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3520.0,"maximum":6427.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3660.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3520.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3625.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3766.4,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3590.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6427.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3731.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3762.88,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3942.4,"additional_payer_notes":"APC"}]}]},{"description":"Rx test def 90+ rx/sbsts ur","code_information":[{"code":"0082U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":246.92,"maximum":450.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":256.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":246.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":251.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":450.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":261.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":263.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":276.55,"additional_payer_notes":"APC"}]}]},{"description":"Onc rspse chemo cntrst tomog","code_information":[{"code":"0083U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.35,"maximum":305.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":174.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":167.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":172.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":179.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":170.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":305.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":177.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":178.9,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":187.43,"additional_payer_notes":"APC"}]}]},{"description":"Rbc dna gnotyp 10 bld groups","code_information":[{"code":"0084U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":720.0,"maximum":1314.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":748.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":720.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":741.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":770.4,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":734.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1314.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":763.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.68,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":806.4,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bact&fng org id 6+","code_information":[{"code":"0086U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":200.0,"maximum":365.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":208.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":200.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":206.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":214.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":204.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":365.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":212.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":213.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.0,"additional_payer_notes":"APC"}]}]},{"description":"Crd hrt trnspl mrna 1283 gen","code_information":[{"code":"0087U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3159.42,"maximum":5769.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3285.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3159.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3254.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3380.58,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3222.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5769.1,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3348.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3377.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3538.55,"additional_payer_notes":"APC"}]}]},{"description":"Trnsplj kdn algrft rej 1494","code_information":[{"code":"0088U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3159.42,"maximum":5769.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3285.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3159.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3254.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3380.58,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3222.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5769.1,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3348.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3377.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3538.55,"additional_payer_notes":"APC"}]}]},{"description":"Onc mlnma prame & linc00518","code_information":[{"code":"0089U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1387.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1387.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":812.44,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":851.2,"additional_payer_notes":"APC"}]}]},{"description":"Onc cutan mlnma mrna 23 gene","code_information":[{"code":"0090U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1950.0,"maximum":3560.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2028.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1950.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2008.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2086.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1989.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3560.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2067.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.55,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2184.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc lng 3 prtn bmrk plsm alg","code_information":[{"code":"0092U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2488.0,"maximum":4543.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2587.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2488.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2562.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2662.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2537.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":4543.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2637.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2659.67,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2786.56,"additional_payer_notes":"APC"}]}]},{"description":"Rx mntr 65 com drugs urine","code_information":[{"code":"0093U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":62.14,"maximum":113.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":64.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":66.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":113.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.87,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":66.43,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.6,"additional_payer_notes":"APC"}]}]},{"description":"Genome rapid sequence alys","code_information":[{"code":"0094U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7582.2,"maximum":13845.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7885.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7582.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7809.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8112.95,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7733.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13845.1,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8037.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8105.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8492.06,"additional_payer_notes":"APC"}]}]},{"description":"Inflm ee elisa alys alg","code_information":[{"code":"0095U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":771.98,"maximum":1409.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":795.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":826.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":787.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1409.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":818.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":825.25,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":864.62,"additional_payer_notes":"APC"}]}]},{"description":"Hpv hi risk types male urine","code_information":[{"code":"0096U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Hered colon ca do 15 genes","code_information":[{"code":"0101U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1743.95,"maximum":3184.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1813.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1743.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1796.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1866.03,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1778.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3184.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1848.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1864.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1953.22,"additional_payer_notes":"APC"}]}]},{"description":"Hered brst ca rltd do 17 gen","code_information":[{"code":"0102U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1303.95,"maximum":2381.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1356.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1303.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1343.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1395.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1330.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2381.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1382.19,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1393.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1460.42,"additional_payer_notes":"APC"}]}]},{"description":"Hered ova ca pnl 24 genes","code_information":[{"code":"0103U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1743.95,"maximum":3184.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1813.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1743.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1796.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1866.03,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1778.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3184.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1848.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1864.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1953.22,"additional_payer_notes":"APC"}]}]},{"description":"Neph ckd mult eclia tum nec","code_information":[{"code":"0105U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":950.0,"maximum":1734.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":950.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":978.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1016.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":969.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1734.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1007.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1015.55,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1064.0,"additional_payer_notes":"APC"}]}]},{"description":"Gstr emptg 7 timed brth spec","code_information":[{"code":"0106U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":874.49,"maximum":1596.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":909.47,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":874.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":900.72,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":935.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":891.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1596.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":926.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":934.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":979.43,"additional_payer_notes":"APC"}]}]},{"description":"C diff tox ag detcj ia stool","code_information":[{"code":"0107U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.0,"maximum":29.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.48,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.12,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":29.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.92,"additional_payer_notes":"APC"}]}]},{"description":"Gi barrett esoph 9 prtn bmrk","code_information":[{"code":"0108U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4950.0,"maximum":9038.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5148.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4950.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5098.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5296.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5049.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9038.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5247.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5291.55,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5544.0,"additional_payer_notes":"APC"}]}]},{"description":"Id aspergillus dna 4 species","code_information":[{"code":"0109U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.63,"maximum":260.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":146.91,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":152.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":145.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":260.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":151.19,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":152.47,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":159.75,"additional_payer_notes":"APC"}]}]},{"description":"Rx mntr 1+oral onc rx&sbsts","code_information":[{"code":"0110U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.11,"maximum":49.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.19,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.11,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.01,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":49.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.36,"additional_payer_notes":"APC"}]}]},{"description":"Onc colon ca kras&nras alys","code_information":[{"code":"0111U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":682.29,"maximum":1245.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":709.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":682.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":702.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":730.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":695.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1245.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":723.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":729.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":764.16,"additional_payer_notes":"APC"}]}]},{"description":"Iadi 16s&18s rrna genes","code_information":[{"code":"0112U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.13,"maximum":650.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":370.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":356.13,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":366.81,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":381.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":363.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":650.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":377.5,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":380.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":398.87,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 pca3&tmprss2-erg","code_information":[{"code":"0113U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1387.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1387.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":812.44,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":851.2,"additional_payer_notes":"APC"}]}]},{"description":"Gi barretts esoph vim&ccna1","code_information":[{"code":"0114U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1938.01,"maximum":3538.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2015.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1938.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1996.15,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2073.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1976.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3538.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2054.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2071.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2170.57,"additional_payer_notes":"APC"}]}]},{"description":"Respir iadna 18 viral&2 bact","code_information":[{"code":"0115U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":275.35,"maximum":502.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":286.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":275.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":283.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":280.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":502.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":291.87,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.35,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":308.39,"additional_payer_notes":"APC"}]}]},{"description":"Rx mntr nzm ia 35+oral flu","code_information":[{"code":"0116U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":246.92,"maximum":450.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":256.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":246.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":251.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":450.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":261.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":263.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":276.55,"additional_payer_notes":"APC"}]}]},{"description":"Pain mgmt 11 endogenous anal","code_information":[{"code":"0117U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":840.65,"maximum":1535.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":874.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.65,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":865.87,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":899.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":857.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1535.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":891.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":898.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":941.53,"additional_payer_notes":"APC"}]}]},{"description":"Trnsplj don-drv cll-fr dna","code_information":[{"code":"0118U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.25,"maximum":5027.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2863.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2753.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2835.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2945.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2808.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5027.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2918.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2943.22,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3083.64,"additional_payer_notes":"APC"}]}]},{"description":"Crd ceramides liq chrom plsm","code_information":[{"code":"0119U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.76,"maximum":152.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":87.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83.76,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":86.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":89.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":85.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":152.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":88.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":89.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":93.81,"additional_payer_notes":"APC"}]}]},{"description":"Onc b cll lymphm mrna 58 gen","code_information":[{"code":"0120U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2510.21,"maximum":4583.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2610.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2510.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2585.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2685.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2560.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":4583.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2660.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2683.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2811.44,"additional_payer_notes":"APC"}]}]},{"description":"Sc dis vcam-1 whole blood","code_information":[{"code":"0121U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":509.2,"maximum":929.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":529.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":509.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":524.48,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":544.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":519.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":929.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":539.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":544.33,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":570.3,"additional_payer_notes":"APC"}]}]},{"description":"Sc dis p-selectin whl blood","code_information":[{"code":"0122U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":526.23,"maximum":960.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":547.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":526.23,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":542.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":563.07,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":536.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":960.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":557.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":562.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":589.38,"additional_payer_notes":"APC"}]}]},{"description":"Mchnl fragility rbc prflg","code_information":[{"code":"0123U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":357.63,"maximum":653.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":371.94,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":357.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":368.36,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":382.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":364.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":653.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":379.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":382.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":400.55,"additional_payer_notes":"APC"}]}]},{"description":"Hered brst ca rltd do panel","code_information":[{"code":"0129U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1303.95,"maximum":2381.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1356.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1303.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1343.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1395.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1330.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2381.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1382.19,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1393.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1460.42,"additional_payer_notes":"APC"}]}]},{"description":"Hered colon ca do mrna pnl","code_information":[{"code":"0130U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":584.9,"maximum":1068.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":608.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":584.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":602.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":625.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":596.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1068.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":619.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":625.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":655.09,"additional_payer_notes":"APC"}]}]},{"description":"Hered prst8 ca rltd do 11","code_information":[{"code":"0133U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":690.29,"maximum":1260.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":717.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":690.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":711.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":738.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":704.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1260.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":731.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":737.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":773.12,"additional_payer_notes":"APC"}]}]},{"description":"Hered pan ca mrna pnl 18 gen","code_information":[{"code":"0134U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":748.39,"maximum":1366.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":778.33,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":748.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":770.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":800.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":763.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1366.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":793.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":800.03,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":838.2,"additional_payer_notes":"APC"}]}]},{"description":"Atm mrna seq alys","code_information":[{"code":"0136U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":407.43,"maximum":743.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":423.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":407.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":419.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":435.95,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":415.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":743.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":431.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":435.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":456.32,"additional_payer_notes":"APC"}]}]},{"description":"Palb2 mrna seq alys","code_information":[{"code":"0137U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":516.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":302.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":516.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":299.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":302.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":316.83,"additional_payer_notes":"APC"}]}]},{"description":"Brca1 brca2 mrna seq alys","code_information":[{"code":"0138U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":468.33,"maximum":855.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":487.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":468.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":482.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":501.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":477.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":855.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":496.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":500.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":524.53,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds fungi dna 15 trgt","code_information":[{"code":"0140U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":156.75,"maximum":286.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":163.02,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":156.75,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":161.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":167.72,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":159.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":286.23,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":166.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":167.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":175.56,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bact&fng gram pos","code_information":[{"code":"0141U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":156.75,"maximum":286.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":163.02,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":156.75,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":161.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":167.72,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":159.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":286.23,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":166.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":167.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":175.56,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bact&fng gram neg","code_information":[{"code":"0142U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":156.75,"maximum":286.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":163.02,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":156.75,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":161.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":167.72,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":159.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":286.23,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":166.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":167.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":175.56,"additional_payer_notes":"APC"}]}]},{"description":"Nfct bct fng prst dna >1000","code_information":[{"code":"0152U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2126.2,"maximum":3882.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2211.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2126.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2189.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2275.03,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2168.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3882.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2253.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2272.91,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2381.34,"additional_payer_notes":"APC"}]}]},{"description":"Onc breast mrna 101 genes","code_information":[{"code":"0153U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3159.42,"maximum":5769.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3285.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3159.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3254.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3380.58,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3222.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5769.1,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3348.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3377.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3538.55,"additional_payer_notes":"APC"}]}]},{"description":"Fgfr3 gene analysis","code_information":[{"code":"0154U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":482.14,"maximum":880.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":501.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":482.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":496.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":515.89,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":491.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":880.39,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":511.07,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":515.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":540.0,"additional_payer_notes":"APC"}]}]},{"description":"Pik3ca gene analysis","code_information":[{"code":"0155U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":501.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":293.79,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":307.81,"additional_payer_notes":"APC"}]}]},{"description":"Copy number sequence alys","code_information":[{"code":"0156U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1740.0,"maximum":3177.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1809.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1792.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1861.8,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1774.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3177.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1844.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1860.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1948.8,"additional_payer_notes":"APC"}]}]},{"description":"Apc mrna seq alys","code_information":[{"code":"0157U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":516.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":302.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":516.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":299.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":302.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":316.83,"additional_payer_notes":"APC"}]}]},{"description":"Mlh1 mrna seq alys","code_information":[{"code":"0158U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":516.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":302.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":516.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":299.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":302.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":316.83,"additional_payer_notes":"APC"}]}]},{"description":"Msh2 mrna seq alys","code_information":[{"code":"0159U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":516.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":302.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":516.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":299.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":302.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":316.83,"additional_payer_notes":"APC"}]}]},{"description":"Msh6 mrna seq alys","code_information":[{"code":"0160U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":516.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":302.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":516.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":299.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":302.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":316.83,"additional_payer_notes":"APC"}]}]},{"description":"Pms2 mrna seq alys","code_information":[{"code":"0161U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":516.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":302.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":516.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":299.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":302.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":316.83,"additional_payer_notes":"APC"}]}]},{"description":"Hered colon ca trgt mrna pnl","code_information":[{"code":"0162U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":486.54,"maximum":888.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":506.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":486.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":501.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":520.6,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":496.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":888.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":515.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":520.11,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":544.92,"additional_payer_notes":"APC"}]}]},{"description":"Gi ibs ia anti-cdtb&vinculin","code_information":[{"code":"0164U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":112.02,"maximum":204.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112.02,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":119.86,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":114.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":204.55,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":118.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":119.75,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":125.46,"additional_payer_notes":"APC"}]}]},{"description":"Peanut allg spec asmt 64 epi","code_information":[{"code":"0165U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":463.76,"maximum":846.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":482.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":463.76,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":477.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":496.22,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":473.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":846.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":491.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":495.76,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":519.41,"additional_payer_notes":"APC"}]}]},{"description":"Liver ds 10 biochem asy srm","code_information":[{"code":"0166U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":503.4,"maximum":919.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":523.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":503.4,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":518.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":538.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":513.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":919.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":533.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":538.13,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":563.81,"additional_payer_notes":"APC"}]}]},{"description":"Nudt15&tpmt gene com vrnt","code_information":[{"code":"0169U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.17,"maximum":851.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":484.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":466.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":480.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":498.8,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":475.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":851.23,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":494.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":498.34,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":522.11,"additional_payer_notes":"APC"}]}]},{"description":"Neuro asd rna next gen seq","code_information":[{"code":"0170U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1950.0,"maximum":3560.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2028.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1950.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2008.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2086.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1989.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3560.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2067.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.55,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2184.0,"additional_payer_notes":"APC"}]}]},{"description":"Trgt gen seq alys pnl dna 23","code_information":[{"code":"0171U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1519.06,"maximum":2773.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1579.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1519.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1564.63,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1625.39,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1549.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2773.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1610.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1623.88,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1701.35,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld tum alys brca1 brca2","code_information":[{"code":"0172U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3030.0,"maximum":5532.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3151.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3030.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3120.9,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3242.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3090.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5532.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3211.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3239.07,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3393.6,"additional_payer_notes":"APC"}]}]},{"description":"Psyc gen alys panel 14 genes","code_information":[{"code":"0173U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":466.17,"maximum":851.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":484.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":466.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":480.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":498.8,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":475.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":851.23,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":494.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":498.34,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":522.11,"additional_payer_notes":"APC"}]}]},{"description":"Onc solid tumor 30 prtn trgt","code_information":[{"code":"0174U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1305.37,"maximum":2383.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1357.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1305.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1344.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1396.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1331.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2383.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1383.69,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1395.44,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1462.01,"additional_payer_notes":"APC"}]}]},{"description":"Psyc gen alys panel 15 genes","code_information":[{"code":"0175U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1336.09,"maximum":2439.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1389.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1336.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1376.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1429.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1362.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2439.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1416.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1428.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1496.42,"additional_payer_notes":"APC"}]}]},{"description":"Cdtb&vinculin igg antb ia","code_information":[{"code":"0176U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.19,"maximum":117.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":66.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":66.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":68.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":117.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":68.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":68.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":71.89,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst ca dna pik3ca 11","code_information":[{"code":"0177U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":501.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":293.79,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":307.81,"additional_payer_notes":"APC"}]}]},{"description":"Peanut allg asmt epi clin rx","code_information":[{"code":"0178U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":459.86,"maximum":839.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":478.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":459.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":473.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":492.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":469.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":839.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":487.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":491.59,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":515.04,"additional_payer_notes":"APC"}]}]},{"description":"Onc nonsm cll lng ca alys 23","code_information":[{"code":"0179U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1943.21,"maximum":3548.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2020.94,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1943.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2001.51,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2079.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1982.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3548.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2059.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2077.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2176.4,"additional_payer_notes":"APC"}]}]},{"description":"Abo gnotyp abo 7 exons","code_information":[{"code":"0180U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":501.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":293.79,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":307.81,"additional_payer_notes":"APC"}]}]},{"description":"Co gnotyp aqp1 exon 1","code_information":[{"code":"0181U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":338.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":192.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":198.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":338.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":196.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":197.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":207.42,"additional_payer_notes":"APC"}]}]},{"description":"Crom gnotyp cd55 exons 1-10","code_information":[{"code":"0182U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":301.35,"maximum":550.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":313.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":301.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":310.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":322.44,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":307.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":550.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":319.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":322.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":337.51,"additional_payer_notes":"APC"}]}]},{"description":"Di gnotyp slc4a1 exon 19","code_information":[{"code":"0183U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":338.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":192.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":198.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":338.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":196.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":197.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":207.42,"additional_payer_notes":"APC"}]}]},{"description":"Do gnotyp art4 exon 2","code_information":[{"code":"0184U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":338.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":192.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":198.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":338.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":196.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":197.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":207.42,"additional_payer_notes":"APC"}]}]},{"description":"Fut1 gnotyp fut1 exon 4","code_information":[{"code":"0185U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":338.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":192.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":198.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":338.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":196.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":197.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":207.42,"additional_payer_notes":"APC"}]}]},{"description":"Fut2 gnotyp fut2 exon 2","code_information":[{"code":"0186U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":338.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":192.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":198.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":338.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":196.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":197.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":207.42,"additional_payer_notes":"APC"}]}]},{"description":"Fy gnotyp ackr1 exons 1-2","code_information":[{"code":"0187U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":501.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":293.79,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":307.81,"additional_payer_notes":"APC"}]}]},{"description":"Ge gnotyp gypc exons 1-4","code_information":[{"code":"0188U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":501.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":293.79,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":307.81,"additional_payer_notes":"APC"}]}]},{"description":"Gypa gnotyp ntrns 1 5 exon 2","code_information":[{"code":"0189U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":501.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":293.79,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":307.81,"additional_payer_notes":"APC"}]}]},{"description":"Gypb gnotyp ntrns 1 5 seux 3","code_information":[{"code":"0190U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":501.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":293.79,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":307.81,"additional_payer_notes":"APC"}]}]},{"description":"In gnotyp cd44 exons 2 3 6","code_information":[{"code":"0191U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":501.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":293.79,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":307.81,"additional_payer_notes":"APC"}]}]},{"description":"Jk gnotyp slc14a1 exon 9","code_information":[{"code":"0192U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":501.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":293.79,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":307.81,"additional_payer_notes":"APC"}]}]},{"description":"Jr gnotyp abcg2 exons 2-26","code_information":[{"code":"0193U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":516.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":302.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":516.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":299.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":302.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":316.83,"additional_payer_notes":"APC"}]}]},{"description":"Kel gnotyp kel exon 8","code_information":[{"code":"0194U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":338.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":192.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":198.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":338.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":196.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":197.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":207.42,"additional_payer_notes":"APC"}]}]},{"description":"Klf1 targeted sequencing","code_information":[{"code":"0195U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":375.25,"maximum":685.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":390.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.51,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":401.52,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":382.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":685.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":401.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":420.28,"additional_payer_notes":"APC"}]}]},{"description":"Lu gnotyp bcam exon 3","code_information":[{"code":"0196U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":338.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":192.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":198.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":338.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":196.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":197.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":207.42,"additional_payer_notes":"APC"}]}]},{"description":"Lw gnotyp icam4 exon 1","code_information":[{"code":"0197U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":338.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":192.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":198.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":338.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":196.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":197.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":207.42,"additional_payer_notes":"APC"}]}]},{"description":"Rhd&rhce gntyp rhd1-10&rhce5","code_information":[{"code":"0198U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":516.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":302.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":516.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":299.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":302.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":316.83,"additional_payer_notes":"APC"}]}]},{"description":"Sc gnotyp ermap exons 4 12","code_information":[{"code":"0199U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":501.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":293.79,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":307.81,"additional_payer_notes":"APC"}]}]},{"description":"Xk gnotyp xk exons 1-3","code_information":[{"code":"0200U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":501.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":293.79,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":307.81,"additional_payer_notes":"APC"}]}]},{"description":"Yt gnotyp ache exon 2","code_information":[{"code":"0201U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":338.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":192.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":198.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":338.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":196.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":197.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":207.42,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds 22 trgt sars-cov-2","code_information":[{"code":"0202U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":761.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":761.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":445.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":466.79,"additional_payer_notes":"APC"}]}]},{"description":"Ai ibd mrna xprsn prfl 17","code_information":[{"code":"0203U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1387.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1387.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":812.44,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":851.2,"additional_payer_notes":"APC"}]}]},{"description":"Oph amd alys 3 gene variants","code_information":[{"code":"0205U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.0,"maximum":85.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":48.41,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":47.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":85.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":49.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50.24,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"APC"}]}]},{"description":"Neuro alzheimer cell aggregj","code_information":[{"code":"0206U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2215.4,"maximum":4045.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2304.02,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2215.4,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2281.86,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2370.48,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2259.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":4045.32,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2348.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2368.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2481.25,"additional_payer_notes":"APC"}]}]},{"description":"Cytog const alys interrog","code_information":[{"code":"0209U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":787.15,"maximum":1437.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":818.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":787.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":810.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":842.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":802.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1437.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":834.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":841.46,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":881.61,"additional_payer_notes":"APC"}]}]},{"description":"Syphilis tst antb ia quan","code_information":[{"code":"0210U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.63,"maximum":34.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.87,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan-tum dna&rna gnrj seq","code_information":[{"code":"0211U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8455.0,"maximum":15438.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8793.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8455.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8708.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9046.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8624.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15438.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8962.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9038.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9469.6,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds gen dna alys proband","code_information":[{"code":"0212U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5475.2,"maximum":9997.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5694.21,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5475.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5639.46,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5858.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5584.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9997.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5803.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5852.99,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6132.22,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds gen dna alys ea comp","code_information":[{"code":"0213U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2709.95,"maximum":4948.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2818.35,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2709.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2791.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2899.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2764.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":4948.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2872.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2896.94,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3035.14,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds xom dna alys proband","code_information":[{"code":"0214U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5224.6,"maximum":9540.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5433.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5224.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5381.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5590.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5329.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9540.12,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5538.08,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5585.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5851.55,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds xom dna alys ea comp","code_information":[{"code":"0215U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2574.65,"maximum":4701.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2677.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2574.65,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2651.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2754.88,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2626.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":4701.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2729.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2752.3,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2883.61,"additional_payer_notes":"APC"}]}]},{"description":"Neuro inh ataxia dna 12 com","code_information":[{"code":"0216U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1537.02,"maximum":2806.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1598.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1537.02,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1583.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1644.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1567.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2806.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1629.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1643.07,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1721.46,"additional_payer_notes":"APC"}]}]},{"description":"Neuro inh ataxia dna 51 gene","code_information":[{"code":"0217U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2198.35,"maximum":4014.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2286.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2198.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2264.3,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2352.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2242.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":4014.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2330.25,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2350.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2462.15,"additional_payer_notes":"APC"}]}]},{"description":"Neuro musc dys dmd seq alys","code_information":[{"code":"0218U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2279.0,"maximum":4161.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2370.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2279.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2347.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2438.53,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2324.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":4161.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2415.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2436.25,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2552.48,"additional_payer_notes":"APC"}]}]},{"description":"Nfct agt hiv gnrj seq alys","code_information":[{"code":"0219U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":725.0,"maximum":1323.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":754.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":725.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":746.75,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":739.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1323.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":768.5,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":775.02,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":812.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst ca ai assmt 12 feat","code_information":[{"code":"0220U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":706.25,"maximum":1289.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":734.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":706.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":727.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":755.69,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":720.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1289.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":748.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":754.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.0,"additional_payer_notes":"APC"}]}]},{"description":"Abo gnotyp next gnrj seq abo","code_information":[{"code":"0221U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":501.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":293.79,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":307.81,"additional_payer_notes":"APC"}]}]},{"description":"Rhd&rhce gntyp next gnrj seq","code_information":[{"code":"0222U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":516.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":302.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":516.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":299.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":302.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":316.83,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds 22 trgt sars-cov-2","code_information":[{"code":"0223U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":761.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":761.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":445.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":466.79,"additional_payer_notes":"APC"}]}]},{"description":"Antibody sars-cov-2 titer(s)","code_information":[{"code":"0224U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.43,"maximum":93.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":52.97,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":55.03,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":52.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":93.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":54.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57.6,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds dna&rna 21 sarscov2","code_information":[{"code":"0225U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":761.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":761.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":445.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":466.79,"additional_payer_notes":"APC"}]}]},{"description":"Svnt sarscov2 elisa plsm srm","code_information":[{"code":"0226U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.28,"maximum":77.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.97,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.28,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43.55,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":77.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.2,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47.35,"additional_payer_notes":"APC"}]}]},{"description":"Rx asy prsmv 30+rx/metablt","code_information":[{"code":"0227U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":62.14,"maximum":113.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":64.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":66.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":113.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.87,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":66.43,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.6,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 ma molec prfl alg","code_information":[{"code":"0228U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":173.03,"maximum":315.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":179.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":173.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":178.22,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":176.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":315.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":184.97,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":193.79,"additional_payer_notes":"APC"}]}]},{"description":"Bcat1 promoter mthyltn alys","code_information":[{"code":"0229U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":384.0,"maximum":701.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":399.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":384.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":395.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":410.88,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":391.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":701.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":407.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":410.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":430.08,"additional_payer_notes":"APC"}]}]},{"description":"Ar full sequence analysis","code_information":[{"code":"0230U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":301.35,"maximum":550.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":313.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":301.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":310.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":322.44,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":307.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":550.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":319.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":322.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":337.51,"additional_payer_notes":"APC"}]}]},{"description":"Cacna1a full gene analysis","code_information":[{"code":"0231U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":846.27,"maximum":1545.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":880.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":846.27,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":871.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":905.51,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":863.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1545.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":897.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":904.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"}]}]},{"description":"Cstb full gene analysis","code_information":[{"code":"0232U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":501.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":293.79,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":307.81,"additional_payer_notes":"APC"}]}]},{"description":"Fxn gene analysis","code_information":[{"code":"0233U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":501.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":293.79,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":307.81,"additional_payer_notes":"APC"}]}]},{"description":"Mecp2 full gene analysis","code_information":[{"code":"0234U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":527.87,"maximum":963.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":548.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":527.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":543.71,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":564.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":538.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":963.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":559.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":564.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":591.21,"additional_payer_notes":"APC"}]}]},{"description":"Pten full gene analysis","code_information":[{"code":"0235U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":600.0,"maximum":1095.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":624.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":600.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":618.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":642.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":612.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1095.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":636.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":641.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":672.0,"additional_payer_notes":"APC"}]}]},{"description":"Smn1&smn2 full gene analysis","code_information":[{"code":"0236U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":602.7,"maximum":1100.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":626.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":602.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":620.78,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":644.89,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":614.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1100.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":638.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":644.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":675.02,"additional_payer_notes":"APC"}]}]},{"description":"Car ion chnlpthy gen seq pnl","code_information":[{"code":"0237U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":584.9,"maximum":1068.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":608.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":584.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":602.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":625.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":596.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1068.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":619.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":625.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":655.09,"additional_payer_notes":"APC"}]}]},{"description":"Onc lnch syn gen dna seq aly","code_information":[{"code":"0238U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":584.9,"maximum":1068.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":608.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":584.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":602.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":625.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":596.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1068.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":619.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":625.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":655.09,"additional_payer_notes":"APC"}]}]},{"description":"Trgt gen seq alys pnl 311+","code_information":[{"code":"0239U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3500.0,"maximum":6391.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3640.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3500.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3605.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3745.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3570.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6391.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3710.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3741.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3920.0,"additional_payer_notes":"APC"}]}]},{"description":"Trgt gen seq alys pnl 55-74","code_information":[{"code":"0242U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5000.0,"maximum":9130.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5200.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5000.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5150.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5350.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5100.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9130.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5300.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5345.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5600.0,"additional_payer_notes":"APC"}]}]},{"description":"Ob pe biochem assay pgf alg","code_information":[{"code":"0243U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.41,"maximum":117.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":66.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64.41,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":66.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":68.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":117.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":68.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":68.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":72.14,"additional_payer_notes":"APC"}]}]},{"description":"Onc solid orgn dna 257 genes","code_information":[{"code":"0244U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3500.0,"maximum":6391.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3640.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3500.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3605.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3745.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3570.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6391.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3710.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3741.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3920.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc thyr mut alys 10 gen&37","code_information":[{"code":"0245U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1266.07,"maximum":2311.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1316.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1266.07,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1304.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1354.69,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1291.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2311.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1342.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1353.43,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1418.0,"additional_payer_notes":"APC"}]}]},{"description":"Rbc dna gnotyp 16 bld groups","code_information":[{"code":"0246U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":720.0,"maximum":1314.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":748.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":720.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":741.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":770.4,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":734.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1314.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":763.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.68,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":806.4,"additional_payer_notes":"APC"}]}]},{"description":"Ob prtrm brth ibp4 shbg meas","code_information":[{"code":"0247U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":750.0,"maximum":1369.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":780.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":750.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":772.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":765.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1369.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":795.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":801.75,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":840.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc brn sphrd cll 12 rx pnl","code_information":[{"code":"0248U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.86,"maximum":5539.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3155.21,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5539.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3243.2,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.92,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst alys 32 phsprtn alg","code_information":[{"code":"0249U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2219.13,"maximum":4052.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2307.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2219.13,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2285.7,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2374.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2263.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":4052.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2352.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2372.25,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2485.43,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld org neo dna 505 gene","code_information":[{"code":"0250U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":5331.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3036.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3123.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5331.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3121.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3269.95,"additional_payer_notes":"APC"}]}]},{"description":"Hepcidin-25 elisa serum/plsm","code_information":[{"code":"0251U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.27,"maximum":31.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.48,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":31.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.46,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.34,"additional_payer_notes":"APC"}]}]},{"description":"Ftl aneuploidy str alys dna","code_information":[{"code":"0252U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":759.05,"maximum":1386.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":789.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":759.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.82,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":812.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":774.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1386.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":804.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":811.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":850.14,"additional_payer_notes":"APC"}]}]},{"description":"Rprdtve med rna gen prfl 238","code_information":[{"code":"0253U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3159.42,"maximum":5769.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3285.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3159.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3254.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3380.58,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3222.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5769.1,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3348.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3377.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3538.55,"additional_payer_notes":"APC"}]}]},{"description":"Reprdtve med alys 24 chrmsm","code_information":[{"code":"0254U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":759.05,"maximum":1386.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":789.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":759.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.82,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":812.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":774.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1386.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":804.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":811.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":850.14,"additional_payer_notes":"APC"}]}]},{"description":"Andrology infertility assmt","code_information":[{"code":"0255U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":31.6,"maximum":57.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.55,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.81,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":57.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33.5,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.78,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35.39,"additional_payer_notes":"APC"}]}]},{"description":"Tma/tmao prfl ms/ms ur alg","code_information":[{"code":"0256U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":159.95,"maximum":292.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":166.35,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":159.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":164.75,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":171.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":163.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":292.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":169.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":170.99,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":179.14,"additional_payer_notes":"APC"}]}]},{"description":"Vlcad leuk nzm actv whl bld","code_information":[{"code":"0257U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":712.47,"maximum":1300.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":740.97,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":712.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":733.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":762.34,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":726.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1300.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":755.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":761.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":797.97,"additional_payer_notes":"APC"}]}]},{"description":"Ai psor mrna 50-100 gen alg","code_information":[{"code":"0258U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3675.0,"maximum":6710.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3822.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3675.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3785.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3932.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3748.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6710.55,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3895.5,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3928.58,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4116.0,"additional_payer_notes":"APC"}]}]},{"description":"Neph ckd nuc mrs meas gfr","code_information":[{"code":"0259U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":52.71,"maximum":96.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":54.29,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56.4,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":53.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":96.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55.87,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56.35,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":59.04,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds id opt genome mapg","code_information":[{"code":"0260U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1263.53,"maximum":2307.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1314.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1263.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1301.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1351.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1288.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2307.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1339.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1350.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1415.15,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct ca img alys w/ai","code_information":[{"code":"0261U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2513.25,"maximum":4589.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2613.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2513.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2588.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2689.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2563.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":4589.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2664.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2686.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2814.84,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld tum rt-pcr 7 gen","code_information":[{"code":"0262U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3200.0,"maximum":5843.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3328.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3200.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3296.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3424.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3264.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5843.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3392.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3420.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3584.0,"additional_payer_notes":"APC"}]}]},{"description":"Neuro asd meas 16 c metblt","code_information":[{"code":"0263U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":750.0,"maximum":1369.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":780.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":750.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":772.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":765.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1369.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":795.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":801.75,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":840.0,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds id opt genome mapg","code_information":[{"code":"0264U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1263.53,"maximum":2307.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1314.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1263.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1301.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1351.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1288.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2307.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1339.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1350.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1415.15,"additional_payer_notes":"APC"}]}]},{"description":"Rar do whl gn&mtcdrl dna als","code_information":[{"code":"0265U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5475.8,"maximum":9998.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5694.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5475.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5640.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5859.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5585.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9998.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5804.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5853.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6132.9,"additional_payer_notes":"APC"}]}]},{"description":"Unxpl cnst hrtbl do gn xprsn","code_information":[{"code":"0266U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3200.0,"maximum":5843.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3328.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3200.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3296.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3424.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3264.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5843.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3392.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3420.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3584.0,"additional_payer_notes":"APC"}]}]},{"description":"Rare do id opt gen mapg&seq","code_information":[{"code":"0267U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6739.33,"maximum":12306.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7008.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6739.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6941.51,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7211.08,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6874.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12306.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7143.69,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7204.34,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7548.05,"additional_payer_notes":"APC"}]}]},{"description":"Hem ahus gen seq alys 15 gen","code_information":[{"code":"0268U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":608.17,"maximum":1110.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":632.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":608.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":626.42,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":650.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":620.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1110.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":644.66,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":650.13,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":681.15,"additional_payer_notes":"APC"}]}]},{"description":"Hem aut dm cgen trmbctpna 14","code_information":[{"code":"0269U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":608.17,"maximum":1110.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":632.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":608.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":626.42,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":650.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":620.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1110.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":644.66,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":650.13,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":681.15,"additional_payer_notes":"APC"}]}]},{"description":"Hem cgen coagj do 20 genes","code_information":[{"code":"0270U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":608.17,"maximum":1110.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":632.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":608.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":626.42,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":650.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":620.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1110.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":644.66,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":650.13,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":681.15,"additional_payer_notes":"APC"}]}]},{"description":"Hem cgen neutropenia 23 gen","code_information":[{"code":"0271U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":608.17,"maximum":1110.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":632.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":608.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":626.42,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":650.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":620.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1110.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":644.66,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":650.13,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":681.15,"additional_payer_notes":"APC"}]}]},{"description":"Hem genetic bld do 51 genes","code_information":[{"code":"0272U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":608.17,"maximum":1110.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":632.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":608.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":626.42,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":650.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":620.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1110.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":644.66,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":650.13,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":681.15,"additional_payer_notes":"APC"}]}]},{"description":"Hem gen hyprfibrnlysis 8 gen","code_information":[{"code":"0273U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":608.17,"maximum":1110.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":632.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":608.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":626.42,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":650.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":620.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1110.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":644.66,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":650.13,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":681.15,"additional_payer_notes":"APC"}]}]},{"description":"Hem gen pltlt do 43 genes","code_information":[{"code":"0274U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":608.17,"maximum":1110.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":632.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":608.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":626.42,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":650.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":620.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1110.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":644.66,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":650.13,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":681.15,"additional_payer_notes":"APC"}]}]},{"description":"Hem heprn nduc trmbctpna srm","code_information":[{"code":"0275U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.37,"maximum":33.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.1,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.92,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.47,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.57,"additional_payer_notes":"APC"}]}]},{"description":"Hem inh thrombocytopenia 23","code_information":[{"code":"0276U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2448.56,"maximum":4471.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2546.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2448.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2522.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2619.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2497.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":4471.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2595.47,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2617.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2742.39,"additional_payer_notes":"APC"}]}]},{"description":"Hem gen pltlt funcj do 31","code_information":[{"code":"0277U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":608.17,"maximum":1110.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":632.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":608.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":626.42,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":650.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":620.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1110.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":644.66,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":650.13,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":681.15,"additional_payer_notes":"APC"}]}]},{"description":"Hem gen thrombosis 12 genes","code_information":[{"code":"0278U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":608.17,"maximum":1110.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":632.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":608.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":626.42,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":650.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":620.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1110.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":644.66,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":650.13,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":681.15,"additional_payer_notes":"APC"}]}]},{"description":"Hem vw factor&clgn iii bndg","code_information":[{"code":"0279U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.53,"maximum":21.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.33,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.91,"additional_payer_notes":"APC"}]}]},{"description":"Hem vw factor&clgn iv bndg","code_information":[{"code":"0280U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.27,"maximum":31.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.48,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":31.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.46,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.34,"additional_payer_notes":"APC"}]}]},{"description":"Hem vwd propeptide ag lvl","code_information":[{"code":"0281U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.27,"maximum":31.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.48,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":31.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.46,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.34,"additional_payer_notes":"APC"}]}]},{"description":"Rbc dna gntyp 12 bld grp gen","code_information":[{"code":"0282U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":720.0,"maximum":1314.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":748.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":720.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":741.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":770.4,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":734.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1314.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":763.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":769.68,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":806.4,"additional_payer_notes":"APC"}]}]},{"description":"Vw factor type 2b eval plsm","code_information":[{"code":"0283U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.4,"maximum":33.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.4,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.69,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.5,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.67,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.61,"additional_payer_notes":"APC"}]}]},{"description":"Vw factor type 2n eval plsm","code_information":[{"code":"0284U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.27,"maximum":31.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.48,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":31.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.46,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.34,"additional_payer_notes":"APC"}]}]},{"description":"Onc rsps radj cll fr dna tox","code_information":[{"code":"0285U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":443.31,"maximum":809.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":461.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":443.31,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":456.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":474.34,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":452.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":809.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":469.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":473.9,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":496.51,"additional_payer_notes":"APC"}]}]},{"description":"Cep72 nudt15&tpmt gene alys","code_information":[{"code":"0286U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":134.13,"maximum":244.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":134.13,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.15,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.52,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":136.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":244.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":142.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.23,"additional_payer_notes":"APC"}]}]},{"description":"Onc thyr dna&mrna 112 genes","code_information":[{"code":"0287U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3600.0,"maximum":6573.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3744.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3600.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3708.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3852.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3672.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6573.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3816.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4032.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc lung mrna quan pcr 11&3","code_information":[{"code":"0288U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3873.0,"maximum":7072.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4027.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3989.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3950.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7072.1,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4105.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4140.24,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4337.76,"additional_payer_notes":"APC"}]}]},{"description":"Neuro alzheimer mrna 24 gen","code_information":[{"code":"0289U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1387.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1387.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":812.44,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":851.2,"additional_payer_notes":"APC"}]}]},{"description":"Pain mgmt mrna gen xprsn 36","code_information":[{"code":"0290U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1387.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1387.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":812.44,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":851.2,"additional_payer_notes":"APC"}]}]},{"description":"Psyc mood do mrna 144 genes","code_information":[{"code":"0291U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1755.0,"maximum":3204.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1825.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1755.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1807.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1877.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1790.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3204.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1860.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1876.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1965.6,"additional_payer_notes":"APC"}]}]},{"description":"Psyc strs do mrna 72 genes","code_information":[{"code":"0292U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1755.0,"maximum":3204.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1825.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1755.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1807.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1877.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1790.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3204.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1860.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1876.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1965.6,"additional_payer_notes":"APC"}]}]},{"description":"Psyc suicidal idea mrna 54","code_information":[{"code":"0293U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1387.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1387.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":812.44,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":851.2,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst dux carc 7 proteins","code_information":[{"code":"0295U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5435.0,"maximum":9924.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5652.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5435.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5598.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5815.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5543.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9924.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5761.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5810.02,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6087.2,"additional_payer_notes":"APC"}]}]},{"description":"Onc orl&/orop ca 20 mlc feat","code_information":[{"code":"0296U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1950.0,"maximum":3560.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2028.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1950.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2008.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2086.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1989.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3560.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2067.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.55,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2184.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan tum whl gen seq dna","code_information":[{"code":"0297U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":5331.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3036.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3123.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5331.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3121.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3269.95,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan tum whl trns seq rna","code_information":[{"code":"0298U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":5331.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3036.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3123.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5331.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3121.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3269.95,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan tum whl gen opt mapg","code_information":[{"code":"0299U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1863.22,"maximum":3402.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1937.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1863.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1919.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1993.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1900.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3402.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1975.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1991.78,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2086.81,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan tum whl gen seq&opt","code_information":[{"code":"0300U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4183.13,"maximum":7638.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4350.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4183.13,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4308.62,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4475.95,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4266.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7638.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4434.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4471.77,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4685.11,"additional_payer_notes":"APC"}]}]},{"description":"Iadna bartonella ddpcr","code_information":[{"code":"0301U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":262.72,"maximum":479.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":273.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":262.72,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":270.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":281.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":267.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":479.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":278.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":280.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.25,"additional_payer_notes":"APC"}]}]},{"description":"Iadna brtnla ddpcr flwg liq","code_information":[{"code":"0302U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":361.37,"maximum":659.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":375.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":361.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":372.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":386.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":368.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":659.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":383.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":386.3,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":404.73,"additional_payer_notes":"APC"}]}]},{"description":"Hem rbc ads whl bld hypoxic","code_information":[{"code":"0303U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2201.62,"maximum":4020.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2289.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2201.62,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2267.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2355.73,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2245.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":4020.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2333.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2353.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2465.81,"additional_payer_notes":"APC"}]}]},{"description":"Hem rbc ads whl bld normoxic","code_information":[{"code":"0304U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2075.8,"maximum":3790.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2158.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2075.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2138.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2221.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2117.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3790.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2200.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2219.03,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2324.9,"additional_payer_notes":"APC"}]}]},{"description":"Hem rbc fnclty&dfrm shr strs","code_information":[{"code":"0305U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":662.58,"maximum":1209.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":689.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":662.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":682.46,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":708.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":675.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1209.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":702.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":708.3,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":742.09,"additional_payer_notes":"APC"}]}]},{"description":"Onc mrd nxt-gnrj alys 1st","code_information":[{"code":"0306U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3878.45,"maximum":7082.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4033.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3878.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3994.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4149.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3956.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7082.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4111.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4146.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4343.86,"additional_payer_notes":"APC"}]}]},{"description":"Onc mrd nxt-gnrj alys sbsq","code_information":[{"code":"0307U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":794.49,"maximum":1450.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":826.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":794.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":818.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":850.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":810.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1450.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":842.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":849.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":889.83,"additional_payer_notes":"APC"}]}]},{"description":"Crd cad alys 3 prtn plsm alg","code_information":[{"code":"0308U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":390.75,"maximum":713.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":406.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":390.75,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":402.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":418.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":398.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":713.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":414.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":417.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":437.64,"additional_payer_notes":"APC"}]}]},{"description":"Crd cv ds aly 4 prtn plm alg","code_information":[{"code":"0309U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":390.75,"maximum":713.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":406.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":390.75,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":402.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":418.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":398.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":713.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":414.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":417.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":437.64,"additional_payer_notes":"APC"}]}]},{"description":"Ped vsclts kd alys 3 bmrks","code_information":[{"code":"0310U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":390.75,"maximum":713.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":406.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":390.75,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":402.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":418.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":398.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":713.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":414.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":417.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":437.64,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bct quan antmcrb sc","code_information":[{"code":"0311U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.08,"maximum":14.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.08,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14.75,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.05,"additional_payer_notes":"APC"}]}]},{"description":"Ai ds sle alys 8 igg autoant","code_information":[{"code":"0312U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":840.65,"maximum":1535.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":874.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.65,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":865.87,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":899.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":857.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1535.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":891.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":898.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":941.53,"additional_payer_notes":"APC"}]}]},{"description":"Onc pncrs dna&mrna seq 74","code_information":[{"code":"0313U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3600.0,"maximum":6573.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3744.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3600.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3708.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3852.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3672.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6573.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3816.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4032.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc cutan mlnma mrna 35 gene","code_information":[{"code":"0314U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1950.0,"maximum":3560.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2028.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1950.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2008.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2086.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1989.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3560.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2067.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2084.55,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2184.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc cutan sq cll ca mrna 40","code_information":[{"code":"0315U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8500.0,"maximum":15521.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8840.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8500.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8755.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9095.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8670.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15521.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9010.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9086.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9520.0,"additional_payer_notes":"APC"}]}]},{"description":"B brgdrferi lyme ds ospa evl","code_information":[{"code":"0316U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.66,"maximum":34.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.66,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.22,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.95,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.9,"additional_payer_notes":"APC"}]}]},{"description":"Onc lung ca 4-prb fish assay","code_information":[{"code":"0317U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2030.0,"maximum":3706.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2111.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2030.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2090.9,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2172.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2070.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3706.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2151.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2170.07,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2273.6,"additional_payer_notes":"APC"}]}]},{"description":"Ped whl gen mthyltn alys 50+","code_information":[{"code":"0318U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1770.48,"maximum":3232.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1841.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1770.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1823.59,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1894.41,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1805.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3232.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1876.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1892.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1982.94,"additional_payer_notes":"APC"}]}]},{"description":"Neph rna pretrnspl perph bld","code_information":[{"code":"0319U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2650.0,"maximum":4838.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2756.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2650.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2729.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2835.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2703.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":4838.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2809.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2832.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2968.0,"additional_payer_notes":"APC"}]}]},{"description":"Neph rna psttrnspl perph bld","code_information":[{"code":"0320U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2650.0,"maximum":4838.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2756.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2650.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2729.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2835.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2703.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":4838.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2809.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2832.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2968.0,"additional_payer_notes":"APC"}]}]},{"description":"Iadna gu pthgn 20bct&fng org","code_information":[{"code":"0321U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":634.84,"maximum":1159.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":660.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":634.84,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":653.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":679.28,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":647.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1159.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":672.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":678.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":711.02,"additional_payer_notes":"APC"}]}]},{"description":"Neuro asd meas 14 acyl carn","code_information":[{"code":"0322U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":750.0,"maximum":1369.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":780.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":750.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":772.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":765.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1369.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":795.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":801.75,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":840.0,"additional_payer_notes":"APC"}]}]},{"description":"Iadna cns pthgn next gen seq","code_information":[{"code":"0323U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2126.2,"maximum":3882.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2211.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2126.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2189.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2275.03,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2168.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3882.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2253.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2272.91,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2381.34,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay 120+ rx&metablt","code_information":[{"code":"0328U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":114.43,"maximum":208.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":119.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":114.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":117.86,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.44,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":116.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":208.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":121.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.33,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":128.16,"additional_payer_notes":"APC"}]}]},{"description":"Iadna vag pthgn panel 27 org","code_information":[{"code":"0330U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":761.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":761.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":445.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":466.79,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan tum gen prflg 8 dna","code_information":[{"code":"0332U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1142.06,"maximum":2085.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1187.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1142.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1176.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1222.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1164.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2085.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1210.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1220.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1279.11,"additional_payer_notes":"APC"}]}]},{"description":"Onc lvr surveilanc hcc cfdna","code_information":[{"code":"0333U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":662.32,"maximum":1209.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":688.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":662.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":682.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":708.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":675.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1209.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":702.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":708.02,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":741.8,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld orgn tgsa dna 84/+","code_information":[{"code":"0334U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3500.0,"maximum":6391.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3640.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3500.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3605.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3745.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3570.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6391.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3710.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3741.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3920.0,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds whl gen seq fetal","code_information":[{"code":"0335U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5224.6,"maximum":9540.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5433.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5224.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5381.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5590.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5329.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9540.12,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5538.08,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5585.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5851.55,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds whl gen seq bld/slv","code_information":[{"code":"0336U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2574.65,"maximum":4701.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2677.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2574.65,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2651.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2754.88,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2626.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":4701.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2729.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2752.3,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2883.61,"additional_payer_notes":"APC"}]}]},{"description":"Onc plsm cell do&myeloma id","code_information":[{"code":"0337U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2435.0,"maximum":4446.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2532.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2435.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2508.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2605.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2483.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":4446.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2581.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2603.02,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2727.2,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld tum crcg tum cl slct","code_information":[{"code":"0338U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2435.0,"maximum":4446.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2532.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2435.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2508.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2605.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2483.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":4446.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2581.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2603.02,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2727.2,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 mrna hoxc6 & dlx1","code_information":[{"code":"0339U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1387.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1387.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":812.44,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":851.2,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan ca alys mrd plasma","code_information":[{"code":"0340U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3590.0,"maximum":6555.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3733.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3590.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3697.7,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3841.3,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3661.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6555.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3805.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3837.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4020.8,"additional_payer_notes":"APC"}]}]},{"description":"Ftl aneup dna seq cmpr alys","code_information":[{"code":"0341U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1900.2,"maximum":3469.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1976.21,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1900.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1957.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2033.21,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1938.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3469.77,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2014.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2031.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2128.22,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 xom aly 442 sncrna","code_information":[{"code":"0343U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1387.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1387.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":812.44,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":851.2,"additional_payer_notes":"APC"}]}]},{"description":"Hep nafld semiq evl 28 lipid","code_information":[{"code":"0344U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":792.17,"maximum":1446.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":823.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":815.94,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":847.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":808.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1446.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":839.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":846.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":887.23,"additional_payer_notes":"APC"}]}]},{"description":"Psyc genom alys pnl 15 gen","code_information":[{"code":"0345U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1336.09,"maximum":2439.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1389.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1336.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1376.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1429.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1362.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2439.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1416.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1428.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1496.42,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab/pcx dna 16 gen alys","code_information":[{"code":"0347U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1336.09,"maximum":2439.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1389.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1336.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1376.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1429.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1362.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2439.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1416.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1428.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1496.42,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab/pcx dna 25 gen alys","code_information":[{"code":"0348U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":742.27,"maximum":1355.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":771.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":742.27,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":764.54,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":794.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":757.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1355.39,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":786.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":793.49,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":831.34,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab/pcx dna 27gen rx ia","code_information":[{"code":"0349U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":742.27,"maximum":1355.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":771.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":742.27,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":764.54,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":794.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":757.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1355.39,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":786.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":793.49,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":831.34,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab/pcx dna 27 gen alys","code_information":[{"code":"0350U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1336.09,"maximum":2439.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1389.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1336.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1376.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1429.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1362.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2439.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1416.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1428.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1496.42,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bct/viral trail ip10","code_information":[{"code":"0351U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":260.5,"maximum":475.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":270.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":260.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":268.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":278.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":475.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":276.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":278.47,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":291.76,"additional_payer_notes":"APC"}]}]},{"description":"Apol1 risk variants","code_information":[{"code":"0355U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":250.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":250.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":153.44,"additional_payer_notes":"APC"}]}]},{"description":"Onc orop 17 dna ddpcr alg","code_information":[{"code":"0356U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1800.0,"maximum":3286.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1872.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1800.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1854.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1926.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1836.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3286.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1908.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1924.2,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2016.0,"additional_payer_notes":"APC"}]}]},{"description":"Neuro alys b-amyl 1-42&1-40","code_information":[{"code":"0358U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":260.5,"maximum":475.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":270.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":260.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":268.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":278.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":475.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":276.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":278.47,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":291.76,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 ca alys all psa","code_information":[{"code":"0359U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1387.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1387.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":812.44,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":851.2,"additional_payer_notes":"APC"}]}]},{"description":"Onc lung elisa 7 autoant alg","code_information":[{"code":"0360U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":840.65,"maximum":1535.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":874.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.65,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":865.87,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":899.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":857.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1535.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":891.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":898.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":941.53,"additional_payer_notes":"APC"}]}]},{"description":"Onc pap thyr ca rna 82&10","code_information":[{"code":"0362U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3600.0,"maximum":6573.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3744.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3600.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3708.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3852.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3672.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6573.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3816.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4032.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc urthl mrna 5 gen alg","code_information":[{"code":"0363U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1387.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1387.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":812.44,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":851.2,"additional_payer_notes":"APC"}]}]},{"description":"Onc hl neo gen seq alys alg","code_information":[{"code":"0364U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2007.25,"maximum":3665.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2087.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2007.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2067.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2147.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2047.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3665.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2127.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2145.75,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2248.12,"additional_payer_notes":"APC"}]}]},{"description":"Onc bldr 10 prb bldr ca","code_information":[{"code":"0365U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":897.0,"maximum":1637.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":932.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":897.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":923.91,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":959.79,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":914.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1637.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":950.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":958.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1004.64,"additional_payer_notes":"APC"}]}]},{"description":"Onc bldr 10 prb recr bldr ca","code_information":[{"code":"0366U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":897.0,"maximum":1637.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":932.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":897.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":923.91,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":959.79,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":914.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1637.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":950.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":958.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1004.64,"additional_payer_notes":"APC"}]}]},{"description":"Onc bldr 10 flwg trurl rescj","code_information":[{"code":"0367U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":902.18,"maximum":1647.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":938.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":902.18,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":929.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":965.33,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":920.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1647.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":956.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":964.43,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1010.44,"additional_payer_notes":"APC"}]}]},{"description":"Iadna gu pthgn semiq dna16&1","code_information":[{"code":"0371U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":761.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":761.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":445.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":466.79,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds gu pthgn arg detcj","code_information":[{"code":"0372U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":761.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":761.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":445.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":466.79,"additional_payer_notes":"APC"}]}]},{"description":"Onc ovrn bchm asy 7 prtn alg","code_information":[{"code":"0375U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":897.0,"maximum":1637.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":932.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":897.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":923.91,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":959.79,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":914.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1637.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":950.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":958.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1004.64,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 ca img alys 128","code_information":[{"code":"0376U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":706.25,"maximum":1289.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":734.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":706.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":727.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":755.69,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":720.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1289.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":748.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":754.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.0,"additional_payer_notes":"APC"}]}]},{"description":"Cv ds quan advsrm/plsm lprtn","code_information":[{"code":"0377U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.58,"maximum":86.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":49.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":48.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":86.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":50.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53.29,"additional_payer_notes":"APC"}]}]},{"description":"Rfc1 repeat xpnsj vrnt alys","code_information":[{"code":"0378U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":250.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":250.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":153.44,"additional_payer_notes":"APC"}]}]},{"description":"Tgsap sl or neo dna523&rna55","code_information":[{"code":"0379U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3288.51,"maximum":6004.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3420.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3288.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3387.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3518.71,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3354.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6004.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3683.13,"additional_payer_notes":"APC"}]}]},{"description":"Maple syrup ur ds mntr quan","code_information":[{"code":"0381U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.12,"maximum":80.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44.12,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":45.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47.21,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":45.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":80.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":46.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49.41,"additional_payer_notes":"APC"}]}]},{"description":"Hyprphenylalninmia mntr quan","code_information":[{"code":"0382U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.64,"maximum":94.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":53.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":55.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":52.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":94.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":54.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":55.2,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57.84,"additional_payer_notes":"APC"}]}]},{"description":"Tyrosinemia typ i mntr quan","code_information":[{"code":"0383U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":52.05,"maximum":95.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":53.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":55.69,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":53.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":95.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55.17,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":55.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.3,"additional_payer_notes":"APC"}]}]},{"description":"Neph ckd rsk hi stg kdn ds","code_information":[{"code":"0384U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":750.0,"maximum":1369.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":780.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":750.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":772.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":765.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1369.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":795.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":801.75,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":840.0,"additional_payer_notes":"APC"}]}]},{"description":"Neph ckd alg rsk dbtc kdn ds","code_information":[{"code":"0385U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":390.75,"maximum":713.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":406.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":390.75,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":402.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":418.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":398.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":713.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":414.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":417.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":437.64,"additional_payer_notes":"APC"}]}]},{"description":"Onc mlnma ambra1&amlo","code_information":[{"code":"0387U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":948.5,"maximum":1731.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":986.44,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":948.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":976.96,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1014.9,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":967.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1731.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1005.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1013.95,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1062.32,"additional_payer_notes":"APC"}]}]},{"description":"Onc nonsm cll lng ca 37 gen","code_information":[{"code":"0388U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3500.0,"maximum":6391.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3640.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3500.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3605.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3745.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3570.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6391.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3710.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3741.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3920.0,"additional_payer_notes":"APC"}]}]},{"description":"Ped fbrl kd ifi27&mcemp1 rna","code_information":[{"code":"0389U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":70.2,"maximum":128.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":73.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":72.31,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":75.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":71.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":128.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":74.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":75.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":78.62,"additional_payer_notes":"APC"}]}]},{"description":"Ob pe kdr eng&rbp4 ia alg","code_information":[{"code":"0390U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.41,"maximum":117.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":66.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64.41,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":66.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":68.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":117.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":68.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":68.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":72.14,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld tum dna&rna 437 gen","code_information":[{"code":"0391U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3600.0,"maximum":6573.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3744.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3600.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3708.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3852.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3672.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6573.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3816.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4032.0,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab genrx ia 16 genes","code_information":[{"code":"0392U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1336.09,"maximum":2439.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1389.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1336.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1376.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1429.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1362.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2439.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1416.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1428.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1496.42,"additional_payer_notes":"APC"}]}]},{"description":"Neu prksn msfl ?-syncln prtn","code_information":[{"code":"0393U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":540.99,"maximum":987.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":562.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":540.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":557.22,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":578.86,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":551.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":987.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":573.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":578.32,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":605.91,"additional_payer_notes":"APC"}]}]},{"description":"Pfas 16 pfas compnd lc ms/ms","code_information":[{"code":"0394U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":198.74,"maximum":362.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":206.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":198.74,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":204.7,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":212.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":202.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":362.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":210.66,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":212.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":222.59,"additional_payer_notes":"APC"}]}]},{"description":"Onc lng multiomics plsm alg","code_information":[{"code":"0395U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":797.45,"maximum":1456.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":829.35,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":797.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":821.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":853.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":813.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1456.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":845.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":852.47,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":893.14,"additional_payer_notes":"APC"}]}]},{"description":"Gi baret esph dna mthyln aly","code_information":[{"code":"0398U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1755.0,"maximum":3204.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1825.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1755.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1807.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1877.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1790.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3204.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1860.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1876.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1965.6,"additional_payer_notes":"APC"}]}]},{"description":"Neuro cere folate defncy srm","code_information":[{"code":"0399U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":300.0,"maximum":547.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":312.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":300.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":309.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":321.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":306.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":547.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":318.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":320.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":336.0,"additional_payer_notes":"APC"}]}]},{"description":"Crd c hrt ds 9 gen 12 vrnts","code_information":[{"code":"0401U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":489.68,"maximum":894.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":509.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":489.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":504.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":523.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":499.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":894.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":519.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":523.47,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":548.44,"additional_payer_notes":"APC"}]}]},{"description":"Nfct agt sti mult amp prb tq","code_information":[{"code":"0402U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.63,"maximum":260.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":146.91,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":152.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":145.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":260.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":151.19,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":152.47,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":159.75,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 mrna 18 gen dre ur","code_information":[{"code":"0403U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1387.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1387.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":812.44,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":851.2,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst semiq meas thym kn","code_information":[{"code":"0404U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":322.96,"maximum":589.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":335.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":322.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":332.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":345.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":329.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":589.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":342.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":345.24,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":361.72,"additional_payer_notes":"APC"}]}]},{"description":"Onc pncrtc 59 mthltn blk mrk","code_information":[{"code":"0405U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1770.48,"maximum":3232.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1841.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1770.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1823.59,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1894.41,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1805.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3232.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1876.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1892.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1982.94,"additional_payer_notes":"APC"}]}]},{"description":"Onc lung flow cytmtry 5 mrk","code_information":[{"code":"0406U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1387.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1387.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":812.44,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":851.2,"additional_payer_notes":"APC"}]}]},{"description":"Neph dbtc ckd mult eclia alg","code_information":[{"code":"0407U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":950.0,"maximum":1734.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":988.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":950.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":978.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1016.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":969.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1734.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1007.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1015.55,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1064.0,"additional_payer_notes":"APC"}]}]},{"description":"Iaad blk ac wv bsnsr sarscv2","code_information":[{"code":"0408U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.13,"maximum":25.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.13,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.55,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.12,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.83,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld tum dna 80 & rna 36","code_information":[{"code":"0409U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":5331.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3036.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3123.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5331.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3121.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3269.95,"additional_payer_notes":"APC"}]}]},{"description":"Onc pncrtc dna whl gn seq 5-","code_information":[{"code":"0410U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1160.0,"maximum":2118.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1206.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1160.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1194.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1241.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1183.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2118.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1229.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1240.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.2,"additional_payer_notes":"APC"}]}]},{"description":"Psyc genom alys pnl 15 gen","code_information":[{"code":"0411U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1336.09,"maximum":2439.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1389.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1336.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1376.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1429.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1362.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2439.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1416.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1428.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1496.42,"additional_payer_notes":"APC"}]}]},{"description":"Beta amyloid a?42/40 imprcip","code_information":[{"code":"0412U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":750.0,"maximum":1369.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":780.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":750.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":772.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":765.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1369.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":795.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":801.75,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":840.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc hl neo opt gen mapg dna","code_information":[{"code":"0413U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1263.53,"maximum":2307.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1314.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1263.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1301.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1351.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1288.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2307.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1339.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1350.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1415.15,"additional_payer_notes":"APC"}]}]},{"description":"Onc lng aug alg aly whl sld8","code_information":[{"code":"0414U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":706.25,"maximum":1289.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":734.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":706.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":727.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":755.69,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":720.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1289.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":748.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":754.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.0,"additional_payer_notes":"APC"}]}]},{"description":"Cv ds acs bld alg 5 yr score","code_information":[{"code":"0415U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":390.75,"maximum":713.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":406.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":390.75,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":402.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":418.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":398.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":713.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":414.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":417.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":437.64,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds alys 335 nuc genes","code_information":[{"code":"0417U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2842.53,"maximum":5190.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2956.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2842.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2927.81,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3041.51,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2899.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5190.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3013.08,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3038.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3183.63,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst aug alg aly whl sl8","code_information":[{"code":"0418U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":706.25,"maximum":1289.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":734.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":706.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":727.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":755.69,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":720.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1289.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":748.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":754.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.0,"additional_payer_notes":"APC"}]}]},{"description":"Nrpsyc gen seq vrnt aly 13","code_information":[{"code":"0419U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1336.09,"maximum":2439.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1389.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1336.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1376.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1429.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1362.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2439.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1416.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1428.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1496.42,"additional_payer_notes":"APC"}]}]},{"description":"Onc urthl mrna xprsn 6 snp","code_information":[{"code":"0420U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1328.32,"maximum":2425.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1381.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1328.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1368.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1421.3,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1354.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2425.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1408.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1419.97,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1487.72,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan solid tum alys dna","code_information":[{"code":"0422U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1943.21,"maximum":3548.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2020.94,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1943.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2001.51,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2079.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1982.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3548.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2059.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2077.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2176.4,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 xom alys 53 sncrna","code_information":[{"code":"0424U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1387.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1387.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":812.44,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":851.2,"additional_payer_notes":"APC"}]}]},{"description":"Genom rpd seq alys ea cmprtr","code_information":[{"code":"0425U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4094.39,"maximum":7476.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4258.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4094.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4217.22,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4381.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4176.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7476.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4340.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4376.9,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4585.72,"additional_payer_notes":"APC"}]}]},{"description":"Genome ultra-rapid seq alys","code_information":[{"code":"0426U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7582.2,"maximum":13845.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7885.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7582.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7809.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8112.95,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7733.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13845.1,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8037.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8105.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8492.06,"additional_payer_notes":"APC"}]}]},{"description":"Monocyte dstrbj wdth whl bld","code_information":[{"code":"0427U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.48,"maximum":8.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.79,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":8.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.79,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.02,"additional_payer_notes":"APC"}]}]},{"description":"Hpv orop swab 14 hi-risk typ","code_information":[{"code":"0429U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Gi malabs aat calpro pncrtc","code_information":[{"code":"0430U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.54,"maximum":112.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.79,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":68.92,"additional_payer_notes":"APC"}]}]},{"description":"Gly rcptr alpha1 igg srm/csf","code_information":[{"code":"0431U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.57,"maximum":66.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36.57,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.13,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":66.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.09,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.96,"additional_payer_notes":"APC"}]}]},{"description":"Klhl11 antb sr/csf asy qual","code_information":[{"code":"0432U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.57,"maximum":66.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36.57,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.13,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":66.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.09,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.96,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 5 dna reg mrk pcr","code_information":[{"code":"0433U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1387.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1387.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":812.44,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":851.2,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab advrs vrnt alys 25","code_information":[{"code":"0434U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":761.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":761.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":445.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":466.79,"additional_payer_notes":"APC"}]}]},{"description":"Onc chemo rx cytox csc 14 rx","code_information":[{"code":"0435U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.86,"maximum":5539.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3155.21,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5539.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3243.2,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.92,"additional_payer_notes":"APC"}]}]},{"description":"Onc lng plsm alys 388 prtn","code_information":[{"code":"0436U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1504.24,"maximum":2746.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1564.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1504.24,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1549.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1609.54,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1534.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2746.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1594.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1608.03,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1684.75,"additional_payer_notes":"APC"}]}]},{"description":"Psyc anxiety do mrna 15 bmrk","code_information":[{"code":"0437U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1387.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1387.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":812.44,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":851.2,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab advrs vrnt alys 33","code_information":[{"code":"0438U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":761.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":761.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":445.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":466.79,"additional_payer_notes":"APC"}]}]},{"description":"Crd chd dna alys 5 snp 3 dna","code_information":[{"code":"0439U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":854.0,"maximum":1559.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":888.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":854.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":879.62,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":913.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":871.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1559.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":905.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":912.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":956.48,"additional_payer_notes":"APC"}]}]},{"description":"Crd chd dna alys 10 snp 6dna","code_information":[{"code":"0440U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":854.0,"maximum":1559.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":888.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":854.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":879.62,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":913.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":871.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1559.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":905.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":912.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":956.48,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bct fngl/viral semiq","code_information":[{"code":"0441U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":444.08,"maximum":810.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":461.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.08,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":457.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":475.17,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":452.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":810.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":470.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":474.72,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":497.37,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds respir nfctj mxa&crp","code_information":[{"code":"0442U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.38,"maximum":75.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.38,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":42.62,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44.28,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":42.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":75.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44.24,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46.35,"additional_payer_notes":"APC"}]}]},{"description":"Neurflmnt lt chn ultrsens ia","code_information":[{"code":"0443U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.23,"maximum":212.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":120.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.23,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":119.72,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":124.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":118.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":212.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":123.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":124.25,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":130.18,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld orgn neo tgsap 361","code_information":[{"code":"0444U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":5331.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3036.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3123.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5331.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3121.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3269.95,"additional_payer_notes":"APC"}]}]},{"description":"Abeta42 & ptau181 eclia csf","code_information":[{"code":"0445U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":260.5,"maximum":475.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":270.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":260.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":268.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":278.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":475.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":276.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":278.47,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":291.76,"additional_payer_notes":"APC"}]}]},{"description":"Ai ds sle alys 10 cytokine","code_information":[{"code":"0446U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":840.65,"maximum":1535.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":874.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.65,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":865.87,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":899.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":857.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1535.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":891.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":898.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":941.53,"additional_payer_notes":"APC"}]}]},{"description":"Ai ds sle alys 11 cytokine","code_information":[{"code":"0447U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":840.65,"maximum":1535.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":874.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.65,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":865.87,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":899.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":857.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1535.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":891.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":898.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":941.53,"additional_payer_notes":"APC"}]}]},{"description":"Onc bldr mthyl penk lte-qmsp","code_information":[{"code":"0452U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":192.0,"maximum":350.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":192.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":197.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.44,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":195.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":350.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":203.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.25,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":215.04,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct ca cfdna qpcr asy","code_information":[{"code":"0453U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":192.0,"maximum":350.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":192.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":197.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.44,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":195.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":350.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":203.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.25,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":215.04,"additional_payer_notes":"APC"}]}]},{"description":"U rare ds id opt genome mapg","code_information":[{"code":"0454U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1263.53,"maximum":2307.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1314.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1263.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1301.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1351.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1288.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2307.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1339.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1350.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1415.15,"additional_payer_notes":"APC"}]}]},{"description":"Nfct agt sti mult amp prb ur","code_information":[{"code":"0455U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.63,"maximum":260.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":146.91,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":152.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":145.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":260.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":151.19,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":152.47,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":159.75,"additional_payer_notes":"APC"}]}]},{"description":"Pfas 9 cmpnd lcms/ms pls/sr","code_information":[{"code":"0457U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":198.74,"maximum":362.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":206.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":198.74,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":204.7,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":212.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":202.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":362.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":210.66,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":212.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":222.59,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst ca s100 a8&a9 elisa","code_information":[{"code":"0458U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":260.5,"maximum":475.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":270.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":260.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":268.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":278.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":475.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":276.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":278.47,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":291.76,"additional_payer_notes":"APC"}]}]},{"description":"Abeta42 & ttau eclia csf","code_information":[{"code":"0459U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":260.5,"maximum":475.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":270.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":260.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":268.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":278.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":475.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":276.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":278.47,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":291.76,"additional_payer_notes":"APC"}]}]},{"description":"Onc whl bld/bucc rtpcr 24gen","code_information":[{"code":"0460U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":917.08,"maximum":1674.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":953.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":917.08,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":944.59,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":981.28,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":935.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1674.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":972.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":980.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1027.13,"additional_payer_notes":"APC"}]}]},{"description":"Onc rxgenom alys rtpcr 24gen","code_information":[{"code":"0461U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":917.08,"maximum":1674.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":953.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":917.08,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":944.59,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":981.28,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":935.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1674.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":972.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":980.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1027.13,"additional_payer_notes":"APC"}]}]},{"description":"Melatonin lvl tst slp std7/9","code_information":[{"code":"0462U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.27,"maximum":31.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.48,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":31.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.46,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.34,"additional_payer_notes":"APC"}]}]},{"description":"Onc crvx mrna genxprsn 14bmk","code_information":[{"code":"0463U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1387.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1387.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":812.44,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":851.2,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct scr qrtsa dna mrk","code_information":[{"code":"0464U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":591.92,"maximum":1080.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":615.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":591.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":609.68,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":633.35,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":603.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1080.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":627.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":632.76,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":662.95,"additional_payer_notes":"APC"}]}]},{"description":"Onc urthl carc dna qmsp 2gen","code_information":[{"code":"0465U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1938.01,"maximum":3538.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2015.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1938.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1996.15,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2073.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1976.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3538.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2054.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2071.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2170.57,"additional_payer_notes":"APC"}]}]},{"description":"Crd cad dna gwas 564856 snp","code_information":[{"code":"0466U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":345.43,"maximum":630.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":359.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":345.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":355.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":369.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":352.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":630.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":366.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":369.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":386.88,"additional_payer_notes":"APC"}]}]},{"description":"Onc bldr dna ngs 60gen&aneup","code_information":[{"code":"0467U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1519.06,"maximum":2773.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1579.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1519.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1564.63,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1625.39,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1549.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2773.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1610.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1623.88,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1701.35,"additional_payer_notes":"APC"}]}]},{"description":"Hep nash mir34a5p ?2m ykl40","code_information":[{"code":"0468U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":251.7,"maximum":459.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":261.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":251.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":259.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":269.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":459.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":266.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":269.07,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":281.9,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds whl gen seq ftl samp","code_information":[{"code":"0469U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1197.94,"maximum":2187.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1245.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1197.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1233.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1281.8,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1221.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2187.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1269.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1280.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1341.69,"additional_payer_notes":"APC"}]}]},{"description":"Onc orop detcj mrd 8 dna hpv","code_information":[{"code":"0470U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":597.91,"maximum":1091.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":621.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":597.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":615.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":639.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":609.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1091.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":633.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":639.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":669.66,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrc ca 35 vrn kras&nras","code_information":[{"code":"0471U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1387.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1387.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":812.44,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":851.2,"additional_payer_notes":"APC"}]}]},{"description":"Ca vi psp&sp1 antb sj?gren","code_information":[{"code":"0472U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.9,"maximum":50.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.02,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.74,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":50.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29.57,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.25,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld tum bld/slv 648 gene","code_information":[{"code":"0473U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4500.0,"maximum":8217.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4680.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4500.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4635.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4815.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4590.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":8217.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4770.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4810.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5040.0,"additional_payer_notes":"APC"}]}]},{"description":"Hered pan ca gsap 88gene ngs","code_information":[{"code":"0474U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1303.95,"maximum":2381.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1356.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1303.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1343.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1395.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1330.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2381.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1382.19,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1393.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1460.42,"additional_payer_notes":"APC"}]}]},{"description":"Hered prst8 ca gsap 23 genes","code_information":[{"code":"0475U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1303.95,"maximum":2381.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1356.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1303.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1343.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1395.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1330.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2381.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1382.19,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1393.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1460.42,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab psyc 14gen&cyp2d6","code_information":[{"code":"0476U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":761.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":761.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":445.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":466.79,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab psy 14&cyp2d6 gn-rx","code_information":[{"code":"0477U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":761.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":761.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":445.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":466.79,"additional_payer_notes":"APC"}]}]},{"description":"Onc nsclc dna&rna dpcr 9 gen","code_information":[{"code":"0478U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":552.99,"maximum":1009.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":575.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":552.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":569.58,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":591.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":564.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1009.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":586.17,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":591.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":619.35,"additional_payer_notes":"APC"}]}]},{"description":"Tau phosphorylated ptau217","code_information":[{"code":"0479U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.27,"maximum":31.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.48,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":31.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.46,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.34,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds csf metag ngs alys","code_information":[{"code":"0480U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2126.2,"maximum":3882.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2211.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2126.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2189.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2275.03,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2168.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3882.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2253.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2272.91,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2381.34,"additional_payer_notes":"APC"}]}]},{"description":"Idh1 idh2&tert promoter ngs","code_information":[{"code":"0481U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":674.24,"maximum":1231.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":701.21,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":674.24,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":694.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":721.44,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":687.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1231.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":714.69,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":720.76,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":755.15,"additional_payer_notes":"APC"}]}]},{"description":"Ob pe biochem asy sfit1&pigf","code_information":[{"code":"0482U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":128.82,"maximum":235.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":133.97,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.68,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":137.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":131.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":235.23,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":136.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":137.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.28,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds ng gyra s91f pt mut","code_information":[{"code":"0483U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds mgen 23s rrna pt mut","code_information":[{"code":"0484U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tum cfdna&rna ngs gm","code_information":[{"code":"0485U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3649.48,"maximum":6663.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3795.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3649.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3758.96,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3904.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3722.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6663.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3868.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3901.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4087.42,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan sol tum ngs cfctdna","code_information":[{"code":"0486U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1644.25,"maximum":3002.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1710.02,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1644.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1693.58,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1759.35,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1677.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3002.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1742.9,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1757.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1841.56,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tum cfcdna tgsap 84","code_information":[{"code":"0487U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":5331.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3036.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3123.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5331.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3121.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3269.95,"additional_payer_notes":"APC"}]}]},{"description":"Onc cutan/uveal mlnma cd146","code_information":[{"code":"0490U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2435.0,"maximum":4446.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2532.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2435.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2508.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2605.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2483.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":4446.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2581.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2603.02,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2727.2,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tum ctc slct er prtn","code_information":[{"code":"0491U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2435.0,"maximum":4446.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2532.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2435.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2508.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2605.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2483.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":4446.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2581.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2603.02,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2727.2,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tum ctc slctn pd-l1","code_information":[{"code":"0492U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2435.0,"maximum":4446.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2532.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2435.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2508.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2605.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2483.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":4446.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2581.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2603.02,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2727.2,"additional_payer_notes":"APC"}]}]},{"description":"Trnspl med quan dd-cfdna ngs","code_information":[{"code":"0493U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.25,"maximum":5027.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2863.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2753.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2835.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2945.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2808.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5027.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2918.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2943.22,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3083.64,"additional_payer_notes":"APC"}]}]},{"description":"Rbc ag ftl rhd gene alys ngs","code_information":[{"code":"0494U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":759.05,"maximum":1386.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":789.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":759.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.82,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":812.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":774.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1386.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":804.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":811.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":850.14,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 alys crcg plsm prt","code_information":[{"code":"0495U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1387.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1387.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":812.44,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":851.2,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct cfdna 8/7 genes","code_information":[{"code":"0496U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":485.86,"maximum":887.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":505.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":485.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":500.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":519.87,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":495.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":887.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":515.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":519.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":544.16,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 mrna rt-pcr 6 gene","code_information":[{"code":"0497U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3873.0,"maximum":7072.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4027.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3989.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3950.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7072.1,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4105.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4140.24,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4337.76,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct ngs mut detc 43gen","code_information":[{"code":"0498U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1345.31,"maximum":2456.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1345.31,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1385.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1439.48,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1372.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2456.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1426.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1438.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1506.75,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct&lng dna ngs 8gene","code_information":[{"code":"0499U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":597.91,"maximum":1091.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":621.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":597.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":615.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":639.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":609.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1091.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":633.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":639.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":669.66,"additional_payer_notes":"APC"}]}]},{"description":"Autoinflam ds vexas synd dna","code_information":[{"code":"0500U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.4,"maximum":320.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":182.42,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175.4,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":180.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":187.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":178.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":320.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":185.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":187.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":196.45,"additional_payer_notes":"APC"}]}]},{"description":"Hpv e6/e7 mrk hi-rsk typ crv","code_information":[{"code":"0502U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Neuro alz ds ?amyl&tau prtn","code_information":[{"code":"0503U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":750.0,"maximum":1369.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":780.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":750.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":772.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":802.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":765.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1369.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":795.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":801.75,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":840.0,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds uti id 17 path orgs","code_information":[{"code":"0504U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":761.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":761.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":445.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":466.79,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds vag infctj id 32orgs","code_information":[{"code":"0505U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":679.77,"maximum":1241.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":706.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":679.77,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":700.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":727.35,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":693.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1241.26,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":720.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":726.67,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":761.34,"additional_payer_notes":"APC"}]}]},{"description":"Gi barretts esophgl cell 89","code_information":[{"code":"0506U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1938.01,"maximum":3538.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2015.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1938.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1996.15,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2073.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1976.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3538.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2054.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2071.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2170.57,"additional_payer_notes":"APC"}]}]},{"description":"Onc ovr dna whole gen w/5hmc","code_information":[{"code":"0507U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1160.0,"maximum":2118.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1206.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1160.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1194.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1241.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1183.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2118.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1229.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1240.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.2,"additional_payer_notes":"APC"}]}]},{"description":"Onc pncrtc ca alg alys 16gen","code_information":[{"code":"0510U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":473.91,"maximum":865.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":492.87,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":473.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":488.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":507.08,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":483.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":865.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":502.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":506.61,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":530.78,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tum 3dmicroenvir 36+","code_information":[{"code":"0511U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.86,"maximum":5539.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3155.21,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5539.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3243.2,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.92,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 alys dgtz img msi","code_information":[{"code":"0512U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":706.25,"maximum":1289.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":734.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":706.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":727.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":755.69,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":720.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1289.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":748.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":754.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 alg alys msi&hrd","code_information":[{"code":"0513U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":706.25,"maximum":1289.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":734.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":706.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":727.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":755.69,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":720.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1289.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":748.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":754.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":791.0,"additional_payer_notes":"APC"}]}]},{"description":"Gi ibd ia quan deter adl lvl","code_information":[{"code":"0514U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.57,"maximum":70.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.57,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":70.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.2,"additional_payer_notes":"APC"}]}]},{"description":"Gi ibd ia quan deter ifx lvl","code_information":[{"code":"0515U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.57,"maximum":70.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.57,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":70.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.2,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab rxgenomic gnotyp 40","code_information":[{"code":"0516U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":761.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":761.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":445.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":466.79,"additional_payer_notes":"APC"}]}]},{"description":"Ther rx mntr 80+ psyactiv rx","code_information":[{"code":"0517U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":246.92,"maximum":450.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":256.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":246.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":251.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":450.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":261.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":263.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":276.55,"additional_payer_notes":"APC"}]}]},{"description":"Ther rx mntr 90+ pn&mtl hlth","code_information":[{"code":"0518U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":246.92,"maximum":450.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":256.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":246.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":251.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":450.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":261.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":263.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":276.55,"additional_payer_notes":"APC"}]}]},{"description":"Ther rx mntr meds p/d/a 110+","code_information":[{"code":"0519U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":246.92,"maximum":450.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":256.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":246.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":251.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":450.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":261.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":263.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":276.55,"additional_payer_notes":"APC"}]}]},{"description":"Ther rx mntr 200+ rx/sbsts","code_information":[{"code":"0520U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":246.92,"maximum":450.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":256.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":246.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":251.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":450.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":261.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":263.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":276.55,"additional_payer_notes":"APC"}]}]},{"description":"Rf iga&igm ccp antb sr-a ia","code_information":[{"code":"0521U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.8,"maximum":94.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53.87,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":53.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":55.43,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":52.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":94.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":54.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":55.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.02,"additional_payer_notes":"APC"}]}]},{"description":"Ca vi psp&sp1 antb cl semiql","code_information":[{"code":"0522U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":260.5,"maximum":475.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":270.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":260.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":268.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":278.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":475.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":276.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":278.47,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":291.76,"additional_payer_notes":"APC"}]}]},{"description":"Onc soltum dna ngs snv 22gen","code_information":[{"code":"0523U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1352.09,"maximum":2468.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1406.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1352.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1392.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1446.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1379.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2468.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1433.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1445.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1514.34,"additional_payer_notes":"APC"}]}]},{"description":"Ob pe sflt-1/plgf ia srm/pls","code_information":[{"code":"0524U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":128.82,"maximum":235.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":133.97,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.68,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":137.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":131.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":235.23,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":136.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":137.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.28,"additional_payer_notes":"APC"}]}]},{"description":"Onc sphrd cell cul 11-rx pnl","code_information":[{"code":"0525U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3033.86,"maximum":5539.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3155.21,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3124.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3246.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5539.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3215.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3243.2,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3397.92,"additional_payer_notes":"APC"}]}]},{"description":"Hsv 1&2 vzv amp prb tq pthgn","code_information":[{"code":"0527U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.63,"maximum":260.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":146.91,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":152.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":145.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":260.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":151.19,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":152.47,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":159.75,"additional_payer_notes":"APC"}]}]},{"description":"Lrt iad 18bct/8vir&7arg rna","code_information":[{"code":"0528U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":634.84,"maximum":1159.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":660.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":634.84,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":653.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":679.28,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":647.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1159.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":672.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":678.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":711.02,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan-sol tum ctdna 77 gen","code_information":[{"code":"0530U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":5331.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3036.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3123.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5331.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3121.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3269.95,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds whlgen&mitochdrl dna","code_information":[{"code":"0532U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5031.2,"maximum":9186.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5232.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5031.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5182.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5383.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5131.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9186.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5333.07,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5378.35,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5634.94,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab advrs gnotyp 16gens","code_information":[{"code":"0533U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":761.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":761.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":445.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":466.79,"additional_payer_notes":"APC"}]}]},{"description":"Pfas lc-ms/ms plsm/srm quan","code_information":[{"code":"0535U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":62.14,"maximum":113.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":64.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":66.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":113.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.87,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":66.43,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.6,"additional_payer_notes":"APC"}]}]},{"description":"Rbcag ftl rhd pcr alys exon4","code_information":[{"code":"0536U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":192.0,"maximum":350.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":192.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":197.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.44,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":195.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":350.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":203.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.25,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":215.04,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct ca cfdna >2500 dmr","code_information":[{"code":"0537U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1495.0,"maximum":2729.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1554.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1495.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1539.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1599.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1524.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2729.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1584.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1598.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1674.4,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tum ngts ffpe 600gen","code_information":[{"code":"0538U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2989.55,"maximum":5458.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3109.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2989.55,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3079.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3198.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3049.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5458.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3168.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3195.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3348.3,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tumor cfctdna 152gen","code_information":[{"code":"0539U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3288.51,"maximum":6004.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3420.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3288.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3387.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3518.71,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3354.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6004.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3683.13,"additional_payer_notes":"APC"}]}]},{"description":"Trnsplj med quan dd-cfdna","code_information":[{"code":"0540U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.25,"maximum":5027.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2863.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2753.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2835.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2945.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2808.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5027.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2918.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2943.22,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3083.64,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tum ngs dna 517 gens","code_information":[{"code":"0543U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2989.55,"maximum":5458.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3109.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2989.55,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3079.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3198.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3049.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5458.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3168.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3195.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3348.3,"additional_payer_notes":"APC"}]}]},{"description":"Achr antb id imfluor livecll","code_information":[{"code":"0545U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.73,"maximum":68.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38.86,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":68.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.33,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42.26,"additional_payer_notes":"APC"}]}]},{"description":"Ldns lrp4 antb imflr livecll","code_information":[{"code":"0546U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.73,"maximum":68.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38.86,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":68.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.33,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42.26,"additional_payer_notes":"APC"}]}]},{"description":"Neurflmnt lt chn cleia plsm","code_information":[{"code":"0547U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.23,"maximum":212.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":120.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.23,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":119.72,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":124.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":118.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":212.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":123.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":124.25,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":130.18,"additional_payer_notes":"APC"}]}]},{"description":"Gfap cleia plasma","code_information":[{"code":"0548U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.23,"maximum":212.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":120.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.23,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":119.72,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":124.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":118.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":212.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":123.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":124.25,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":130.18,"additional_payer_notes":"APC"}]}]},{"description":"Onc urthl dna mthyltd rt pcr","code_information":[{"code":"0549U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1387.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1387.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":812.44,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":851.2,"additional_payer_notes":"APC"}]}]},{"description":"Repr med pga embry te strux","code_information":[{"code":"0553U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":759.05,"maximum":1386.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":789.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":759.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.82,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":812.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":774.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1386.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":804.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":811.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":850.14,"additional_payer_notes":"APC"}]}]},{"description":"Repr med pga 24chrm te bx qc","code_information":[{"code":"0554U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":759.05,"maximum":1386.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":789.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":759.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.82,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":812.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":774.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1386.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":804.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":811.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":850.14,"additional_payer_notes":"APC"}]}]},{"description":"Repr med pga embryonic te qc","code_information":[{"code":"0555U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":759.05,"maximum":1386.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":789.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":759.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.82,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":812.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":774.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1386.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":804.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":811.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":850.14,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds p-s dna&rna 12 trgts","code_information":[{"code":"0556U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.63,"maximum":260.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":146.91,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":152.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":145.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":260.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":151.19,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":152.47,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":159.75,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bv dna mrk vag fluid","code_information":[{"code":"0557U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":262.99,"maximum":480.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":273.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":262.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":270.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":281.4,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":268.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":480.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":278.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":281.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.55,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct elisa bf7 ag serum","code_information":[{"code":"0558U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.81,"maximum":38.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":38.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.25,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.31,"additional_payer_notes":"APC"}]}]},{"description":"Onc brs quan elisa bf9ag srm","code_information":[{"code":"0559U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.81,"maximum":38.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":38.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.25,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.31,"additional_payer_notes":"APC"}]}]},{"description":"Onc mrd gsa cfdna baseline","code_information":[{"code":"0560U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3878.45,"maximum":7082.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4033.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3878.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3994.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4149.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3956.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7082.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4111.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4146.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4343.86,"additional_payer_notes":"APC"}]}]},{"description":"Onc mrd gsa cfdna subsequent","code_information":[{"code":"0561U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":794.49,"maximum":1450.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":826.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":794.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":818.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":850.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":810.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1450.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":842.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":849.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":889.83,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tum tgsa 33gens snvs","code_information":[{"code":"0562U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":597.91,"maximum":1091.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":621.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":597.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":615.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":639.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":609.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1091.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":633.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":639.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":669.66,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds pthgn-sna 11vir&4bct","code_information":[{"code":"0563U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":761.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":761.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":445.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":466.79,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds pthgn-sna 10vir&4bct","code_information":[{"code":"0564U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":761.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":761.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":445.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":466.79,"additional_payer_notes":"APC"}]}]},{"description":"Onc hcc ngs detc 6626epigalt","code_information":[{"code":"0565U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1160.0,"maximum":2118.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1206.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1160.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1194.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1241.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1183.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2118.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1229.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1240.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.2,"additional_payer_notes":"APC"}]}]},{"description":"Onc lng qpcr-bsd alys 13dmrs","code_information":[{"code":"0566U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":761.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":761.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":445.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":466.79,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds whl gen seq srs&lrs","code_information":[{"code":"0567U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5031.2,"maximum":9186.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5232.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5031.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5182.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5383.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5131.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9186.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5333.07,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5378.35,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5634.94,"additional_payer_notes":"APC"}]}]},{"description":"Neurol dementia ?amyl ptau","code_information":[{"code":"0568U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":897.0,"maximum":1637.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":932.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":897.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":923.91,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":959.79,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":914.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1637.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":950.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":958.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1004.64,"additional_payer_notes":"APC"}]}]},{"description":"Neurol tbi alys gfap&uch-l1","code_information":[{"code":"0570U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":260.5,"maximum":475.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":270.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":260.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":268.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":278.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":475.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":276.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":278.47,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":291.76,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tum dna80&rna10g ngs","code_information":[{"code":"0571U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":5331.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3036.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3123.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5331.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3121.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3269.95,"additional_payer_notes":"APC"}]}]},{"description":"Trnsplj med lar rtpcr 4genes","code_information":[{"code":"0575U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":380.0,"maximum":693.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":395.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":380.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":391.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":406.6,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":387.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":693.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":402.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":406.22,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":425.6,"additional_payer_notes":"APC"}]}]},{"description":"Trnsplj med lar quan ddcfdna","code_information":[{"code":"0576U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3240.0,"maximum":5916.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3369.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3240.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3337.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3466.8,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3304.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5916.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3434.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3463.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3628.8,"additional_payer_notes":"APC"}]}]},{"description":"Onc cutan mln rna qpcr 10gen","code_information":[{"code":"0578U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3873.0,"maximum":7072.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4027.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3989.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3950.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7072.1,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4105.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4140.24,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4337.76,"additional_payer_notes":"APC"}]}]},{"description":"Nfro dbtc ckd elisa apoa4","code_information":[{"code":"0579U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":390.75,"maximum":713.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":406.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":390.75,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":402.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":418.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":398.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":713.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":414.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":417.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":437.64,"additional_payer_notes":"APC"}]}]},{"description":"Bbrgdrferi antb detc 24rprtn","code_information":[{"code":"0580U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.21,"maximum":31.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.41,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":31.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.28,"additional_payer_notes":"APC"}]}]},{"description":"Trnspl med antb nohla 39trgt","code_information":[{"code":"0581U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":325.8,"maximum":594.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":338.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":325.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":335.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":348.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":332.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":594.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":345.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":348.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":364.9,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds rpd whlgen dna vrnts","code_information":[{"code":"0582U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7582.2,"maximum":13845.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7885.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7582.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7809.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8112.95,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7733.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13845.1,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8037.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8105.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8492.06,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds rpd whlgen cmptr dna","code_information":[{"code":"0583U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3791.1,"maximum":6922.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3942.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3791.1,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3904.83,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4056.48,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3866.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6922.55,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4018.57,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4052.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4246.03,"additional_payer_notes":"APC"}]}]},{"description":"Neuro csf prion prtn qual","code_information":[{"code":"0584U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":540.99,"maximum":987.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":562.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":540.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":557.22,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":578.86,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":551.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":987.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":573.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":578.32,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":605.91,"additional_payer_notes":"APC"}]}]},{"description":"Tgsap so neo cfdna 521 genes","code_information":[{"code":"0585U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":5331.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3036.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3123.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5331.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3121.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3269.95,"additional_payer_notes":"APC"}]}]},{"description":"Onc mrna gen xprsn 216 genes","code_information":[{"code":"0586U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":5331.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3036.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3123.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5331.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3121.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3269.95,"additional_payer_notes":"APC"}]}]},{"description":"Ther rx mntr 60-150rx&metabl","code_information":[{"code":"0587U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":114.43,"maximum":208.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":119.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":114.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":117.86,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.44,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":116.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":208.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":121.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.33,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":128.16,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bct/vir 32genes mrna","code_information":[{"code":"0588U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1387.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1387.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":812.44,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":851.2,"additional_payer_notes":"APC"}]}]},{"description":"Pfas24cmpnd hi-perf lc-ms/ms","code_information":[{"code":"0589U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":198.74,"maximum":362.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":206.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":198.74,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":204.7,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":212.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":202.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":362.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":210.66,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":212.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":222.59,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 ca 3prtns plsm srm","code_information":[{"code":"0591U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1387.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1387.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":812.44,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":851.2,"additional_payer_notes":"APC"}]}]},{"description":"Onc hl neo dna tgs 417 genes","code_information":[{"code":"0592U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":5331.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3036.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3123.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5331.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3121.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3269.95,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds gu pthgn dna 46trgt","code_information":[{"code":"0593U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":634.84,"maximum":1159.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":660.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":634.84,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":653.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":679.28,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":647.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1159.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":672.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":678.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":711.02,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds tfp vctrbrn&zoonotic","code_information":[{"code":"0595U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":262.99,"maximum":480.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":273.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":262.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":270.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":281.4,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":268.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":480.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":278.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":281.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.55,"additional_payer_notes":"APC"}]}]},{"description":"Gi ibs igg antb 18food items","code_information":[{"code":"0598U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":300.0,"maximum":547.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":312.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":300.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":309.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":321.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":306.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":547.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":318.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":320.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":336.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc pncrtc ca mult ia serum","code_information":[{"code":"0599U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":897.0,"maximum":1637.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":932.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":897.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":923.91,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":959.79,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":914.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1637.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":950.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":958.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1004.64,"additional_payer_notes":"APC"}]}]},{"description":"Routine venipuncture","code_information":[{"code":"36415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.34,"maximum":17.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.62,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.9,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.46,"additional_payer_notes":"APC"}]}]},{"description":"Metabolic panel ionized ca","code_information":[{"code":"80047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.73,"maximum":25.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.69,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.68,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.38,"additional_payer_notes":"APC"}]}]},{"description":"Metabolic panel total ca","code_information":[{"code":"80048","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.46,"maximum":15.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.71,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.48,"additional_payer_notes":"APC"}]}]},{"description":"Electrolyte panel","code_information":[{"code":"80051","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.01,"maximum":12.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.22,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.49,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.85,"additional_payer_notes":"APC"}]}]},{"description":"Comprehen metabolic panel","code_information":[{"code":"80053","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.56,"maximum":19.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.3,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.19,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.83,"additional_payer_notes":"APC"}]}]},{"description":"Obstetric panel","code_information":[{"code":"80055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.81,"maximum":87.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":49.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":48.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":87.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":50.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51.11,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53.55,"additional_payer_notes":"APC"}]}]},{"description":"Lipid panel","code_information":[{"code":"80061","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.39,"maximum":24.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.33,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.19,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.0,"additional_payer_notes":"APC"}]}]},{"description":"Renal function panel","code_information":[{"code":"80069","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.68,"maximum":15.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.94,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.72,"additional_payer_notes":"APC"}]}]},{"description":"Acute hepatitis panel","code_information":[{"code":"80074","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.63,"maximum":86.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":49.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":48.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":86.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":50.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53.35,"additional_payer_notes":"APC"}]}]},{"description":"Hepatic function panel","code_information":[{"code":"80076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.17,"maximum":14.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.42,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.66,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.15,"additional_payer_notes":"APC"}]}]},{"description":"Obstetric panel","code_information":[{"code":"80081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":74.86,"maximum":136.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":77.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":77.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":76.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":136.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":79.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80.03,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":83.84,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay acetaminophen","code_information":[{"code":"80143","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.64,"maximum":34.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.88,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay adalimumab","code_information":[{"code":"80145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.57,"maximum":70.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.57,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":70.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.2,"additional_payer_notes":"APC"}]}]},{"description":"Assay of amikacin","code_information":[{"code":"80150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.08,"maximum":27.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.08,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.12,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.89,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay amiodarone","code_information":[{"code":"80151","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.64,"maximum":34.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.88,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay caffeine","code_information":[{"code":"80155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.57,"maximum":70.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.57,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":70.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.2,"additional_payer_notes":"APC"}]}]},{"description":"Assay carbamazepine total","code_information":[{"code":"80156","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.57,"maximum":26.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.57,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.59,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.58,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.32,"additional_payer_notes":"APC"}]}]},{"description":"Assay carbamazepine free","code_information":[{"code":"80157","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.25,"maximum":24.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.84,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay cyclosporine","code_information":[{"code":"80158","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.05,"maximum":32.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.59,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.31,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.3,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.22,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay clozapine","code_information":[{"code":"80159","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.15,"maximum":36.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.75,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.56,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.57,"additional_payer_notes":"APC"}]}]},{"description":"Asy carbamazepin 10,11-epxid","code_information":[{"code":"80161","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.64,"maximum":34.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.88,"additional_payer_notes":"APC"}]}]},{"description":"Assay of digoxin total","code_information":[{"code":"80162","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.28,"maximum":24.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.28,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.68,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.21,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.08,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.2,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.87,"additional_payer_notes":"APC"}]}]},{"description":"Assay of digoxin free","code_information":[{"code":"80163","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.28,"maximum":24.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.28,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.68,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.21,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.08,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.2,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.87,"additional_payer_notes":"APC"}]}]},{"description":"Assay dipropylacetic acd tot","code_information":[{"code":"80164","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.54,"maximum":24.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.47,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.16,"additional_payer_notes":"APC"}]}]},{"description":"Dipropylacetic acid free","code_information":[{"code":"80165","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.54,"maximum":24.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.47,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.16,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay felbamate","code_information":[{"code":"80167","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.64,"maximum":34.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.88,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ethosuximide","code_information":[{"code":"80168","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.34,"maximum":29.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.83,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.48,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":29.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.47,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.3,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay everolimus","code_information":[{"code":"80169","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.73,"maximum":25.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.69,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.68,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.38,"additional_payer_notes":"APC"}]}]},{"description":"Assay of gentamicin","code_information":[{"code":"80170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.38,"maximum":29.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.38,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.87,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.53,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":29.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.35,"additional_payer_notes":"APC"}]}]},{"description":"Drug screen quant gabapentin","code_information":[{"code":"80171","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.67,"maximum":39.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.67,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.19,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":39.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.27,"additional_payer_notes":"APC"}]}]},{"description":"Assay Of Haloperidol","code_information":[{"code":"80173","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.78,"maximum":28.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.88,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.87,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.67,"additional_payer_notes":"APC"}]}]},{"description":"Drug screen quan lamotrigine","code_information":[{"code":"80175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.25,"maximum":24.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.84,"additional_payer_notes":"APC"}]}]},{"description":"Assay of lidocaine","code_information":[{"code":"80176","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.69,"maximum":26.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.69,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.72,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.57,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.45,"additional_payer_notes":"APC"}]}]},{"description":"Drug scrn quan levetiracetam","code_information":[{"code":"80177","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.25,"maximum":24.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.84,"additional_payer_notes":"APC"}]}]},{"description":"Assay of lithium","code_information":[{"code":"80178","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.61,"maximum":12.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.87,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.61,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.81,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.07,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.07,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.4,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay salicylate","code_information":[{"code":"80179","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.64,"maximum":34.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.88,"additional_payer_notes":"APC"}]}]},{"description":"Drug scrn quan mycophenolate","code_information":[{"code":"80180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.05,"maximum":32.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.59,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.31,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.3,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.22,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay flecainide","code_information":[{"code":"80181","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.64,"maximum":34.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.88,"additional_payer_notes":"APC"}]}]},{"description":"Drug scrn quant oxcarbazepin","code_information":[{"code":"80183","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.25,"maximum":24.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.84,"additional_payer_notes":"APC"}]}]},{"description":"Assay of phenobarbital","code_information":[{"code":"80184","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.3,"maximum":27.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.14,"additional_payer_notes":"APC"}]}]},{"description":"Assay of phenytoin total","code_information":[{"code":"80185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.25,"maximum":24.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.84,"additional_payer_notes":"APC"}]}]},{"description":"Assay of phenytoin free","code_information":[{"code":"80186","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.76,"maximum":25.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.76,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.72,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.41,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay posaconazole","code_information":[{"code":"80187","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.11,"maximum":49.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.19,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.11,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.01,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":49.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.36,"additional_payer_notes":"APC"}]}]},{"description":"Assay of primidone","code_information":[{"code":"80188","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.59,"maximum":30.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.09,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.58,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay itraconzaole","code_information":[{"code":"80189","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.11,"maximum":49.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.19,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.11,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.01,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":49.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.36,"additional_payer_notes":"APC"}]}]},{"description":"Assay of procainamide","code_information":[{"code":"80190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":60.0,"maximum":109.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":62.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":61.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":61.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":109.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":67.2,"additional_payer_notes":"APC"}]}]},{"description":"Assay of procainamide","code_information":[{"code":"80192","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.75,"maximum":30.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.42,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.75,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.91,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.76,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay leflunomide","code_information":[{"code":"80193","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.57,"maximum":70.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.57,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":70.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.2,"additional_payer_notes":"APC"}]}]},{"description":"Assay of quinidine","code_information":[{"code":"80194","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.6,"maximum":26.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.04,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.61,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.35,"additional_payer_notes":"APC"}]}]},{"description":"Assay of sirolimus","code_information":[{"code":"80195","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.73,"maximum":25.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.69,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.68,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.38,"additional_payer_notes":"APC"}]}]},{"description":"Assay of tacrolimus","code_information":[{"code":"80197","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.73,"maximum":25.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.69,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.68,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.38,"additional_payer_notes":"APC"}]}]},{"description":"Assay of theophylline","code_information":[{"code":"80198","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.14,"maximum":25.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.13,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.12,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.84,"additional_payer_notes":"APC"}]}]},{"description":"Drug screen quant tiagabine","code_information":[{"code":"80199","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.11,"maximum":49.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.19,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.11,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.01,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":49.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.36,"additional_payer_notes":"APC"}]}]},{"description":"Assay of tobramycin","code_information":[{"code":"80200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.13,"maximum":29.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.13,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.26,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":29.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.24,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.07,"additional_payer_notes":"APC"}]}]},{"description":"Assay of topiramate","code_information":[{"code":"80201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.92,"maximum":21.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.77,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.64,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.74,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.35,"additional_payer_notes":"APC"}]}]},{"description":"Assay of vancomycin","code_information":[{"code":"80202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.54,"maximum":24.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.47,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.16,"additional_payer_notes":"APC"}]}]},{"description":"Drug screen quant zonisamide","code_information":[{"code":"80203","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.25,"maximum":24.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.84,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay methotrexate","code_information":[{"code":"80204","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.57,"maximum":70.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.57,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":70.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.2,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay rufinamide","code_information":[{"code":"80210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.11,"maximum":49.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.19,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.11,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.01,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":49.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.36,"additional_payer_notes":"APC"}]}]},{"description":"Drug asy hydroxychloroquine","code_information":[{"code":"80220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.64,"maximum":34.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.88,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay infliximab","code_information":[{"code":"80230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.57,"maximum":70.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.57,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":70.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.2,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay lacosamide","code_information":[{"code":"80235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.11,"maximum":49.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.19,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.11,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.01,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":49.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.36,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay vedolizumab","code_information":[{"code":"80280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.57,"maximum":70.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.57,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":70.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.2,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay voriconazole","code_information":[{"code":"80285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.11,"maximum":49.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.19,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.11,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.01,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":49.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.36,"additional_payer_notes":"APC"}]}]},{"description":"Quantitative assay drug","code_information":[{"code":"80299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.64,"maximum":34.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.88,"additional_payer_notes":"APC"}]}]},{"description":"Drug test prsmv dir opt obs","code_information":[{"code":"80305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.6,"maximum":23.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.1,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.98,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.48,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.47,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.11,"additional_payer_notes":"APC"}]}]},{"description":"Drug test prsmv instrmnt","code_information":[{"code":"80306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.14,"maximum":31.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.34,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":31.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.17,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.32,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.2,"additional_payer_notes":"APC"}]}]},{"description":"Drug test prsmv chem anlyzr","code_information":[{"code":"80307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":62.14,"maximum":113.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":64.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":66.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":113.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.87,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":66.43,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.6,"additional_payer_notes":"APC"}]}]},{"description":"Acth stimulation panel","code_information":[{"code":"80400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.62,"maximum":59.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.62,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34.9,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":59.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34.87,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.53,"additional_payer_notes":"APC"}]}]},{"description":"Acth stimulation panel","code_information":[{"code":"80402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.96,"maximum":158.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":90.44,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":89.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":93.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":88.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":158.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":92.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.4,"additional_payer_notes":"APC"}]}]},{"description":"Acth stimulation panel","code_information":[{"code":"80406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":78.26,"maximum":142.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":81.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":80.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":83.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":79.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":142.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":82.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":83.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":87.65,"additional_payer_notes":"APC"}]}]},{"description":"Aldosterone suppression eval","code_information":[{"code":"80408","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":125.5,"maximum":229.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":130.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":125.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":129.26,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":134.28,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":128.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":229.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":134.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":140.56,"additional_payer_notes":"APC"}]}]},{"description":"Calcitonin stimul panel","code_information":[{"code":"80410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.37,"maximum":146.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":83.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":82.78,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":86.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":81.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":146.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":85.19,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":85.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":90.01,"additional_payer_notes":"APC"}]}]},{"description":"CRH stimulation panel","code_information":[{"code":"80412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":801.62,"maximum":1463.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":833.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":801.62,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":825.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":857.73,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":817.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1463.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":849.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":856.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":897.81,"additional_payer_notes":"APC"}]}]},{"description":"Testosterone response","code_information":[{"code":"80414","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.64,"maximum":94.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":53.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":55.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":52.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":94.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":54.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":55.2,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57.84,"additional_payer_notes":"APC"}]}]},{"description":"Estradiol response panel","code_information":[{"code":"80415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":55.89,"maximum":102.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55.89,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":57.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":59.8,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":57.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":102.06,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":59.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":59.75,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":62.6,"additional_payer_notes":"APC"}]}]},{"description":"Renin stimulation panel","code_information":[{"code":"80416","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.32,"maximum":382.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":382.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":221.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.76,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":234.44,"additional_payer_notes":"APC"}]}]},{"description":"Renin stimulation panel","code_information":[{"code":"80417","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":43.99,"maximum":80.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":45.31,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47.07,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":80.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":46.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47.03,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49.27,"additional_payer_notes":"APC"}]}]},{"description":"Pituitary evaluation panel","code_information":[{"code":"80418","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":579.48,"maximum":1058.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":602.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":579.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":596.86,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":620.04,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":591.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1058.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":614.25,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":619.46,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":649.02,"additional_payer_notes":"APC"}]}]},{"description":"Dexamethasone panel","code_information":[{"code":"80420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":161.88,"maximum":295.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":168.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":161.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":166.74,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":173.21,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":165.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":295.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":171.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":173.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.31,"additional_payer_notes":"APC"}]}]},{"description":"Glucagon tolerance panel","code_information":[{"code":"80422","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":46.07,"maximum":84.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46.07,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":47.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":46.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":84.12,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":48.83,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49.25,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51.6,"additional_payer_notes":"APC"}]}]},{"description":"Glucagon tolerance panel","code_information":[{"code":"80424","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":50.5,"maximum":92.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":52.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.04,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":51.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":92.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":53.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56.56,"additional_payer_notes":"APC"}]}]},{"description":"Gonadotropin hormone panel","code_information":[{"code":"80426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.41,"maximum":271.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":154.35,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.41,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":152.86,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":158.8,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":151.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":271.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":157.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":158.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":166.22,"additional_payer_notes":"APC"}]}]},{"description":"Growth hormone panel","code_information":[{"code":"80428","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":66.7,"maximum":121.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.37,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":68.7,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":71.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":68.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":121.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":70.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":71.3,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":74.7,"additional_payer_notes":"APC"}]}]},{"description":"Growth hormone panel","code_information":[{"code":"80430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.33,"maximum":236.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":134.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":129.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":131.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":236.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":137.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.25,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.85,"additional_payer_notes":"APC"}]}]},{"description":"Insulin suppression panel","code_information":[{"code":"80432","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":165.61,"maximum":302.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":172.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":165.61,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":170.58,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":177.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":168.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":302.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":175.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":177.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.48,"additional_payer_notes":"APC"}]}]},{"description":"Insulin tolerance panel","code_information":[{"code":"80434","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":285.03,"maximum":520.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":296.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":285.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":293.58,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":304.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":290.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":520.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":302.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":304.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":319.23,"additional_payer_notes":"APC"}]}]},{"description":"Insulin tolerance panel","code_information":[{"code":"80435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.0,"maximum":188.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":107.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":103.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":106.09,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":110.21,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":105.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":188.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":109.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":110.11,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":115.36,"additional_payer_notes":"APC"}]}]},{"description":"Metyrapone panel","code_information":[{"code":"80436","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":91.16,"maximum":166.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91.16,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.54,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":92.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":166.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":102.1,"additional_payer_notes":"APC"}]}]},{"description":"TRH stimulation panel","code_information":[{"code":"80438","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":50.41,"maximum":92.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50.41,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":51.92,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":51.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":92.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":53.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56.46,"additional_payer_notes":"APC"}]}]},{"description":"TRH stimulation panel","code_information":[{"code":"80439","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":67.21,"maximum":122.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":69.23,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":71.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":68.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":122.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":71.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":71.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":75.28,"additional_payer_notes":"APC"}]}]},{"description":"Urinalysis nonauto w/scope","code_information":[{"code":"81000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.02,"maximum":7.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.02,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.3,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.3,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.5,"additional_payer_notes":"APC"}]}]},{"description":"Urinalysis auto w/scope","code_information":[{"code":"81001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.17,"maximum":5.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.39,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.39,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.55,"additional_payer_notes":"APC"}]}]},{"description":"Urinalysis nonauto w/o scope","code_information":[{"code":"81002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.48,"maximum":6.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3.58,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.72,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3.69,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.72,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.9,"additional_payer_notes":"APC"}]}]},{"description":"Urinalysis auto w/o scope","code_information":[{"code":"81003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2.25,"maximum":4.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2.41,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":4.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2.52,"additional_payer_notes":"APC"}]}]},{"description":"Urinalysis","code_information":[{"code":"81005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2.17,"maximum":3.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2.32,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2.43,"additional_payer_notes":"APC"}]}]},{"description":"Urine screen for bacteria","code_information":[{"code":"81007","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.98,"maximum":54.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.08,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":54.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.58,"additional_payer_notes":"APC"}]}]},{"description":"Microscopic exam of urine","code_information":[{"code":"81015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.05,"maximum":5.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.26,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.42,"additional_payer_notes":"APC"}]}]},{"description":"Urinalysis glass test","code_information":[{"code":"81020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.7,"maximum":8.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.03,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":8.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.02,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.26,"additional_payer_notes":"APC"}]}]},{"description":"Urine pregnancy test","code_information":[{"code":"81025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.61,"maximum":15.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.61,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.87,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.21,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.2,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.64,"additional_payer_notes":"APC"}]}]},{"description":"Urinalysis volume measure","code_information":[{"code":"81050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.64,"maximum":6.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.79,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3.75,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.89,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6.65,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.08,"additional_payer_notes":"APC"}]}]},{"description":"Hpa-1 genotyping","code_information":[{"code":"81105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.22,"maximum":223.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":127.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":122.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":125.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":130.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":124.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":223.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":129.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":130.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":136.89,"additional_payer_notes":"APC"}]}]},{"description":"Hpa-2 genotyping","code_information":[{"code":"81106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.22,"maximum":223.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":127.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":122.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":125.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":130.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":124.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":223.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":129.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":130.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":136.89,"additional_payer_notes":"APC"}]}]},{"description":"Hpa-3 genotyping","code_information":[{"code":"81107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.22,"maximum":223.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":127.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":122.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":125.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":130.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":124.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":223.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":129.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":130.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":136.89,"additional_payer_notes":"APC"}]}]},{"description":"Hpa-4 genotyping","code_information":[{"code":"81108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.22,"maximum":223.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":127.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":122.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":125.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":130.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":124.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":223.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":129.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":130.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":136.89,"additional_payer_notes":"APC"}]}]},{"description":"Hpa-5 genotyping","code_information":[{"code":"81109","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.22,"maximum":223.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":127.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":122.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":125.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":130.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":124.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":223.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":129.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":130.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":136.89,"additional_payer_notes":"APC"}]}]},{"description":"Hpa-6 genotyping","code_information":[{"code":"81110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.22,"maximum":223.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":127.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":122.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":125.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":130.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":124.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":223.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":129.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":130.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":136.89,"additional_payer_notes":"APC"}]}]},{"description":"Hpa-9 genotyping","code_information":[{"code":"81111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.22,"maximum":223.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":127.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":122.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":125.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":130.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":124.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":223.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":129.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":130.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":136.89,"additional_payer_notes":"APC"}]}]},{"description":"Hpa-15 genotyping","code_information":[{"code":"81112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.22,"maximum":223.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":127.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":122.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":125.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":130.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":124.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":223.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":129.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":130.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":136.89,"additional_payer_notes":"APC"}]}]},{"description":"Idh1 common variants","code_information":[{"code":"81120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.25,"maximum":352.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":200.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":199.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":206.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":197.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":352.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":204.84,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":206.58,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":216.44,"additional_payer_notes":"APC"}]}]},{"description":"Idh2 common variants","code_information":[{"code":"81121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":295.79,"maximum":540.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":307.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":295.79,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":304.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":316.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":301.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":540.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":313.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":316.2,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":331.28,"additional_payer_notes":"APC"}]}]},{"description":"DMD dup/delet analysis","code_information":[{"code":"81161","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":279.0,"maximum":509.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":290.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":279.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":287.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":298.53,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":284.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":509.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":295.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":298.25,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":312.48,"additional_payer_notes":"APC"}]}]},{"description":"Brca1&2 seq & full dup/del","code_information":[{"code":"81162","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1824.88,"maximum":3332.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1897.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1824.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1879.63,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1952.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1861.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3332.23,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1934.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1950.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2043.87,"additional_payer_notes":"APC"}]}]},{"description":"Brca1&2 gene full seq alys","code_information":[{"code":"81163","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":468.0,"maximum":854.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":486.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":468.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":482.04,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":500.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":477.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":854.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":496.08,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":500.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":524.16,"additional_payer_notes":"APC"}]}]},{"description":"Brca1&2 gen ful dup/del alys","code_information":[{"code":"81164","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":584.23,"maximum":1066.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":607.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":584.23,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":601.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":625.13,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":595.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1066.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":619.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":624.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":654.34,"additional_payer_notes":"APC"}]}]},{"description":"Brca1 gene full seq alys","code_information":[{"code":"81165","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":516.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":302.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":516.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":299.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":302.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":316.83,"additional_payer_notes":"APC"}]}]},{"description":"Brca1 gene full dup/del alys","code_information":[{"code":"81166","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":301.35,"maximum":550.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":313.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":301.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":310.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":322.44,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":307.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":550.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":319.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":322.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":337.51,"additional_payer_notes":"APC"}]}]},{"description":"Brca2 gene full dup/del alys","code_information":[{"code":"81167","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":516.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":302.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":516.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":299.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":302.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":316.83,"additional_payer_notes":"APC"}]}]},{"description":"Ccnd1/igh translocation alys","code_information":[{"code":"81168","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":207.31,"maximum":378.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":215.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":207.31,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":221.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":211.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":378.55,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":219.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":221.61,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":232.19,"additional_payer_notes":"APC"}]}]},{"description":"Abl1 gene","code_information":[{"code":"81170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":300.0,"maximum":547.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":312.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":300.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":309.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":321.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":306.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":547.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":318.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":320.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":336.0,"additional_payer_notes":"APC"}]}]},{"description":"Aff2 gene detc abnor alleles","code_information":[{"code":"81171","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":250.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":250.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":153.44,"additional_payer_notes":"APC"}]}]},{"description":"Aff2 gene charac alleles","code_information":[{"code":"81172","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":501.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":293.79,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":307.81,"additional_payer_notes":"APC"}]}]},{"description":"Ar gene full gene sequence","code_information":[{"code":"81173","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":301.35,"maximum":550.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":313.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":301.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":310.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":322.44,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":307.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":550.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":319.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":322.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":337.51,"additional_payer_notes":"APC"}]}]},{"description":"Ar gene known famil variant","code_information":[{"code":"81174","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":338.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":192.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":198.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":338.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":196.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":197.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":207.42,"additional_payer_notes":"APC"}]}]},{"description":"Asxl1 full gene sequence","code_information":[{"code":"81175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.5,"maximum":1235.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":703.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":676.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":696.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":723.86,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":690.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1235.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":717.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":723.18,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":757.68,"additional_payer_notes":"APC"}]}]},{"description":"Asxl1 gene target seq alys","code_information":[{"code":"81176","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":241.9,"maximum":441.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":251.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":241.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":249.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":258.83,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":246.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":441.71,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":258.59,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":270.93,"additional_payer_notes":"APC"}]}]},{"description":"Atn1 gene detc abnor alleles","code_information":[{"code":"81177","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":250.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":250.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":153.44,"additional_payer_notes":"APC"}]}]},{"description":"Atxn1 gene detc abnor allele","code_information":[{"code":"81178","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":250.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":250.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":153.44,"additional_payer_notes":"APC"}]}]},{"description":"Atxn2 gene detc abnor allele","code_information":[{"code":"81179","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":250.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":250.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":153.44,"additional_payer_notes":"APC"}]}]},{"description":"Atxn3 gene detc abnor allele","code_information":[{"code":"81180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":250.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":250.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":153.44,"additional_payer_notes":"APC"}]}]},{"description":"Atxn7 gene detc abnor allele","code_information":[{"code":"81181","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":250.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":250.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":153.44,"additional_payer_notes":"APC"}]}]},{"description":"Atxn8os gen detc abnor allel","code_information":[{"code":"81182","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":250.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":250.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":153.44,"additional_payer_notes":"APC"}]}]},{"description":"Atxn10 gene detc abnor allel","code_information":[{"code":"81183","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":250.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":250.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":153.44,"additional_payer_notes":"APC"}]}]},{"description":"Cacna1a gen detc abnor allel","code_information":[{"code":"81184","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":250.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":250.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":153.44,"additional_payer_notes":"APC"}]}]},{"description":"Cacna1a gene full gene seq","code_information":[{"code":"81185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":846.27,"maximum":1545.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":880.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":846.27,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":871.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":905.51,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":863.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1545.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":897.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":904.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"}]}]},{"description":"Cacna1a gen known famil vrnt","code_information":[{"code":"81186","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":338.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":192.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":198.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":338.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":196.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":197.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":207.42,"additional_payer_notes":"APC"}]}]},{"description":"Cnbp gene detc abnor allele","code_information":[{"code":"81187","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":250.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":250.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":153.44,"additional_payer_notes":"APC"}]}]},{"description":"Cstb gene detc abnor allele","code_information":[{"code":"81188","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":250.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":250.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":153.44,"additional_payer_notes":"APC"}]}]},{"description":"Cstb gene full gene sequence","code_information":[{"code":"81189","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":501.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":293.79,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":307.81,"additional_payer_notes":"APC"}]}]},{"description":"Cstb gene known famil vrnt","code_information":[{"code":"81190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":338.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":192.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":198.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":338.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":196.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":197.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":207.42,"additional_payer_notes":"APC"}]}]},{"description":"Ntrk1 translocation analysis","code_information":[{"code":"81191","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":207.31,"maximum":378.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":215.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":207.31,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":221.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":211.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":378.55,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":219.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":221.61,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":232.19,"additional_payer_notes":"APC"}]}]},{"description":"Ntrk2 translocation analysis","code_information":[{"code":"81192","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":207.31,"maximum":378.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":215.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":207.31,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":221.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":211.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":378.55,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":219.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":221.61,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":232.19,"additional_payer_notes":"APC"}]}]},{"description":"Ntrk3 translocation analysis","code_information":[{"code":"81193","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":207.31,"maximum":378.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":215.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":207.31,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":221.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":211.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":378.55,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":219.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":221.61,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":232.19,"additional_payer_notes":"APC"}]}]},{"description":"Ntrk translocation analysis","code_information":[{"code":"81194","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":518.28,"maximum":946.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":539.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":518.28,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":533.83,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":554.56,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":528.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":946.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":549.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":554.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":580.47,"additional_payer_notes":"APC"}]}]},{"description":"Cytog genom-wid alys hem mal","code_information":[{"code":"81195","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1863.22,"maximum":3402.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1937.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1863.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1919.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1993.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1900.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3402.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1975.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1991.78,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2086.81,"additional_payer_notes":"APC"}]}]},{"description":"Aspa gene","code_information":[{"code":"81200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.25,"maximum":86.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":48.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50.56,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":48.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":86.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":50.08,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.92,"additional_payer_notes":"APC"}]}]},{"description":"Apc gene full sequence","code_information":[{"code":"81201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":780.0,"maximum":1424.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":811.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":780.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":803.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":834.6,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":795.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1424.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":826.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":833.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":873.6,"additional_payer_notes":"APC"}]}]},{"description":"Apc gene known fam variants","code_information":[{"code":"81202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":280.0,"maximum":511.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":291.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":280.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":288.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":299.6,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":285.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":511.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":296.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":299.32,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":313.6,"additional_payer_notes":"APC"}]}]},{"description":"Apc gene dup/delet variants","code_information":[{"code":"81203","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":200.0,"maximum":365.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":208.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":200.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":206.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":214.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":204.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":365.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":212.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":213.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":224.0,"additional_payer_notes":"APC"}]}]},{"description":"Ar gene charac alleles","code_information":[{"code":"81204","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":250.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":250.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":153.44,"additional_payer_notes":"APC"}]}]},{"description":"Bckdhb gene","code_information":[{"code":"81205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":94.99,"maximum":173.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":98.79,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":97.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":173.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":100.69,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":106.39,"additional_payer_notes":"APC"}]}]},{"description":"Bcr/abl1 gene major bp","code_information":[{"code":"81206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":163.96,"maximum":299.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":170.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":163.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":168.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":175.44,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":167.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":299.39,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":173.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":175.27,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":183.64,"additional_payer_notes":"APC"}]}]},{"description":"Bcr/abl1 gene minor bp","code_information":[{"code":"81207","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":144.84,"maximum":264.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":144.84,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":149.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":154.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":264.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":153.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":154.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":162.22,"additional_payer_notes":"APC"}]}]},{"description":"Bcr/abl1 gene other bp","code_information":[{"code":"81208","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.62,"maximum":391.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":214.62,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":221.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":229.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":218.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":391.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":227.5,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":229.43,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":240.37,"additional_payer_notes":"APC"}]}]},{"description":"Blm gene","code_information":[{"code":"81209","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.31,"maximum":71.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.31,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.49,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42.02,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44.03,"additional_payer_notes":"APC"}]}]},{"description":"Braf gene","code_information":[{"code":"81210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.4,"maximum":320.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":182.42,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175.4,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":180.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":187.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":178.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":320.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":185.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":187.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":196.45,"additional_payer_notes":"APC"}]}]},{"description":"Brca1&2 185&5385&6174 var","code_information":[{"code":"81212","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":440.0,"maximum":803.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":457.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":440.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":453.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":470.8,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":448.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":803.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":466.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":470.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":492.8,"additional_payer_notes":"APC"}]}]},{"description":"Brca1 gene known fam variant","code_information":[{"code":"81215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":375.25,"maximum":685.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":390.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.51,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":401.52,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":382.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":685.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":401.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":420.28,"additional_payer_notes":"APC"}]}]},{"description":"Brca2 gene full sequence","code_information":[{"code":"81216","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.12,"maximum":338.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":192.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":185.12,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":190.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":198.08,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":338.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":196.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":197.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":207.33,"additional_payer_notes":"APC"}]}]},{"description":"Brca2 gene known fam variant","code_information":[{"code":"81217","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":375.25,"maximum":685.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":390.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.51,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":401.52,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":382.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":685.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":401.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":420.28,"additional_payer_notes":"APC"}]}]},{"description":"Cebpa gene full sequence","code_information":[{"code":"81218","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":241.9,"maximum":441.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":251.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":241.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":249.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":258.83,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":246.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":441.71,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":256.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":258.59,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":270.93,"additional_payer_notes":"APC"}]}]},{"description":"Calr gene com variants","code_information":[{"code":"81219","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":121.63,"maximum":222.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":126.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":121.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":125.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":130.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":124.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":222.1,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":128.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":130.02,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":136.23,"additional_payer_notes":"APC"}]}]},{"description":"Cftr gene com variants","code_information":[{"code":"81220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":556.6,"maximum":1016.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":578.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":556.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":573.3,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":595.56,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":567.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1016.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":590.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":595.01,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":623.39,"additional_payer_notes":"APC"}]}]},{"description":"Cftr gene known fam variants","code_information":[{"code":"81221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.22,"maximum":177.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":100.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":104.03,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":99.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":177.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":103.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":103.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":108.89,"additional_payer_notes":"APC"}]}]},{"description":"Cftr gene dup/delet variants","code_information":[{"code":"81222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.07,"maximum":794.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":452.47,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.07,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":448.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":465.52,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":443.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":794.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":461.17,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":465.09,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":487.28,"additional_payer_notes":"APC"}]}]},{"description":"Cftr gene full sequence","code_information":[{"code":"81223","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":499.0,"maximum":911.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":518.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":499.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":513.97,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":533.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":508.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":911.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":528.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":533.43,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":558.88,"additional_payer_notes":"APC"}]}]},{"description":"Cftr gene intron poly t","code_information":[{"code":"81224","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":168.75,"maximum":308.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":175.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":168.75,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":173.81,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":180.56,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":172.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":308.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":178.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":180.39,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":189.0,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2c19 gene com variants","code_information":[{"code":"81225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":291.36,"maximum":532.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":303.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":291.36,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":300.1,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":311.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":297.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":532.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":308.84,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":311.46,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":326.32,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2d6 gene com variants","code_information":[{"code":"81226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":450.91,"maximum":823.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":468.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":450.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":464.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":482.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":459.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":823.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":477.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":482.02,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":505.02,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2c9 gene com variants","code_information":[{"code":"81227","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.81,"maximum":319.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":180.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":178.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":319.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":185.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":186.87,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.79,"additional_payer_notes":"APC"}]}]},{"description":"Cytogen micrarray copy nmbr","code_information":[{"code":"81228","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":900.0,"maximum":1643.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":936.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":900.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":927.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":963.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":918.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1643.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":954.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":962.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1008.0,"additional_payer_notes":"APC"}]}]},{"description":"Cytogen m array copy no&snp","code_information":[{"code":"81229","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1160.0,"maximum":2118.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1206.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1160.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1194.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1241.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1183.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2118.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1229.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1240.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.2,"additional_payer_notes":"APC"}]}]},{"description":"Cyp3a4 gene common variants","code_information":[{"code":"81230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.81,"maximum":319.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":180.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":178.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":319.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":185.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":186.87,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.79,"additional_payer_notes":"APC"}]}]},{"description":"Cyp3a5 gene common variants","code_information":[{"code":"81231","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.81,"maximum":319.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":180.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":178.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":319.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":185.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":186.87,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.79,"additional_payer_notes":"APC"}]}]},{"description":"Dpyd gene common variants","code_information":[{"code":"81232","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.81,"maximum":319.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":180.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":178.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":319.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":185.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":186.87,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.79,"additional_payer_notes":"APC"}]}]},{"description":"Btk gene common variants","code_information":[{"code":"81233","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.4,"maximum":320.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":182.42,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175.4,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":180.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":187.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":178.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":320.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":185.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":187.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":196.45,"additional_payer_notes":"APC"}]}]},{"description":"Dmpk gene detc abnor allele","code_information":[{"code":"81234","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":250.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":250.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":153.44,"additional_payer_notes":"APC"}]}]},{"description":"Egfr gene com variants","code_information":[{"code":"81235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":324.58,"maximum":592.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":337.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":324.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":334.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":347.3,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":331.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":592.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":344.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":346.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":363.53,"additional_payer_notes":"APC"}]}]},{"description":"Ezh2 gene full gene sequence","code_information":[{"code":"81236","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":516.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":302.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":516.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":299.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":302.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":316.83,"additional_payer_notes":"APC"}]}]},{"description":"Ezh2 gene common variants","code_information":[{"code":"81237","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.4,"maximum":320.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":182.42,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175.4,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":180.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":187.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":178.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":320.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":185.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":187.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":196.45,"additional_payer_notes":"APC"}]}]},{"description":"F9 full gene sequence","code_information":[{"code":"81238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":600.0,"maximum":1095.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":624.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":600.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":618.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":642.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":612.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1095.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":636.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":641.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":672.0,"additional_payer_notes":"APC"}]}]},{"description":"Dmpk gene charac alleles","code_information":[{"code":"81239","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":501.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":293.79,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":307.81,"additional_payer_notes":"APC"}]}]},{"description":"F2 gene","code_information":[{"code":"81240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.69,"maximum":119.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":68.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.69,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":67.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":70.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":67.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":119.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":69.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":70.22,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":73.57,"additional_payer_notes":"APC"}]}]},{"description":"F5 gene","code_information":[{"code":"81241","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":73.37,"maximum":133.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":76.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":75.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":78.51,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":74.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":133.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":77.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":78.43,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":82.17,"additional_payer_notes":"APC"}]}]},{"description":"Fancc gene","code_information":[{"code":"81242","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.62,"maximum":66.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36.62,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.72,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":66.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.01,"additional_payer_notes":"APC"}]}]},{"description":"Fmr1 gene detection","code_information":[{"code":"81243","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":57.04,"maximum":104.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":59.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57.04,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":58.75,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":61.03,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":58.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":104.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":60.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":63.88,"additional_payer_notes":"APC"}]}]},{"description":"Fmr1 gene characterization","code_information":[{"code":"81244","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.89,"maximum":81.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44.89,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":46.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48.03,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":45.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":81.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":47.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47.99,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50.28,"additional_payer_notes":"APC"}]}]},{"description":"Flt3 gene","code_information":[{"code":"81245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":165.51,"maximum":302.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":172.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":165.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":170.48,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":177.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":168.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":302.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":175.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":176.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.37,"additional_payer_notes":"APC"}]}]},{"description":"Flt3 gene analysis","code_information":[{"code":"81246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.0,"maximum":151.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":86.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":85.49,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":88.81,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":84.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":151.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":87.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":88.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":92.96,"additional_payer_notes":"APC"}]}]},{"description":"G6pd gene alys cmn variant","code_information":[{"code":"81247","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.81,"maximum":319.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":180.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":178.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":319.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":185.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":186.87,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.79,"additional_payer_notes":"APC"}]}]},{"description":"G6pd known familial variant","code_information":[{"code":"81248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":375.25,"maximum":685.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":390.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.51,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":401.52,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":382.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":685.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":401.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":420.28,"additional_payer_notes":"APC"}]}]},{"description":"G6pd full gene sequence","code_information":[{"code":"81249","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":600.0,"maximum":1095.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":624.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":600.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":618.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":642.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":612.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1095.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":636.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":641.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":672.0,"additional_payer_notes":"APC"}]}]},{"description":"G6pc gene","code_information":[{"code":"81250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.49,"maximum":106.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":60.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":62.58,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":59.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":106.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":62.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.51,"additional_payer_notes":"APC"}]}]},{"description":"Gba gene","code_information":[{"code":"81251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.25,"maximum":86.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":48.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50.56,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":48.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":86.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":50.08,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.92,"additional_payer_notes":"APC"}]}]},{"description":"Gjb2 gene full sequence","code_information":[{"code":"81252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":101.12,"maximum":184.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":105.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":101.12,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":104.15,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":108.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":103.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":184.65,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":107.19,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":108.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.25,"additional_payer_notes":"APC"}]}]},{"description":"Gjb2 gene known fam variants","code_information":[{"code":"81253","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.52,"maximum":112.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":63.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.83,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.76,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":68.9,"additional_payer_notes":"APC"}]}]},{"description":"Gjb6 gene com variants","code_information":[{"code":"81254","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.0,"maximum":63.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":63.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.2,"additional_payer_notes":"APC"}]}]},{"description":"Hexa gene","code_information":[{"code":"81255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.45,"maximum":93.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":52.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":55.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":52.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":93.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":54.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":55.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57.62,"additional_payer_notes":"APC"}]}]},{"description":"Hfe gene","code_information":[{"code":"81256","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.36,"maximum":119.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":67.97,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.36,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":67.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":66.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":119.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":69.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.87,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":73.2,"additional_payer_notes":"APC"}]}]},{"description":"Hba1/hba2 gene","code_information":[{"code":"81257","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":102.26,"maximum":186.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":106.35,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":105.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":109.42,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":104.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":186.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":108.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":109.32,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":114.53,"additional_payer_notes":"APC"}]}]},{"description":"Hba1/hba2 gene fam vrnt","code_information":[{"code":"81258","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":375.25,"maximum":685.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":390.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.51,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":401.52,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":382.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":685.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":401.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":420.28,"additional_payer_notes":"APC"}]}]},{"description":"Hba1/hba2 full gene sequence","code_information":[{"code":"81259","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":600.0,"maximum":1095.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":624.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":600.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":618.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":642.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":612.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1095.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":636.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":641.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":672.0,"additional_payer_notes":"APC"}]}]},{"description":"Ikbkap gene","code_information":[{"code":"81260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.31,"maximum":71.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.31,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.49,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42.02,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44.03,"additional_payer_notes":"APC"}]}]},{"description":"Igh gene rearrange amp meth","code_information":[{"code":"81261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":197.99,"maximum":361.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":197.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":203.93,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":211.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":201.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":361.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":209.87,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":211.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":221.75,"additional_payer_notes":"APC"}]}]},{"description":"Igh gene rearrang dir probe","code_information":[{"code":"81262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.55,"maximum":125.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":71.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68.55,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":70.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":73.35,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":69.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":125.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":72.66,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":73.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":76.78,"additional_payer_notes":"APC"}]}]},{"description":"Igh vari regional mutation","code_information":[{"code":"81263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":294.52,"maximum":537.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":306.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":294.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":303.36,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":315.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":300.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":537.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":312.19,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":314.84,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":329.86,"additional_payer_notes":"APC"}]}]},{"description":"Igk rearrangeabn clonal pop","code_information":[{"code":"81264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":172.73,"maximum":315.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":179.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":172.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":184.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":176.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":315.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":184.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":193.46,"additional_payer_notes":"APC"}]}]},{"description":"Str markers specimen anal","code_information":[{"code":"81265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":233.07,"maximum":425.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":242.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":233.07,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":240.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":249.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":237.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":425.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":247.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":249.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":261.04,"additional_payer_notes":"APC"}]}]},{"description":"Str markers spec anal addl","code_information":[{"code":"81266","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":304.81,"maximum":556.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":317.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":304.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":313.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":326.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":310.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":556.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":323.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":325.84,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":341.39,"additional_payer_notes":"APC"}]}]},{"description":"Chimerism anal no cell selec","code_information":[{"code":"81267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":207.46,"maximum":378.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":215.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":207.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.68,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":221.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":211.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":378.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":219.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":221.77,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":232.36,"additional_payer_notes":"APC"}]}]},{"description":"Chimerism anal w/cell select","code_information":[{"code":"81268","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":260.79,"maximum":476.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":271.22,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":260.79,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":268.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":279.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":266.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":476.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":276.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":278.78,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":292.08,"additional_payer_notes":"APC"}]}]},{"description":"Hba1/hba2 gene dup/del vrnts","code_information":[{"code":"81269","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":202.4,"maximum":369.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":210.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":202.4,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":208.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":216.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":206.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":369.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":214.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":216.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":226.69,"additional_payer_notes":"APC"}]}]},{"description":"Jak2 gene","code_information":[{"code":"81270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":91.66,"maximum":167.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":95.33,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91.66,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":94.41,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":98.08,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":167.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":97.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":97.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":102.66,"additional_payer_notes":"APC"}]}]},{"description":"Htt gene detc abnor alleles","code_information":[{"code":"81271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":250.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":250.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":153.44,"additional_payer_notes":"APC"}]}]},{"description":"Kit gene targeted seq analys","code_information":[{"code":"81272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":329.51,"maximum":601.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":339.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":352.58,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":336.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":601.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":349.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":352.25,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":369.05,"additional_payer_notes":"APC"}]}]},{"description":"Kit gene analys d816 variant","code_information":[{"code":"81273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":124.87,"maximum":228.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":129.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":124.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":128.62,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":133.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":127.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":228.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":133.49,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.85,"additional_payer_notes":"APC"}]}]},{"description":"Htt gene charac alleles","code_information":[{"code":"81274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":501.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":293.79,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":307.81,"additional_payer_notes":"APC"}]}]},{"description":"Kras gene variants exon 2","code_information":[{"code":"81275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.25,"maximum":352.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":200.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":199.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":206.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":197.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":352.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":204.84,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":206.58,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":216.44,"additional_payer_notes":"APC"}]}]},{"description":"Kras gene addl variants","code_information":[{"code":"81276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.25,"maximum":352.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":200.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":199.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":206.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":197.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":352.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":204.84,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":206.58,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":216.44,"additional_payer_notes":"APC"}]}]},{"description":"Cytogenomic neo microra alys","code_information":[{"code":"81277","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1160.0,"maximum":2118.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1206.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1160.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1194.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1241.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1183.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2118.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1229.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1240.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1299.2,"additional_payer_notes":"APC"}]}]},{"description":"Igh@/bcl2 translocation alys","code_information":[{"code":"81278","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":207.31,"maximum":378.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":215.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":207.31,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":221.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":211.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":378.55,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":219.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":221.61,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":232.19,"additional_payer_notes":"APC"}]}]},{"description":"Jak2 gene trgt sequence alys","code_information":[{"code":"81279","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":338.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":192.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":198.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":338.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":196.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":197.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":207.42,"additional_payer_notes":"APC"}]}]},{"description":"Ifnl3 gene","code_information":[{"code":"81283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":73.37,"maximum":133.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":76.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":75.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":78.51,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":74.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":133.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":77.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":78.43,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":82.17,"additional_payer_notes":"APC"}]}]},{"description":"Fxn gene detc abnor alleles","code_information":[{"code":"81284","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":250.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":250.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":153.44,"additional_payer_notes":"APC"}]}]},{"description":"Fxn gene charac alleles","code_information":[{"code":"81285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":501.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":293.79,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":307.81,"additional_payer_notes":"APC"}]}]},{"description":"Fxn gene full gene sequence","code_information":[{"code":"81286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":501.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":293.79,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":307.81,"additional_payer_notes":"APC"}]}]},{"description":"Mgmt gene methylation anal","code_information":[{"code":"81287","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":124.64,"maximum":227.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":129.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":124.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":128.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":133.36,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":127.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":227.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":133.24,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.6,"additional_payer_notes":"APC"}]}]},{"description":"Mlh1 gene","code_information":[{"code":"81288","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":192.32,"maximum":351.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":200.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":192.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":198.09,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":196.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":351.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":203.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.59,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":215.4,"additional_payer_notes":"APC"}]}]},{"description":"Fxn gene known famil variant","code_information":[{"code":"81289","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":338.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":192.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":198.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":338.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":196.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":197.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":207.42,"additional_payer_notes":"APC"}]}]},{"description":"Mcoln1 gene","code_information":[{"code":"81290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.31,"maximum":71.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.31,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.49,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42.02,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44.03,"additional_payer_notes":"APC"}]}]},{"description":"Mthfr gene","code_information":[{"code":"81291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.34,"maximum":119.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":67.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":67.3,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":66.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":119.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":69.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":73.18,"additional_payer_notes":"APC"}]}]},{"description":"Mlh1 gene full seq","code_information":[{"code":"81292","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":675.4,"maximum":1233.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":702.42,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":675.4,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":695.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":722.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":688.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1233.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":715.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":722.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":756.45,"additional_payer_notes":"APC"}]}]},{"description":"Mlh1 gene known variants","code_information":[{"code":"81293","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":331.0,"maximum":604.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":344.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":331.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":340.93,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":354.17,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":337.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":604.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":350.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":353.84,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":370.72,"additional_payer_notes":"APC"}]}]},{"description":"Mlh1 gene dup/delete variant","code_information":[{"code":"81294","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":202.4,"maximum":369.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":210.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":202.4,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":208.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":216.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":206.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":369.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":214.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":216.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":226.69,"additional_payer_notes":"APC"}]}]},{"description":"Msh2 gene full seq","code_information":[{"code":"81295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":381.7,"maximum":696.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":396.97,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":381.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":393.15,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.42,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":389.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":696.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":404.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":408.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":427.5,"additional_payer_notes":"APC"}]}]},{"description":"Msh2 gene known variants","code_information":[{"code":"81296","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":337.73,"maximum":616.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":351.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":337.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":347.86,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":361.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":344.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":616.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":357.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":361.03,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":378.26,"additional_payer_notes":"APC"}]}]},{"description":"Msh2 gene dup/delete variant","code_information":[{"code":"81297","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":213.3,"maximum":389.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":221.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":213.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":219.7,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":228.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":217.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":389.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":226.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":228.02,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":238.9,"additional_payer_notes":"APC"}]}]},{"description":"Msh6 gene full seq","code_information":[{"code":"81298","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":641.85,"maximum":1172.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":667.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":641.85,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":661.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":686.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":654.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1172.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":680.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":686.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":718.87,"additional_payer_notes":"APC"}]}]},{"description":"Msh6 gene known variants","code_information":[{"code":"81299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":308.0,"maximum":562.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":320.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":308.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":317.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":329.56,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":314.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":562.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":326.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":329.25,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":344.96,"additional_payer_notes":"APC"}]}]},{"description":"Msh6 gene dup/delete variant","code_information":[{"code":"81300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.0,"maximum":434.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":247.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":238.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":245.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":254.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":242.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":434.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":252.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":254.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":266.56,"additional_payer_notes":"APC"}]}]},{"description":"Microsatellite instability","code_information":[{"code":"81301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":348.56,"maximum":636.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":362.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":348.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":359.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":372.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":355.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":636.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":369.47,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":372.61,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":390.39,"additional_payer_notes":"APC"}]}]},{"description":"Mecp2 gene full seq","code_information":[{"code":"81302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":527.87,"maximum":963.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":548.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":527.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":543.71,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":564.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":538.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":963.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":559.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":564.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":591.21,"additional_payer_notes":"APC"}]}]},{"description":"Mecp2 gene known variant","code_information":[{"code":"81303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":120.0,"maximum":219.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":124.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":120.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":123.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":128.4,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":122.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":219.12,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":127.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":128.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":134.4,"additional_payer_notes":"APC"}]}]},{"description":"Mecp2 gene dup/delet variant","code_information":[{"code":"81304","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":150.0,"maximum":273.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":156.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":150.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":160.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":153.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":273.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":159.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":160.35,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":168.0,"additional_payer_notes":"APC"}]}]},{"description":"Myd88 gene p.leu265pro vrnt","code_information":[{"code":"81305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.4,"maximum":320.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":182.42,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175.4,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":180.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":187.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":178.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":320.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":185.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":187.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":196.45,"additional_payer_notes":"APC"}]}]},{"description":"Nudt15 gene common variants","code_information":[{"code":"81306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":291.36,"maximum":532.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":303.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":291.36,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":300.1,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":311.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":297.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":532.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":308.84,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":311.46,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":326.32,"additional_payer_notes":"APC"}]}]},{"description":"Palb2 gene full gene seq","code_information":[{"code":"81307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.5,"maximum":1235.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":703.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":676.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":696.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":723.86,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":690.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1235.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":717.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":723.18,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":757.68,"additional_payer_notes":"APC"}]}]},{"description":"Palb2 gene known famil vrnt","code_information":[{"code":"81308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":301.35,"maximum":550.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":313.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":301.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":310.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":322.44,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":307.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":550.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":319.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":322.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":337.51,"additional_payer_notes":"APC"}]}]},{"description":"Pik3ca gene trgt seq alys","code_information":[{"code":"81309","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":501.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":293.79,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":307.81,"additional_payer_notes":"APC"}]}]},{"description":"Npm1 gene","code_information":[{"code":"81310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":246.52,"maximum":450.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":256.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":246.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":253.92,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":263.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":251.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":450.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":261.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":263.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":276.1,"additional_payer_notes":"APC"}]}]},{"description":"Nras gene variants exon 2&3","code_information":[{"code":"81311","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":295.79,"maximum":540.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":307.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":295.79,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":304.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":316.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":301.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":540.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":313.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":316.2,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":331.28,"additional_payer_notes":"APC"}]}]},{"description":"Pabpn1 gene detc abnor allel","code_information":[{"code":"81312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":250.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":250.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":153.44,"additional_payer_notes":"APC"}]}]},{"description":"Pca3/klk3 antigen","code_information":[{"code":"81313","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":255.05,"maximum":465.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":265.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":255.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.7,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":272.9,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":260.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":465.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":270.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":272.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":285.66,"additional_payer_notes":"APC"}]}]},{"description":"Pdgfra gene","code_information":[{"code":"81314","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":329.51,"maximum":601.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":339.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":352.58,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":336.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":601.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":349.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":352.25,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":369.05,"additional_payer_notes":"APC"}]}]},{"description":"Pml/raralpha com breakpoints","code_information":[{"code":"81315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":207.31,"maximum":378.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":215.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":207.31,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":221.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":211.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":378.55,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":219.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":221.61,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":232.19,"additional_payer_notes":"APC"}]}]},{"description":"Pml/raralpha 1 breakpoint","code_information":[{"code":"81316","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":207.31,"maximum":378.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":215.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":207.31,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":221.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":211.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":378.55,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":219.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":221.61,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":232.19,"additional_payer_notes":"APC"}]}]},{"description":"Pms2 gene full seq analysis","code_information":[{"code":"81317","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.5,"maximum":1235.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":703.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":676.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":696.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":723.86,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":690.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1235.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":717.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":723.18,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":757.68,"additional_payer_notes":"APC"}]}]},{"description":"Pms2 known familial variants","code_information":[{"code":"81318","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":331.0,"maximum":604.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":344.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":331.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":340.93,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":354.17,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":337.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":604.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":350.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":353.84,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":370.72,"additional_payer_notes":"APC"}]}]},{"description":"Pms2 gene dup/delet variants","code_information":[{"code":"81319","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":203.5,"maximum":371.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":211.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":203.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":209.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":207.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":371.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":227.92,"additional_payer_notes":"APC"}]}]},{"description":"Plcg2 gene common variants","code_information":[{"code":"81320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":291.36,"maximum":532.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":303.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":291.36,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":300.1,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":311.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":297.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":532.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":308.84,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":311.46,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":326.32,"additional_payer_notes":"APC"}]}]},{"description":"Pten gene full sequence","code_information":[{"code":"81321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":600.0,"maximum":1095.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":624.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":600.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":618.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":642.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":612.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1095.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":636.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":641.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":672.0,"additional_payer_notes":"APC"}]}]},{"description":"Pten gene known fam variant","code_information":[{"code":"81322","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":46.6,"maximum":85.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":48.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49.86,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":47.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":85.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":49.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.19,"additional_payer_notes":"APC"}]}]},{"description":"Pten gene dup/delet variant","code_information":[{"code":"81323","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":300.0,"maximum":547.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":312.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":300.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":309.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":321.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":306.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":547.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":318.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":320.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":336.0,"additional_payer_notes":"APC"}]}]},{"description":"Pmp22 gene dup/delet","code_information":[{"code":"81324","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.36,"maximum":1384.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":788.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.36,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":811.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":773.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1384.77,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":803.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":810.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":849.36,"additional_payer_notes":"APC"}]}]},{"description":"Pmp22 gene full sequence","code_information":[{"code":"81325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":769.58,"maximum":1405.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":800.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":769.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":792.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":823.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":784.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1405.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":815.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":822.68,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":861.93,"additional_payer_notes":"APC"}]}]},{"description":"Pmp22 gene known fam variant","code_information":[{"code":"81326","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":46.6,"maximum":85.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":48.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49.86,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":47.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":85.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":49.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.19,"additional_payer_notes":"APC"}]}]},{"description":"Sept9 methylation analysis","code_information":[{"code":"81327","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":192.0,"maximum":350.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":199.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":192.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":197.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.44,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":195.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":350.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":203.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":205.25,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":215.04,"additional_payer_notes":"APC"}]}]},{"description":"Slco1b1 gene com variants","code_information":[{"code":"81328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.81,"maximum":319.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":180.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":178.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":319.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":185.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":186.87,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.79,"additional_payer_notes":"APC"}]}]},{"description":"Smn1 gene dos/deletion alys","code_information":[{"code":"81329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":250.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":250.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":153.44,"additional_payer_notes":"APC"}]}]},{"description":"Smpd1 gene common variants","code_information":[{"code":"81330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.0,"maximum":85.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":48.41,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":47.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":85.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":49.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50.24,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"APC"}]}]},{"description":"Snrpn/ube3a gene","code_information":[{"code":"81331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.07,"maximum":93.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51.07,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":52.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":52.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":93.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":54.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.59,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57.2,"additional_payer_notes":"APC"}]}]},{"description":"Serpina1 gene","code_information":[{"code":"81332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":43.65,"maximum":79.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43.65,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44.96,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46.71,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":79.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":46.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48.89,"additional_payer_notes":"APC"}]}]},{"description":"Tgfbi gene common variants","code_information":[{"code":"81333","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":250.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":250.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":153.44,"additional_payer_notes":"APC"}]}]},{"description":"Runx1 gene targeted seq alys","code_information":[{"code":"81334","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":329.51,"maximum":601.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":339.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":352.58,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":336.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":601.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":349.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":352.25,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":369.05,"additional_payer_notes":"APC"}]}]},{"description":"Tpmt gene com variants","code_information":[{"code":"81335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.81,"maximum":319.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":180.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":178.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":319.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":185.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":186.87,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.79,"additional_payer_notes":"APC"}]}]},{"description":"Smn1 gene full gene sequence","code_information":[{"code":"81336","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":301.35,"maximum":550.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":313.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":301.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":310.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":322.44,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":307.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":550.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":319.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":322.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":337.51,"additional_payer_notes":"APC"}]}]},{"description":"Smn1 gen nown famil seq vrnt","code_information":[{"code":"81337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":338.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":192.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":198.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":338.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":196.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":197.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":207.42,"additional_payer_notes":"APC"}]}]},{"description":"Mpl gene common variants","code_information":[{"code":"81338","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":150.33,"maximum":274.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":156.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":150.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":154.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":160.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":153.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":274.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":159.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":160.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":168.37,"additional_payer_notes":"APC"}]}]},{"description":"Mpl gene seq alys exon 10","code_information":[{"code":"81339","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":338.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":192.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":198.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":338.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":196.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":197.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":207.42,"additional_payer_notes":"APC"}]}]},{"description":"Trb@ gene rearrange amplify","code_information":[{"code":"81340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":208.92,"maximum":381.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":217.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":208.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":215.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.54,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":381.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":221.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":223.34,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":233.99,"additional_payer_notes":"APC"}]}]},{"description":"Trb@ gene rearrange dirprobe","code_information":[{"code":"81341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.59,"maximum":90.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":51.08,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":50.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":90.55,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":52.57,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53.01,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":55.54,"additional_payer_notes":"APC"}]}]},{"description":"Trg gene rearrangement anal","code_information":[{"code":"81342","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":201.5,"maximum":367.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":209.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":201.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":207.54,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":215.6,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":205.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":367.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":213.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":215.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":225.68,"additional_payer_notes":"APC"}]}]},{"description":"Ppp2r2b gen detc abnor allel","code_information":[{"code":"81343","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":250.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":250.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":153.44,"additional_payer_notes":"APC"}]}]},{"description":"Tbp gene detc abnor alleles","code_information":[{"code":"81344","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":250.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":250.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":153.44,"additional_payer_notes":"APC"}]}]},{"description":"Tert gene targeted seq alys","code_information":[{"code":"81345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":338.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":192.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":198.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":338.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":196.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":197.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":207.42,"additional_payer_notes":"APC"}]}]},{"description":"Tyms gene com variants","code_information":[{"code":"81346","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.81,"maximum":319.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":180.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":178.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":319.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":185.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":186.87,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.79,"additional_payer_notes":"APC"}]}]},{"description":"Sf3b1 gene common variants","code_information":[{"code":"81347","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.25,"maximum":352.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":200.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":199.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":206.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":197.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":352.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":204.84,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":206.58,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":216.44,"additional_payer_notes":"APC"}]}]},{"description":"Srsf2 gene common variants","code_information":[{"code":"81348","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.4,"maximum":320.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":182.42,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175.4,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":180.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":187.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":178.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":320.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":185.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":187.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":196.45,"additional_payer_notes":"APC"}]}]},{"description":"Cytog alys chrml abnr lw-ps","code_information":[{"code":"81349","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1197.94,"maximum":2187.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1245.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1197.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1233.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1281.8,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1221.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2187.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1269.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1280.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1341.69,"additional_payer_notes":"APC"}]}]},{"description":"Ugt1a1 gene","code_information":[{"code":"81350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":234.0,"maximum":427.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":243.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":234.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":241.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":250.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":238.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":427.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":248.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":250.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":262.08,"additional_payer_notes":"APC"}]}]},{"description":"Tp53 gene full gene sequence","code_information":[{"code":"81351","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":641.85,"maximum":1172.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":667.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":641.85,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":661.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":686.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":654.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1172.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":680.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":686.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":718.87,"additional_payer_notes":"APC"}]}]},{"description":"Tp53 gene trgt sequence alys","code_information":[{"code":"81352","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":329.51,"maximum":601.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":339.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":352.58,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":336.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":601.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":349.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":352.25,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":369.05,"additional_payer_notes":"APC"}]}]},{"description":"Tp53 gene known famil vrnt","code_information":[{"code":"81353","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":308.0,"maximum":562.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":320.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":308.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":317.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":329.56,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":314.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":562.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":326.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":329.25,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":344.96,"additional_payer_notes":"APC"}]}]},{"description":"Cytog alys chrml abnor ogm","code_information":[{"code":"81354","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1263.53,"maximum":2307.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1314.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1263.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1301.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1351.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1288.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2307.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1339.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1350.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1415.15,"additional_payer_notes":"APC"}]}]},{"description":"Vkorc1 gene","code_information":[{"code":"81355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":88.2,"maximum":161.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":91.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":90.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":89.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":161.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":98.78,"additional_payer_notes":"APC"}]}]},{"description":"U2af1 gene common variants","code_information":[{"code":"81357","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.25,"maximum":352.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":200.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":199.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":206.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":197.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":352.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":204.84,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":206.58,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":216.44,"additional_payer_notes":"APC"}]}]},{"description":"Zrsr2 gene common variants","code_information":[{"code":"81360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.25,"maximum":352.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":200.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":193.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":199.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":206.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":197.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":352.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":204.84,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":206.58,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":216.44,"additional_payer_notes":"APC"}]}]},{"description":"Hbb gene com variants","code_information":[{"code":"81361","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.81,"maximum":319.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":180.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":178.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":319.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":185.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":186.87,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":195.79,"additional_payer_notes":"APC"}]}]},{"description":"Hbb gene known fam variant","code_information":[{"code":"81362","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":375.25,"maximum":685.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":390.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":386.51,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":401.52,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":382.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":685.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":397.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":401.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":420.28,"additional_payer_notes":"APC"}]}]},{"description":"Hbb gene dup/del variants","code_information":[{"code":"81363","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":202.4,"maximum":369.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":210.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":202.4,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":208.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":216.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":206.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":369.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":214.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":216.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":226.69,"additional_payer_notes":"APC"}]}]},{"description":"Hbb full gene sequence","code_information":[{"code":"81364","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":324.58,"maximum":592.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":337.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":324.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":334.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":347.3,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":331.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":592.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":344.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":346.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":363.53,"additional_payer_notes":"APC"}]}]},{"description":"Hla i & ii typing lr","code_information":[{"code":"81370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":402.12,"maximum":734.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":418.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":402.12,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":414.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":430.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":410.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":734.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":426.25,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":429.87,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":450.37,"additional_payer_notes":"APC"}]}]},{"description":"Hla i & ii type verify lr","code_information":[{"code":"81371","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":404.52,"maximum":738.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":420.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":404.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":416.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":432.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":412.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":738.65,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":428.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":432.43,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":453.06,"additional_payer_notes":"APC"}]}]},{"description":"Hla i typing complete lr","code_information":[{"code":"81372","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.59,"maximum":736.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":419.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":403.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":415.7,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":431.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":411.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":736.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":427.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":431.44,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":452.02,"additional_payer_notes":"APC"}]}]},{"description":"Hla i typing 1 locus lr","code_information":[{"code":"81373","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.43,"maximum":232.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":132.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":127.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":131.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":136.35,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":129.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":232.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":135.08,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":136.22,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":142.72,"additional_payer_notes":"APC"}]}]},{"description":"Hla i typing 1 antigen lr","code_information":[{"code":"81374","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":74.33,"maximum":135.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":77.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":76.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":79.53,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":75.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":135.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":78.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":79.46,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":83.25,"additional_payer_notes":"APC"}]}]},{"description":"Hla ii typing ag equiv lr","code_information":[{"code":"81375","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":220.74,"maximum":403.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":229.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":220.74,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":227.36,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":236.19,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":225.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":403.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":233.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":235.97,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":247.23,"additional_payer_notes":"APC"}]}]},{"description":"Hla ii typing 1 locus lr","code_information":[{"code":"81376","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.22,"maximum":223.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":127.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":122.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":125.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":130.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":124.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":223.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":129.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":130.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":136.89,"additional_payer_notes":"APC"}]}]},{"description":"Hla ii type 1 ag equiv lr","code_information":[{"code":"81377","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":94.74,"maximum":173.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":98.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94.74,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":97.58,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":96.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":173.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":100.42,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":101.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":106.11,"additional_payer_notes":"APC"}]}]},{"description":"Hla i & ii typing hr","code_information":[{"code":"81378","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":345.57,"maximum":631.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":359.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":345.57,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":355.94,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":369.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":352.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":631.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":366.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":369.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":387.04,"additional_payer_notes":"APC"}]}]},{"description":"Hla i typing complete hr","code_information":[{"code":"81379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":335.38,"maximum":612.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":348.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.38,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":345.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":358.86,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":342.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":612.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":355.5,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":358.52,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":375.63,"additional_payer_notes":"APC"}]}]},{"description":"Hla i typing 1 locus hr","code_information":[{"code":"81380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.25,"maximum":323.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":184.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":182.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":189.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":180.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":323.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":187.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":189.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":198.52,"additional_payer_notes":"APC"}]}]},{"description":"Hla i typing 1 allele hr","code_information":[{"code":"81381","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.9,"maximum":310.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":176.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":169.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":175.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.79,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":173.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":310.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":180.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":181.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":190.29,"additional_payer_notes":"APC"}]}]},{"description":"Hla ii typing 1 loc hr","code_information":[{"code":"81382","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":123.68,"maximum":225.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":128.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":123.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":127.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":132.34,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":126.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":225.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":131.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":132.21,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":138.52,"additional_payer_notes":"APC"}]}]},{"description":"Hla ii typing 1 allele hr","code_information":[{"code":"81383","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.13,"maximum":199.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.13,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.77,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":115.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":116.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.23,"additional_payer_notes":"APC"}]}]},{"description":"Mopath procedure level 1","code_information":[{"code":"81400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":63.96,"maximum":116.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":66.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":68.44,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":116.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":67.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":68.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":71.64,"additional_payer_notes":"APC"}]}]},{"description":"Mopath procedure level 2","code_information":[{"code":"81401","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.0,"maximum":250.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":139.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":250.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":153.44,"additional_payer_notes":"APC"}]}]},{"description":"Mopath procedure level 3","code_information":[{"code":"81402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":150.33,"maximum":274.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":156.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":150.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":154.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":160.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":153.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":274.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":159.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":160.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":168.37,"additional_payer_notes":"APC"}]}]},{"description":"Mopath procedure level 4","code_information":[{"code":"81403","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":185.2,"maximum":338.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":192.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":198.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":338.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":196.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":197.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":207.42,"additional_payer_notes":"APC"}]}]},{"description":"Mopath procedure level 5","code_information":[{"code":"81404","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":274.83,"maximum":501.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":280.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":501.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":293.79,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":307.81,"additional_payer_notes":"APC"}]}]},{"description":"Mopath procedure level 6","code_information":[{"code":"81405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":301.35,"maximum":550.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":313.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":301.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":310.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":322.44,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":307.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":550.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":319.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":322.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":337.51,"additional_payer_notes":"APC"}]}]},{"description":"Mopath procedure level 7","code_information":[{"code":"81406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":282.88,"maximum":516.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":302.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":288.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":516.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":299.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":302.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":316.83,"additional_payer_notes":"APC"}]}]},{"description":"Mopath procedure level 8","code_information":[{"code":"81407","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":846.27,"maximum":1545.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":880.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":846.27,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":871.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":905.51,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":863.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1545.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":897.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":904.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"}]}]},{"description":"Mopath procedure level 9","code_information":[{"code":"81408","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2000.0,"maximum":3652.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2080.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2000.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2060.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2140.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2040.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3652.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2120.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2138.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2240.0,"additional_payer_notes":"APC"}]}]},{"description":"Aortic dysfunction/dilation","code_information":[{"code":"81410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":504.0,"maximum":920.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":524.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":504.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":519.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":539.28,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":514.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":920.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":534.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":538.78,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":564.48,"additional_payer_notes":"APC"}]}]},{"description":"Aortic dysfunction/dilation","code_information":[{"code":"81411","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1350.19,"maximum":2465.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1404.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1350.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1390.7,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1444.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1377.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2465.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1431.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1443.35,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1512.21,"additional_payer_notes":"APC"}]}]},{"description":"Ashkenazi jewish assoc dis","code_information":[{"code":"81412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2448.56,"maximum":4471.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2546.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2448.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2522.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2619.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2497.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":4471.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2595.47,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2617.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2742.39,"additional_payer_notes":"APC"}]}]},{"description":"Car ion chnnlpath inc 10 gns","code_information":[{"code":"81413","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":584.9,"maximum":1068.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":608.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":584.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":602.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":625.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":596.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1068.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":619.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":625.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":655.09,"additional_payer_notes":"APC"}]}]},{"description":"Car ion chnnlpath inc 2 gns","code_information":[{"code":"81414","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":584.9,"maximum":1068.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":608.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":584.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":602.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":625.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":596.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1068.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":619.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":625.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":655.09,"additional_payer_notes":"APC"}]}]},{"description":"Exome sequence analysis","code_information":[{"code":"81415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4780.0,"maximum":8728.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4971.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4780.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4923.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5114.6,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4875.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":8728.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5066.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5109.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5353.6,"additional_payer_notes":"APC"}]}]},{"description":"Exome sequence analysis","code_information":[{"code":"81416","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12000.0,"maximum":21912.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12480.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12000.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12360.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12840.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12240.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21912.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12720.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12828.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13440.0,"additional_payer_notes":"APC"}]}]},{"description":"Exome re-evaluation","code_information":[{"code":"81417","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.0,"maximum":584.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":332.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":320.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":329.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.4,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":326.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":584.32,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":339.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":342.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":358.4,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab gen seq alys pnl 6","code_information":[{"code":"81418","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":917.08,"maximum":1674.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":953.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":917.08,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":944.59,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":981.28,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":935.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1674.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":972.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":980.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1027.13,"additional_payer_notes":"APC"}]}]},{"description":"Epilepsy gen seq alys panel","code_information":[{"code":"81419","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2448.56,"maximum":4471.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2546.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2448.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2522.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2619.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2497.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":4471.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2595.47,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2617.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2742.39,"additional_payer_notes":"APC"}]}]},{"description":"Fetal chrmoml aneuploidy","code_information":[{"code":"81420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":759.05,"maximum":1386.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":789.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":759.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.82,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":812.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":774.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1386.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":804.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":811.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":850.14,"additional_payer_notes":"APC"}]}]},{"description":"Fetal chrmoml microdeltj","code_information":[{"code":"81422","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":759.05,"maximum":1386.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":789.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":759.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":781.82,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":812.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":774.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1386.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":804.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":811.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":850.14,"additional_payer_notes":"APC"}]}]},{"description":"Genome sequence analysis","code_information":[{"code":"81425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5031.2,"maximum":9186.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5232.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5031.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5182.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5383.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5131.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9186.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5333.07,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5378.35,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5634.94,"additional_payer_notes":"APC"}]}]},{"description":"Genome sequence analysis","code_information":[{"code":"81426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2709.95,"maximum":4948.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2818.35,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2709.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2791.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2899.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2764.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":4948.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2872.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2896.94,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3035.14,"additional_payer_notes":"APC"}]}]},{"description":"Genome re-evaluation","code_information":[{"code":"81427","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2337.65,"maximum":4268.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2431.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2337.65,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2407.78,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2501.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2384.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":4268.55,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2477.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2498.95,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2618.17,"additional_payer_notes":"APC"}]}]},{"description":"Hearing loss sequence analys","code_information":[{"code":"81430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1625.0,"maximum":2967.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1690.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1625.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1673.75,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1738.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1657.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2967.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1722.5,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1737.12,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1820.0,"additional_payer_notes":"APC"}]}]},{"description":"Hearing loss dup/del analys","code_information":[{"code":"81431","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":679.57,"maximum":1240.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":706.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":679.57,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":699.96,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":727.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":693.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1240.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":720.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":726.46,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":761.12,"additional_payer_notes":"APC"}]}]},{"description":"Hrdtry brst ca-rlatd dsordrs","code_information":[{"code":"81432","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1303.95,"maximum":2381.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1356.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1303.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1343.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1395.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1330.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2381.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1382.19,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1393.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1460.42,"additional_payer_notes":"APC"}]}]},{"description":"Hereditary retinal disorders","code_information":[{"code":"81434","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":597.91,"maximum":1091.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":621.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":597.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":615.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":639.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":609.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1091.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":633.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":639.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":669.66,"additional_payer_notes":"APC"}]}]},{"description":"Hereditary colon ca dsordrs","code_information":[{"code":"81435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1303.95,"maximum":2381.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1356.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1303.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1343.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1395.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1330.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2381.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1382.19,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1393.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1460.42,"additional_payer_notes":"APC"}]}]},{"description":"Heredtry nurondcrn tum dsrdr","code_information":[{"code":"81437","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1303.95,"maximum":2381.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1356.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1303.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1343.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1395.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1330.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2381.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1382.19,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1393.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1460.42,"additional_payer_notes":"APC"}]}]},{"description":"Inherited cardmypthy 5 gns","code_information":[{"code":"81439","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":584.9,"maximum":1068.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":608.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":584.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":602.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":625.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":596.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1068.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":619.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":625.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":655.09,"additional_payer_notes":"APC"}]}]},{"description":"Mitochondrial gene","code_information":[{"code":"81440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3324.0,"maximum":6069.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3456.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3324.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3423.72,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3556.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3390.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6069.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3523.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3553.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3722.88,"additional_payer_notes":"APC"}]}]},{"description":"Ibmfs seq alys pnl 30 genes","code_information":[{"code":"81441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2448.56,"maximum":4471.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2546.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2448.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2522.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2619.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2497.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":4471.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2595.47,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2617.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2742.39,"additional_payer_notes":"APC"}]}]},{"description":"Noonan spectrum disorders","code_information":[{"code":"81442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2143.6,"maximum":3914.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2229.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2143.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2207.91,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2293.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2186.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3914.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2272.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2291.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2400.83,"additional_payer_notes":"APC"}]}]},{"description":"Genetic tstg severe inh cond","code_information":[{"code":"81443","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2448.56,"maximum":4471.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2546.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2448.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2522.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2619.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2497.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":4471.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2595.47,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2617.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2742.39,"additional_payer_notes":"APC"}]}]},{"description":"Targeted genomic seq analys","code_information":[{"code":"81445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":597.91,"maximum":1091.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":621.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":597.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":615.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":639.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":609.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1091.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":633.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":639.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":669.66,"additional_payer_notes":"APC"}]}]},{"description":"Hrdtry perph neurphy panel","code_information":[{"code":"81448","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":584.9,"maximum":1068.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":608.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":584.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":602.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":625.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":596.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1068.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":619.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":625.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":655.09,"additional_payer_notes":"APC"}]}]},{"description":"Tgsap so neo 5-50 rna alys","code_information":[{"code":"81449","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":597.91,"maximum":1091.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":621.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":597.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":615.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":639.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":609.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1091.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":633.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":639.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":669.66,"additional_payer_notes":"APC"}]}]},{"description":"Targeted genomic seq analys","code_information":[{"code":"81450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":759.53,"maximum":1386.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":789.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":759.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":782.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":812.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":774.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1386.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":805.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":811.94,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":850.67,"additional_payer_notes":"APC"}]}]},{"description":"Tgsap hl neo 5-50 rna alys","code_information":[{"code":"81451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":759.53,"maximum":1386.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":789.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":759.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":782.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":812.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":774.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1386.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":805.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":811.94,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":850.67,"additional_payer_notes":"APC"}]}]},{"description":"Targeted genomic seq analys","code_information":[{"code":"81455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":5331.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3036.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3123.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5331.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3121.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3269.95,"additional_payer_notes":"APC"}]}]},{"description":"Tgsap so/hl 51/< rna alys","code_information":[{"code":"81456","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2919.6,"maximum":5331.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3036.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3123.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2977.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5331.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3094.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3121.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3269.95,"additional_payer_notes":"APC"}]}]},{"description":"So neo gsap dna mcrstl ins","code_information":[{"code":"81457","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":896.87,"maximum":1637.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":932.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":896.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":923.78,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":959.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":914.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1637.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":950.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":958.75,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1004.49,"additional_payer_notes":"APC"}]}]},{"description":"So gsap dna cpy nmbr&mcrstl","code_information":[{"code":"81458","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1046.35,"maximum":1910.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1088.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1046.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1077.74,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1119.59,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1067.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1910.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1109.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1118.55,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1171.91,"additional_payer_notes":"APC"}]}]},{"description":"So neo gsap dna/dna&rna","code_information":[{"code":"81459","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2989.55,"maximum":5458.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3109.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2989.55,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3079.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3198.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3049.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5458.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3168.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3195.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3348.3,"additional_payer_notes":"APC"}]}]},{"description":"Whole mitochondrial genome","code_information":[{"code":"81460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1287.0,"maximum":2350.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1338.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1287.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1325.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1377.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1312.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2350.06,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1364.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1375.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1441.44,"additional_payer_notes":"APC"}]}]},{"description":"So gsap cll fr dna/dna&rna","code_information":[{"code":"81462","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1195.83,"maximum":2183.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1243.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1195.83,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1231.7,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1279.54,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1219.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2183.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1267.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1278.34,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1339.33,"additional_payer_notes":"APC"}]}]},{"description":"So gsap cl fr cpy nmbr&mcrst","code_information":[{"code":"81463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1345.31,"maximum":2456.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1399.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1345.31,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1385.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1439.48,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1372.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2456.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1426.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1438.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1506.75,"additional_payer_notes":"APC"}]}]},{"description":"So gsap cll fr mcrstl ins","code_information":[{"code":"81464","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3288.51,"maximum":6004.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3420.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3288.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3387.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3518.71,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3354.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6004.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3485.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3515.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3683.13,"additional_payer_notes":"APC"}]}]},{"description":"Whole mitochondrial genome","code_information":[{"code":"81465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":936.0,"maximum":1709.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":973.44,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":936.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":964.08,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1001.52,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":954.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1709.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":992.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1000.58,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1048.32,"additional_payer_notes":"APC"}]}]},{"description":"X-linked intellectual dblt","code_information":[{"code":"81470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":914.0,"maximum":1668.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":950.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":914.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":941.42,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":977.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":932.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1668.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":968.84,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":977.07,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1023.68,"additional_payer_notes":"APC"}]}]},{"description":"X-linked intellectual dblt","code_information":[{"code":"81471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":914.0,"maximum":1668.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":950.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":914.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":941.42,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":977.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":932.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1668.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":968.84,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":977.07,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1023.68,"additional_payer_notes":"APC"}]}]},{"description":"Autoimmune rheumatoid arthr","code_information":[{"code":"81490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":840.65,"maximum":1535.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":874.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.65,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":865.87,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":899.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":857.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1535.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":891.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":898.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":941.53,"additional_payer_notes":"APC"}]}]},{"description":"Cor artery disease mrna","code_information":[{"code":"81493","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1050.0,"maximum":1917.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1092.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1050.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1081.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1123.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1071.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1917.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1113.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1122.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1176.0,"additional_payer_notes":"APC"}]}]},{"description":"Onco (ovar) two proteins","code_information":[{"code":"81500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":260.5,"maximum":475.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":270.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":260.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":268.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":278.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":475.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":276.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":278.47,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":291.76,"additional_payer_notes":"APC"}]}]},{"description":"Onco (ovar) five proteins","code_information":[{"code":"81503","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":897.0,"maximum":1637.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":932.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":897.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":923.91,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":959.79,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":914.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1637.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":950.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":958.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1004.64,"additional_payer_notes":"APC"}]}]},{"description":"Oncology tissue of origin","code_information":[{"code":"81504","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":520.0,"maximum":949.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":540.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":520.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":535.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":556.4,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":530.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":949.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":551.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":555.88,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":582.4,"additional_payer_notes":"APC"}]}]},{"description":"Endo assay seven anal","code_information":[{"code":"81506","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.92,"maximum":125.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":71.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":70.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":73.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":70.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":125.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":73.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":73.68,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":77.19,"additional_payer_notes":"APC"}]}]},{"description":"Fetal aneuploidy trisom risk","code_information":[{"code":"81507","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":795.0,"maximum":1451.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":826.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":795.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":818.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":850.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":810.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1451.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":842.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":849.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":890.4,"additional_payer_notes":"APC"}]}]},{"description":"Ftl cgen abnor two proteins","code_information":[{"code":"81508","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.3,"maximum":99.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56.47,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55.93,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":99.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":57.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":58.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60.82,"additional_payer_notes":"APC"}]}]},{"description":"Ftl cgen abnor 3 proteins","code_information":[{"code":"81509","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1487.37,"maximum":2715.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1546.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1487.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1531.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1591.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1517.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":2715.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":1576.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1590.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":1665.85,"additional_payer_notes":"APC"}]}]},{"description":"Ftl cgen abnor three anal","code_information":[{"code":"81510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":55.54,"maximum":101.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":57.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":59.43,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":56.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":101.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":58.87,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":59.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":62.2,"additional_payer_notes":"APC"}]}]},{"description":"Ftl cgen abnor four anal","code_information":[{"code":"81511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":153.5,"maximum":280.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":159.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":153.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":158.1,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":164.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":156.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":280.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":162.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":164.09,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":171.92,"additional_payer_notes":"APC"}]}]},{"description":"Ftl cgen abnor five anal","code_information":[{"code":"81512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":69.52,"maximum":126.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":72.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":71.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":74.39,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":70.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":126.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":73.69,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":74.32,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":77.86,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bv rna vag flu alg","code_information":[{"code":"81513","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.63,"maximum":260.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":146.91,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":152.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":145.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":260.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":151.19,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":152.47,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":159.75,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bv&vaginitis dna alg","code_information":[{"code":"81514","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":262.99,"maximum":480.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":273.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":262.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":270.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":281.4,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":268.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":480.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":278.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":281.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.55,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bv&vaginitis dna alg","code_information":[{"code":"81515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":262.99,"maximum":480.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":273.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":262.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":270.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":281.4,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":268.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":480.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":278.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":281.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.55,"additional_payer_notes":"APC"}]}]},{"description":"Liver ds alys 3 bmrk srm alg","code_information":[{"code":"81517","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":176.19,"maximum":321.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":183.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":176.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.48,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":188.52,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":179.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":321.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":186.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":188.35,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":197.33,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst mrna 11 genes","code_information":[{"code":"81518","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3873.0,"maximum":7072.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4027.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3989.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3950.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7072.1,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4105.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4140.24,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4337.76,"additional_payer_notes":"APC"}]}]},{"description":"Oncology breast mrna","code_information":[{"code":"81519","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3873.0,"maximum":7072.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4027.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3989.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3950.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7072.1,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4105.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4140.24,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4337.76,"additional_payer_notes":"APC"}]}]},{"description":"Onc breast mrna 58 genes","code_information":[{"code":"81520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2510.21,"maximum":4583.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2610.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2510.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2585.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2685.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2560.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":4583.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2660.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2683.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2811.44,"additional_payer_notes":"APC"}]}]},{"description":"Onc breast mrna 70 genes","code_information":[{"code":"81521","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3873.0,"maximum":7072.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4027.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3989.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3950.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7072.1,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4105.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4140.24,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4337.76,"additional_payer_notes":"APC"}]}]},{"description":"Onc breast mrna 12 genes","code_information":[{"code":"81522","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3873.0,"maximum":7072.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4027.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3989.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3950.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7072.1,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4105.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4140.24,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4337.76,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst mrna 70 cnt 31 gene","code_information":[{"code":"81523","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3873.0,"maximum":7072.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4027.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3989.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3950.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7072.1,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4105.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4140.24,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4337.76,"additional_payer_notes":"APC"}]}]},{"description":"Oncology colon mrna","code_information":[{"code":"81525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3116.0,"maximum":5689.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3240.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3116.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3209.48,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3334.12,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3178.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5689.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3302.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3331.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3489.92,"additional_payer_notes":"APC"}]}]},{"description":"Oncology colorectal scr","code_information":[{"code":"81528","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":508.87,"maximum":929.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":529.22,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":508.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":524.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":544.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":519.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":929.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":539.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":543.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":569.93,"additional_payer_notes":"APC"}]}]},{"description":"Onc cutan mlnma mrna 31 gene","code_information":[{"code":"81529","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7193.0,"maximum":13134.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7480.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7193.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7408.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7696.51,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7336.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13134.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7624.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7689.32,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8056.16,"additional_payer_notes":"APC"}]}]},{"description":"Oncology gynecologic","code_information":[{"code":"81535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":579.46,"maximum":1058.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":602.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":579.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":596.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":620.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":591.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1058.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":614.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":619.44,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":649.0,"additional_payer_notes":"APC"}]}]},{"description":"Oncology gynecologic","code_information":[{"code":"81536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":177.56,"maximum":324.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":184.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":182.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":189.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":181.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":324.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":188.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":189.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":198.87,"additional_payer_notes":"APC"}]}]},{"description":"Oncology lung","code_information":[{"code":"81538","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2871.0,"maximum":5242.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2985.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2871.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2957.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3071.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2928.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5242.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3043.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3069.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3215.52,"additional_payer_notes":"APC"}]}]},{"description":"Oncology prostate prob score","code_information":[{"code":"81539","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":760.0,"maximum":1387.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":775.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1387.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":812.44,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":851.2,"additional_payer_notes":"APC"}]}]},{"description":"Oncology tum unknown origin","code_information":[{"code":"81540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3750.0,"maximum":6847.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3900.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3750.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3862.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4012.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3825.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6847.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3975.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4008.75,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4200.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc prostate mrna 46 genes","code_information":[{"code":"81541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3873.0,"maximum":7072.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4027.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3989.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3950.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7072.1,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4105.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4140.24,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4337.76,"additional_payer_notes":"APC"}]}]},{"description":"Onc prostate mrna 22 cnt gen","code_information":[{"code":"81542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3873.0,"maximum":7072.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4027.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3989.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4144.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3950.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7072.1,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4105.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4140.24,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4337.76,"additional_payer_notes":"APC"}]}]},{"description":"Onc thyr mrna 10,196 gen alg","code_information":[{"code":"81546","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3600.0,"maximum":6573.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3744.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3600.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3708.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3852.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3672.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6573.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3816.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3848.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4032.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc prostate 3 genes","code_information":[{"code":"81551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2030.0,"maximum":3706.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2111.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2030.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2090.9,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2172.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2070.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":3706.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2151.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2170.07,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2273.6,"additional_payer_notes":"APC"}]}]},{"description":"Onc uveal mlnma mrna 15 gene","code_information":[{"code":"81552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7776.0,"maximum":14198.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8087.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7776.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8009.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8320.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7931.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14198.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8242.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8312.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8709.12,"additional_payer_notes":"APC"}]}]},{"description":"Pulm ds ipf mrna 190 gen alg","code_information":[{"code":"81554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5409.6,"maximum":9877.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5625.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5409.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5571.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5788.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5517.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9877.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5734.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5782.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6058.75,"additional_payer_notes":"APC"}]}]},{"description":"Trnspl rej kdn mrna qpcr 139","code_information":[{"code":"81558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3240.0,"maximum":5916.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3369.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3240.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3337.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3466.8,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3304.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5916.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3434.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3463.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3628.8,"additional_payer_notes":"APC"}]}]},{"description":"Trnsplj pd lvr&bwl cd154+cll","code_information":[{"code":"81560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":640.73,"maximum":1169.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":666.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":640.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":659.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":685.58,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":653.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1169.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":679.17,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":684.94,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":717.62,"additional_payer_notes":"APC"}]}]},{"description":"Cardiology hrt trnspl mrna","code_information":[{"code":"81595","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3240.0,"maximum":5916.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3369.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3240.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3337.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3466.8,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3304.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5916.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3434.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3463.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3628.8,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds chrnc hcv 6 assays","code_information":[{"code":"81596","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":72.19,"maximum":131.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":75.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":74.36,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":77.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":73.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":131.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":76.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":77.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80.85,"additional_payer_notes":"APC"}]}]},{"description":"Test for acetone/ketones","code_information":[{"code":"82009","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.52,"maximum":8.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":8.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.06,"additional_payer_notes":"APC"}]}]},{"description":"Acetone assay","code_information":[{"code":"82010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.17,"maximum":14.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.42,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.66,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.15,"additional_payer_notes":"APC"}]}]},{"description":"Acetylcholinesterase assay","code_information":[{"code":"82013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.29,"maximum":22.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.76,"additional_payer_notes":"APC"}]}]},{"description":"Acylcarnitines qual","code_information":[{"code":"82016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.49,"maximum":30.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.98,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.47,"additional_payer_notes":"APC"}]}]},{"description":"Acylcarnitines quant","code_information":[{"code":"82017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.87,"maximum":30.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.03,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.89,"additional_payer_notes":"APC"}]}]},{"description":"Assay of acth","code_information":[{"code":"82024","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.62,"maximum":70.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.62,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":70.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.25,"additional_payer_notes":"APC"}]}]},{"description":"Assay of adp & amp","code_information":[{"code":"82030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.8,"maximum":47.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":47.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.58,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.9,"additional_payer_notes":"APC"}]}]},{"description":"Assay of serum albumin","code_information":[{"code":"82040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.95,"maximum":9.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.1,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.3,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.25,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.54,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine albumin","code_information":[{"code":"82042","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.78,"maximum":14.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.25,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.32,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.71,"additional_payer_notes":"APC"}]}]},{"description":"Microalbumin quantitative","code_information":[{"code":"82043","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.78,"maximum":10.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10.55,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.18,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"APC"}]}]},{"description":"Microalbumin semiquant","code_information":[{"code":"82044","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.23,"maximum":11.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.23,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.42,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.98,"additional_payer_notes":"APC"}]}]},{"description":"Albumin ischemia modified","code_information":[{"code":"82045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.94,"maximum":61.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34.96,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":61.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38.01,"additional_payer_notes":"APC"}]}]},{"description":"Assay of breath ethanol","code_information":[{"code":"82075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.0,"maximum":54.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.9,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":54.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.07,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.6,"additional_payer_notes":"APC"}]}]},{"description":"Assay spec xcp ur&breath ia","code_information":[{"code":"82077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.27,"maximum":31.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.48,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":31.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.46,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.34,"additional_payer_notes":"APC"}]}]},{"description":"Assay of aldolase","code_information":[{"code":"82085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.71,"maximum":17.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.1,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.39,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.88,"additional_payer_notes":"APC"}]}]},{"description":"Assay of aldosterone","code_information":[{"code":"82088","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.75,"maximum":74.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40.75,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.97,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.6,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":74.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.64,"additional_payer_notes":"APC"}]}]},{"description":"Alpha-1-antitrypsin total","code_information":[{"code":"82103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.44,"maximum":24.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.25,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.05,"additional_payer_notes":"APC"}]}]},{"description":"Alpha-1-antitrypsin pheno","code_information":[{"code":"82104","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.46,"maximum":26.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.46,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.2,"additional_payer_notes":"APC"}]}]},{"description":"Alpha-fetoprotein serum","code_information":[{"code":"82105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.77,"maximum":30.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.44,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.77,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.78,"additional_payer_notes":"APC"}]}]},{"description":"Alpha-fetoprotein amniotic","code_information":[{"code":"82106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.0,"maximum":31.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.51,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.19,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":31.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.04,"additional_payer_notes":"APC"}]}]},{"description":"Alpha-Fetoprotein L3","code_information":[{"code":"82107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.41,"maximum":117.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":66.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64.41,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":66.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":68.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":117.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":68.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":68.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":72.14,"additional_payer_notes":"APC"}]}]},{"description":"Assay of aluminum","code_information":[{"code":"82108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.48,"maximum":46.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.26,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":46.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.24,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.54,"additional_payer_notes":"APC"}]}]},{"description":"Amines vaginal fluid qual","code_information":[{"code":"82120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.99,"maximum":10.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.41,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.71,"additional_payer_notes":"APC"}]}]},{"description":"Amino acid single qual","code_information":[{"code":"82127","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.18,"maximum":25.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.18,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.17,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.88,"additional_payer_notes":"APC"}]}]},{"description":"Amino acids mult qual","code_information":[{"code":"82128","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.87,"maximum":25.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.42,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.29,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.53,"additional_payer_notes":"APC"}]}]},{"description":"Amino acids single quant","code_information":[{"code":"82131","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.98,"maximum":41.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.59,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":41.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.74,"additional_payer_notes":"APC"}]}]},{"description":"Assay aminolevulinic acid","code_information":[{"code":"82135","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.45,"maximum":30.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.94,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.6,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.59,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.42,"additional_payer_notes":"APC"}]}]},{"description":"Amino acids quant 2-5","code_information":[{"code":"82136","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.61,"maximum":35.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.61,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":35.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.96,"additional_payer_notes":"APC"}]}]},{"description":"Amino acids quan 6 or more","code_information":[{"code":"82139","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.87,"maximum":30.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.03,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.89,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ammonia","code_information":[{"code":"82140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.57,"maximum":26.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.57,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.59,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.58,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.32,"additional_payer_notes":"APC"}]}]},{"description":"Amniotic fluid scan","code_information":[{"code":"82143","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.35,"maximum":17.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.63,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.47,"additional_payer_notes":"APC"}]}]},{"description":"Assay of amylase","code_information":[{"code":"82150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.48,"maximum":11.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.87,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.26,"additional_payer_notes":"APC"}]}]},{"description":"Androstanediol glucuronide","code_information":[{"code":"82154","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.83,"maximum":52.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28.83,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29.69,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":52.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.29,"additional_payer_notes":"APC"}]}]},{"description":"Assay of androstenedione","code_information":[{"code":"82157","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.28,"maximum":53.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.28,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.33,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":53.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.3,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.79,"additional_payer_notes":"APC"}]}]},{"description":"Assay of androsterone","code_information":[{"code":"82160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.55,"maximum":46.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.55,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.34,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":46.65,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.08,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.62,"additional_payer_notes":"APC"}]}]},{"description":"Assay of angiotensin II","code_information":[{"code":"82163","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.52,"maximum":37.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":37.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.94,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.98,"additional_payer_notes":"APC"}]}]},{"description":"Angiotensin I enzyme test","code_information":[{"code":"82164","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.6,"maximum":26.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.04,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.61,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.35,"additional_payer_notes":"APC"}]}]},{"description":"Assay anti-mullerian horm","code_information":[{"code":"82166","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.62,"maximum":70.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.62,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":70.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.25,"additional_payer_notes":"APC"}]}]},{"description":"Assay of apolipoprotein","code_information":[{"code":"82172","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.09,"maximum":38.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.72,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":38.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.55,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.62,"additional_payer_notes":"APC"}]}]},{"description":"Assay of arsenic","code_information":[{"code":"82175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.97,"maximum":34.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.97,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.54,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.3,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.25,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ascorbic acid","code_information":[{"code":"82180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.89,"maximum":18.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.89,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.58,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18.06,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.08,"additional_payer_notes":"APC"}]}]},{"description":"Atomic absorption","code_information":[{"code":"82190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.9,"maximum":29.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.01,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":29.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.81,"additional_payer_notes":"APC"}]}]},{"description":"Assay of beta-2 protein","code_information":[{"code":"82232","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.18,"maximum":29.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.18,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.31,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":29.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.3,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.12,"additional_payer_notes":"APC"}]}]},{"description":"Beta-amyloid 1-40 (abeta 40)","code_information":[{"code":"82233","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":128.92,"maximum":235.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":134.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":137.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":131.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":235.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":136.66,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":137.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.39,"additional_payer_notes":"APC"}]}]},{"description":"Beta-amyloid 1-42 (abeta 42)","code_information":[{"code":"82234","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":128.92,"maximum":235.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":134.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":137.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":131.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":235.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":136.66,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":137.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.39,"additional_payer_notes":"APC"}]}]},{"description":"Bile acids total","code_information":[{"code":"82239","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.12,"maximum":31.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.12,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.63,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":31.26,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.3,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.17,"additional_payer_notes":"APC"}]}]},{"description":"Bile acids cholylglycine","code_information":[{"code":"82240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.58,"maximum":48.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.44,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":48.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.17,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.77,"additional_payer_notes":"APC"}]}]},{"description":"Bilirubin total","code_information":[{"code":"82247","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.02,"maximum":9.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.22,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.02,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.62,"additional_payer_notes":"APC"}]}]},{"description":"Bilirubin direct","code_information":[{"code":"82248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.02,"maximum":9.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.22,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.02,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.62,"additional_payer_notes":"APC"}]}]},{"description":"Fecal bilirubin test","code_information":[{"code":"82252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.56,"maximum":8.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.7,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.88,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":8.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.83,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.87,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.11,"additional_payer_notes":"APC"}]}]},{"description":"Assay of biotinidase","code_information":[{"code":"82261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.87,"maximum":30.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.03,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.89,"additional_payer_notes":"APC"}]}]},{"description":"Occult blood feces","code_information":[{"code":"82270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.38,"maximum":8.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.38,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.51,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.69,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":8.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.64,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.68,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.91,"additional_payer_notes":"APC"}]}]},{"description":"Occult blood other sources","code_information":[{"code":"82271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.32,"maximum":9.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.48,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.69,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9.71,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.64,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.96,"additional_payer_notes":"APC"}]}]},{"description":"Occult bld feces 1-3 tests","code_information":[{"code":"82272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.23,"maximum":7.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.23,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.36,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.53,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.52,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.74,"additional_payer_notes":"APC"}]}]},{"description":"Assay test for blood fecal","code_information":[{"code":"82274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.92,"maximum":29.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.03,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":29.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.02,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.83,"additional_payer_notes":"APC"}]}]},{"description":"Assay of bradykinin","code_information":[{"code":"82286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.16,"maximum":9.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.37,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.16,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.31,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.52,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.47,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.52,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.78,"additional_payer_notes":"APC"}]}]},{"description":"Assay of cadmium","code_information":[{"code":"82300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.64,"maximum":43.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":43.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.27,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.48,"additional_payer_notes":"APC"}]}]},{"description":"Vitamin d 25 hydroxy","code_information":[{"code":"82306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.6,"maximum":54.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.49,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":54.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.15,"additional_payer_notes":"APC"}]}]},{"description":"Assay of calcitonin","code_information":[{"code":"82308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.79,"maximum":48.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.79,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.59,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":48.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.0,"additional_payer_notes":"APC"}]}]},{"description":"Assay of calcium","code_information":[{"code":"82310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.16,"maximum":9.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.37,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.16,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.31,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.52,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.47,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.52,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.78,"additional_payer_notes":"APC"}]}]},{"description":"Assay of calcium","code_information":[{"code":"82330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.68,"maximum":24.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.09,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.5,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.32,"additional_payer_notes":"APC"}]}]},{"description":"Calcium infusion test","code_information":[{"code":"82331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.34,"maximum":24.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.87,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.74,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.94,"additional_payer_notes":"APC"}]}]},{"description":"Assay of calcium in urine","code_information":[{"code":"82340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.03,"maximum":11.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.75,"additional_payer_notes":"APC"}]}]},{"description":"Calculus analysis qual","code_information":[{"code":"82355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.58,"maximum":21.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.93,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.39,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.97,"additional_payer_notes":"APC"}]}]},{"description":"Calculus assay quant","code_information":[{"code":"82360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.87,"maximum":23.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.26,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.77,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.64,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.76,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.41,"additional_payer_notes":"APC"}]}]},{"description":"Calculus spectroscopy","code_information":[{"code":"82365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.9,"maximum":23.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.29,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.8,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.79,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.45,"additional_payer_notes":"APC"}]}]},{"description":"X-ray assay calculus","code_information":[{"code":"82370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.52,"maximum":22.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.02,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.9,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.4,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.02,"additional_payer_notes":"APC"}]}]},{"description":"Assay c-d transfer measure","code_information":[{"code":"82373","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.06,"maximum":32.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.23,"additional_payer_notes":"APC"}]}]},{"description":"Assay blood carbon dioxide","code_information":[{"code":"82374","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.88,"maximum":8.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.03,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.22,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":8.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.17,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.22,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.47,"additional_payer_notes":"APC"}]}]},{"description":"Assay carboxyhb quant","code_information":[{"code":"82375","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.32,"maximum":22.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.69,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.8,"additional_payer_notes":"APC"}]}]},{"description":"Assay carboxyhb qual","code_information":[{"code":"82376","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.07,"maximum":25.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.07,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.49,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.76,"additional_payer_notes":"APC"}]}]},{"description":"Carcinoembryonic antigen","code_information":[{"code":"82378","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.96,"maximum":34.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.27,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.24,"additional_payer_notes":"APC"}]}]},{"description":"Assay of carnitine","code_information":[{"code":"82379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.87,"maximum":30.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.03,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.89,"additional_payer_notes":"APC"}]}]},{"description":"Assay of carotene","code_information":[{"code":"82380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.22,"maximum":16.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.87,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.33,"additional_payer_notes":"APC"}]}]},{"description":"Assay urine catecholamines","code_information":[{"code":"82382","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.3,"maximum":49.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.21,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":49.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.18,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.58,"additional_payer_notes":"APC"}]}]},{"description":"Assay blood catecholamines","code_information":[{"code":"82383","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.08,"maximum":53.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.08,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.12,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":53.1,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.09,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.57,"additional_payer_notes":"APC"}]}]},{"description":"Assay three catecholamines","code_information":[{"code":"82384","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.25,"maximum":46.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":46.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.99,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.28,"additional_payer_notes":"APC"}]}]},{"description":"Assay of cathepsin-d","code_information":[{"code":"82387","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.06,"maximum":32.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.23,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ceruloplasmin","code_information":[{"code":"82390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.74,"maximum":19.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.74,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.03,"additional_payer_notes":"APC"}]}]},{"description":"Chemiluminescent assay","code_information":[{"code":"82397","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.12,"maximum":25.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.12,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.54,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.09,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.81,"additional_payer_notes":"APC"}]}]},{"description":"Assay of chloramphenicol","code_information":[{"code":"82415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.67,"maximum":23.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.67,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.56,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.19,"additional_payer_notes":"APC"}]}]},{"description":"Assay of blood chloride","code_information":[{"code":"82435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.6,"maximum":8.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.74,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":8.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.15,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine chloride","code_information":[{"code":"82436","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.75,"maximum":10.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.75,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.92,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.44,"additional_payer_notes":"APC"}]}]},{"description":"Assay other fluid chlorides","code_information":[{"code":"82438","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.0,"maximum":9.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.15,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.35,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.34,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.6,"additional_payer_notes":"APC"}]}]},{"description":"Test for chlorohydrocarbons","code_information":[{"code":"82441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.01,"maximum":10.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.43,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.73,"additional_payer_notes":"APC"}]}]},{"description":"Assay bld/serum cholesterol","code_information":[{"code":"82465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.35,"maximum":7.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.48,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.87,"additional_payer_notes":"APC"}]}]},{"description":"Assay serum cholinesterase","code_information":[{"code":"82480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.87,"maximum":14.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.42,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.81,"additional_payer_notes":"APC"}]}]},{"description":"Assay rbc cholinesterase","code_information":[{"code":"82482","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.81,"maximum":17.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.1,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.49,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.99,"additional_payer_notes":"APC"}]}]},{"description":"Assay chondroitin sulfate","code_information":[{"code":"82485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.65,"maximum":37.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.65,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":37.71,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.07,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.13,"additional_payer_notes":"APC"}]}]},{"description":"Assay of chromium","code_information":[{"code":"82495","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.28,"maximum":37.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.28,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":37.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.5,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.68,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.71,"additional_payer_notes":"APC"}]}]},{"description":"Assay of citrate","code_information":[{"code":"82507","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.8,"maximum":50.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.63,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":50.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29.47,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.72,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.14,"additional_payer_notes":"APC"}]}]},{"description":"Collagen crosslinks","code_information":[{"code":"82523","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.68,"maximum":34.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.97,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.92,"additional_payer_notes":"APC"}]}]},{"description":"Assay of copper","code_information":[{"code":"82525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.41,"maximum":22.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.78,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.28,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.27,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.9,"additional_payer_notes":"APC"}]}]},{"description":"Assay of corticosterone","code_information":[{"code":"82528","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.52,"maximum":41.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.42,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":41.12,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.87,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.07,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.22,"additional_payer_notes":"APC"}]}]},{"description":"Cortisol free","code_information":[{"code":"82530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.71,"maximum":30.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.88,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.72,"additional_payer_notes":"APC"}]}]},{"description":"Total cortisol","code_information":[{"code":"82533","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.3,"maximum":29.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.44,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":29.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.26,"additional_payer_notes":"APC"}]}]},{"description":"Assay of creatine","code_information":[{"code":"82540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.64,"maximum":8.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.78,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":8.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.2,"additional_payer_notes":"APC"}]}]},{"description":"Col chromotography qual/quan","code_information":[{"code":"82542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.09,"maximum":43.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24.81,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":43.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.75,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.98,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ck (cpk)","code_information":[{"code":"82550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.51,"maximum":11.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.71,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.9,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.29,"additional_payer_notes":"APC"}]}]},{"description":"Assay of cpk in blood","code_information":[{"code":"82552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.39,"maximum":24.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.33,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.19,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.0,"additional_payer_notes":"APC"}]}]},{"description":"Creatine mb fraction","code_information":[{"code":"82553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.55,"maximum":21.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.55,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.9,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.36,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.35,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.94,"additional_payer_notes":"APC"}]}]},{"description":"Creatine isoforms","code_information":[{"code":"82554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.87,"maximum":21.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.23,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.29,"additional_payer_notes":"APC"}]}]},{"description":"Assay of creatinine","code_information":[{"code":"82565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.12,"maximum":9.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.12,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.48,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.47,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.73,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine creatinine","code_information":[{"code":"82570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.18,"maximum":9.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.18,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.54,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.8,"additional_payer_notes":"APC"}]}]},{"description":"Creatinine clearance test","code_information":[{"code":"82575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.46,"maximum":17.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.74,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.12,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.11,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.6,"additional_payer_notes":"APC"}]}]},{"description":"Assay of cryofibrinogen","code_information":[{"code":"82585","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.14,"maximum":25.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.13,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.12,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.84,"additional_payer_notes":"APC"}]}]},{"description":"Assay of cryoglobulin","code_information":[{"code":"82595","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.47,"maximum":11.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.25,"additional_payer_notes":"APC"}]}]},{"description":"Assay of cyanide","code_information":[{"code":"82600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.4,"maximum":35.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.4,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.98,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":35.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.74,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.73,"additional_payer_notes":"APC"}]}]},{"description":"Vitamin B-12","code_information":[{"code":"82607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.08,"maximum":27.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.08,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.12,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.89,"additional_payer_notes":"APC"}]}]},{"description":"B-12 binding capacity","code_information":[{"code":"82608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.32,"maximum":26.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.75,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.04,"additional_payer_notes":"APC"}]}]},{"description":"Cystatin c","code_information":[{"code":"82610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.52,"maximum":33.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.08,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.74,"additional_payer_notes":"APC"}]}]},{"description":"Test for urine cystines","code_information":[{"code":"82615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.55,"maximum":17.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.55,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.22,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.21,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.7,"additional_payer_notes":"APC"}]}]},{"description":"Dehydroepiandrosterone","code_information":[{"code":"82626","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.27,"maximum":46.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.27,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.03,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.04,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":46.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.01,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.3,"additional_payer_notes":"APC"}]}]},{"description":"Dehydroepiandrosterone","code_information":[{"code":"82627","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.23,"maximum":40.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.23,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.9,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.79,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":40.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.76,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.9,"additional_payer_notes":"APC"}]}]},{"description":"Desoxycorticosterone","code_information":[{"code":"82633","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.98,"maximum":56.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.22,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.91,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":56.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.84,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.12,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34.7,"additional_payer_notes":"APC"}]}]},{"description":"Deoxycortisol","code_information":[{"code":"82634","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.28,"maximum":53.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.28,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.33,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":53.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.3,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.79,"additional_payer_notes":"APC"}]}]},{"description":"Assay of dibucaine number","code_information":[{"code":"82638","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.25,"maximum":22.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.62,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.72,"additional_payer_notes":"APC"}]}]},{"description":"Dihydrotestosterone","code_information":[{"code":"82642","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.28,"maximum":53.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.28,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.33,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":53.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.3,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.79,"additional_payer_notes":"APC"}]}]},{"description":"Vit d 1 25-dihydroxy","code_information":[{"code":"82652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.5,"maximum":70.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":70.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.12,"additional_payer_notes":"APC"}]}]},{"description":"El-1 fecal quantitative","code_information":[{"code":"82653","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.97,"maximum":41.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.97,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.58,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":41.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.55,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.73,"additional_payer_notes":"APC"}]}]},{"description":"Pancreatic elastase fecal","code_information":[{"code":"82656","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.53,"maximum":21.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.33,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.91,"additional_payer_notes":"APC"}]}]},{"description":"Enzyme cell activity","code_information":[{"code":"82657","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.17,"maximum":40.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.72,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":40.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.5,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.83,"additional_payer_notes":"APC"}]}]},{"description":"Enzyme cell activity ra","code_information":[{"code":"82658","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.03,"maximum":80.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.79,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":45.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":80.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":46.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47.07,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49.31,"additional_payer_notes":"APC"}]}]},{"description":"Electrophoretic test","code_information":[{"code":"82664","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.5,"maximum":112.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":63.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.8,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":112.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.19,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.74,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":68.88,"additional_payer_notes":"APC"}]}]},{"description":"Assay of erythropoietin","code_information":[{"code":"82668","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.79,"maximum":34.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.79,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.09,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.04,"additional_payer_notes":"APC"}]}]},{"description":"Assay of estradiol","code_information":[{"code":"82670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.94,"maximum":51.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.78,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.9,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":51.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.87,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.29,"additional_payer_notes":"APC"}]}]},{"description":"Assay of estrogens","code_information":[{"code":"82671","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.3,"maximum":58.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34.56,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":58.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.18,"additional_payer_notes":"APC"}]}]},{"description":"Assay of estrogen","code_information":[{"code":"82672","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.7,"maximum":39.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.22,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":39.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.2,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.3,"additional_payer_notes":"APC"}]}]},{"description":"Assay of estriol","code_information":[{"code":"82677","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.18,"maximum":44.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.18,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24.91,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.87,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":44.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.08,"additional_payer_notes":"APC"}]}]},{"description":"Assay of estrone","code_information":[{"code":"82679","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.95,"maximum":45.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.7,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":45.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.67,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.94,"additional_payer_notes":"APC"}]}]},{"description":"Assay dir meas fr estradiol","code_information":[{"code":"82681","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.94,"maximum":51.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.78,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.9,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":51.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.87,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.29,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ethylene glycol","code_information":[{"code":"82693","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.9,"maximum":27.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.69,"additional_payer_notes":"APC"}]}]},{"description":"Assay of etiocholanolone","code_information":[{"code":"82696","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.24,"maximum":47.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.24,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.03,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.08,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":47.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.39,"additional_payer_notes":"APC"}]}]},{"description":"Fats/lipids feces qual","code_information":[{"code":"82705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.1,"maximum":9.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.1,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.71,"additional_payer_notes":"APC"}]}]},{"description":"Fats/lipids feces quant","code_information":[{"code":"82710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.8,"maximum":30.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.47,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.3,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.82,"additional_payer_notes":"APC"}]}]},{"description":"Assay of fecal fat","code_information":[{"code":"82715","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.97,"maximum":41.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.97,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.58,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":41.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.55,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.73,"additional_payer_notes":"APC"}]}]},{"description":"Assay of blood fatty acids","code_information":[{"code":"82725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.77,"maximum":34.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.77,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.08,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.9,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.07,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.02,"additional_payer_notes":"APC"}]}]},{"description":"Long chain fatty acids","code_information":[{"code":"82726","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.75,"maximum":36.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.75,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.13,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36.06,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.11,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.12,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ferritin","code_information":[{"code":"82728","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.63,"maximum":24.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.04,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.58,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.27,"additional_payer_notes":"APC"}]}]},{"description":"Assay of fetal fibronectin","code_information":[{"code":"82731","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.41,"maximum":117.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":66.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64.41,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":66.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":68.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":117.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":68.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":68.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":72.14,"additional_payer_notes":"APC"}]}]},{"description":"Assay of fluoride","code_information":[{"code":"82735","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.54,"maximum":33.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.1,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.65,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.76,"additional_payer_notes":"APC"}]}]},{"description":"Assay of folic acid serum","code_information":[{"code":"82746","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.7,"maximum":26.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.73,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.46,"additional_payer_notes":"APC"}]}]},{"description":"Assay of folic acid rbc","code_information":[{"code":"82747","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.65,"maximum":32.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.65,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.89,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32.23,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.87,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.77,"additional_payer_notes":"APC"}]}]},{"description":"Assay of semen fructose","code_information":[{"code":"82757","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.34,"maximum":31.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.86,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":31.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.42,"additional_payer_notes":"APC"}]}]},{"description":"Assay of rbc galactokinase","code_information":[{"code":"82759","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.48,"maximum":39.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":39.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.06,"additional_payer_notes":"APC"}]}]},{"description":"Assay of galactose","code_information":[{"code":"82760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.2,"maximum":20.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.54,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.87,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.97,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.54,"additional_payer_notes":"APC"}]}]},{"description":"Assay galactose transferase","code_information":[{"code":"82775","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.07,"maximum":38.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.07,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.7,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.54,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":38.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.52,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.6,"additional_payer_notes":"APC"}]}]},{"description":"Galactose transferase test","code_information":[{"code":"82776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.74,"maximum":21.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.21,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.74,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.09,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.56,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.55,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.15,"additional_payer_notes":"APC"}]}]},{"description":"Galectin-3","code_information":[{"code":"82777","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.25,"maximum":80.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46.02,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":45.58,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47.35,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":45.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":80.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":46.9,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47.3,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49.56,"additional_payer_notes":"APC"}]}]},{"description":"Assay iga/igd/igg/igm each","code_information":[{"code":"82784","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.3,"maximum":16.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.58,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.95,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.94,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.42,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ige","code_information":[{"code":"82785","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.46,"maximum":30.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30.06,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.44,"additional_payer_notes":"APC"}]}]},{"description":"Igg 1 2 3 or 4 each","code_information":[{"code":"82787","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.02,"maximum":14.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.02,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.26,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.58,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.5,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.98,"additional_payer_notes":"APC"}]}]},{"description":"Blood pH","code_information":[{"code":"82800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.0,"maximum":20.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.44,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.77,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.66,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.76,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.32,"additional_payer_notes":"APC"}]}]},{"description":"Blood gases any combination","code_information":[{"code":"82803","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.07,"maximum":47.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.07,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.89,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":47.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.87,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.2,"additional_payer_notes":"APC"}]}]},{"description":"Blood gases w/o2 saturation","code_information":[{"code":"82805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":78.77,"maximum":143.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":81.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78.77,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":81.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":84.28,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":80.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":143.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":83.5,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":84.21,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":88.22,"additional_payer_notes":"APC"}]}]},{"description":"Blood gases o2 sat only","code_information":[{"code":"82810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.77,"maximum":17.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.77,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.44,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.94,"additional_payer_notes":"APC"}]}]},{"description":"Hemoglobin-oxygen affinity","code_information":[{"code":"82820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.34,"maximum":24.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.87,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.74,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.94,"additional_payer_notes":"APC"}]}]},{"description":"Gastric analy w/ph ea spec","code_information":[{"code":"82930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.71,"maximum":12.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.91,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.52,"additional_payer_notes":"APC"}]}]},{"description":"Gastrin test","code_information":[{"code":"82938","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.69,"maximum":32.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.69,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.22,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.81,"additional_payer_notes":"APC"}]}]},{"description":"Assay of gastrin","code_information":[{"code":"82941","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.63,"maximum":32.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.86,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.69,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.75,"additional_payer_notes":"APC"}]}]},{"description":"Assay of glucagon","code_information":[{"code":"82943","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.29,"maximum":26.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.72,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.0,"additional_payer_notes":"APC"}]}]},{"description":"Glucose Other Fluid","code_information":[{"code":"82945","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.93,"maximum":7.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.93,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.21,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.17,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.2,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"}]}]},{"description":"Glucagon tolerance test","code_information":[{"code":"82946","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.77,"maximum":32.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.77,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.3,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.01,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.84,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.9,"additional_payer_notes":"APC"}]}]},{"description":"Assay glucose blood quant","code_information":[{"code":"82947","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.93,"maximum":7.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.93,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.21,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.17,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.2,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"}]}]},{"description":"Reagent strip/blood glucose","code_information":[{"code":"82948","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.04,"maximum":9.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.04,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.39,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.39,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.64,"additional_payer_notes":"APC"}]}]},{"description":"Glucose test","code_information":[{"code":"82950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.75,"maximum":8.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.94,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.75,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.08,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":8.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.32,"additional_payer_notes":"APC"}]}]},{"description":"Glucose tolerance test (GTT)","code_information":[{"code":"82951","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.87,"maximum":23.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.26,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.77,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.64,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.76,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.41,"additional_payer_notes":"APC"}]}]},{"description":"GTT-added samples","code_information":[{"code":"82952","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.92,"maximum":7.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.04,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.19,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.39,"additional_payer_notes":"APC"}]}]},{"description":"Assay of g6pd enzyme","code_information":[{"code":"82955","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.7,"maximum":17.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17.71,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.86,"additional_payer_notes":"APC"}]}]},{"description":"Test for G6PD enzyme","code_information":[{"code":"82960","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.05,"maximum":11.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.23,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.78,"additional_payer_notes":"APC"}]}]},{"description":"Glucose blood test","code_information":[{"code":"82962","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.28,"maximum":5.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.28,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.51,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.67,"additional_payer_notes":"APC"}]}]},{"description":"Assay of glucosidase","code_information":[{"code":"82963","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.48,"maximum":39.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":39.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.06,"additional_payer_notes":"APC"}]}]},{"description":"Assay of gdh enzyme","code_information":[{"code":"82965","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.15,"maximum":24.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.54,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.07,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.73,"additional_payer_notes":"APC"}]}]},{"description":"Assay of GGT","code_information":[{"code":"82977","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.2,"maximum":13.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.42,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.06,"additional_payer_notes":"APC"}]}]},{"description":"Assay of glutathione","code_information":[{"code":"82978","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.45,"maximum":28.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.91,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.53,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.52,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.3,"additional_payer_notes":"APC"}]}]},{"description":"Assay rbc glutathione","code_information":[{"code":"82979","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.44,"maximum":17.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.72,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.09,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.57,"additional_payer_notes":"APC"}]}]},{"description":"Assay of glycated protein","code_information":[{"code":"82985","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.76,"maximum":30.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.76,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.26,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.77,"additional_payer_notes":"APC"}]}]},{"description":"Assay of gonadotropin (fsh)","code_information":[{"code":"83001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.58,"maximum":33.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.88,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.69,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"APC"}]}]},{"description":"Assay of gonadotropin (lh)","code_information":[{"code":"83002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.52,"maximum":33.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.08,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.74,"additional_payer_notes":"APC"}]}]},{"description":"Assay growth hormone (hgh)","code_information":[{"code":"83003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.67,"maximum":30.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.67,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.67,"additional_payer_notes":"APC"}]}]},{"description":"Growth stimulation gene 2","code_information":[{"code":"83006","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":75.6,"maximum":138.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":78.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":77.87,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80.89,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":77.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":138.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":80.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":84.67,"additional_payer_notes":"APC"}]}]},{"description":"H pylori (c-13) blood","code_information":[{"code":"83009","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":67.36,"maximum":123.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":70.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.36,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":69.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":72.08,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":68.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":123.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":71.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":72.01,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":75.44,"additional_payer_notes":"APC"}]}]},{"description":"Assay of haptoglobin quant","code_information":[{"code":"83010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.58,"maximum":22.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.96,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.09,"additional_payer_notes":"APC"}]}]},{"description":"Assay of haptoglobins","code_information":[{"code":"83012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.89,"maximum":49.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.97,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.89,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.7,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.77,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":49.1,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.5,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.75,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.12,"additional_payer_notes":"APC"}]}]},{"description":"H pylori (c-13) breath","code_information":[{"code":"83013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":67.36,"maximum":123.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":70.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67.36,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":69.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":72.08,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":68.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":123.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":71.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":72.01,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":75.44,"additional_payer_notes":"APC"}]}]},{"description":"H pylori drug admin","code_information":[{"code":"83014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.86,"maximum":14.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.1,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.41,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.8,"additional_payer_notes":"APC"}]}]},{"description":"Heavy metal qual any anal","code_information":[{"code":"83015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.94,"maximum":38.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.41,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":38.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.45,"additional_payer_notes":"APC"}]}]},{"description":"Heavy metal quant each nes","code_information":[{"code":"83018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.96,"maximum":40.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.62,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":40.1,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.6,"additional_payer_notes":"APC"}]}]},{"description":"Hemoglobin electrophoresis","code_information":[{"code":"83020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.87,"maximum":23.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.26,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.77,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.64,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.76,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.41,"additional_payer_notes":"APC"}]}]},{"description":"Hemoglobin chromotography","code_information":[{"code":"83021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.06,"maximum":32.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.23,"additional_payer_notes":"APC"}]}]},{"description":"Hemoglobin copper sulfate","code_information":[{"code":"83026","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.01,"maximum":7.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7.32,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.25,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.49,"additional_payer_notes":"APC"}]}]},{"description":"Fetal hemoglobin chemical","code_information":[{"code":"83030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.74,"maximum":19.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.74,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.03,"additional_payer_notes":"APC"}]}]},{"description":"Fetal hemoglobin assay qual","code_information":[{"code":"83033","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.0,"maximum":14.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.56,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.55,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.96,"additional_payer_notes":"APC"}]}]},{"description":"Glycosylated hemoglobin test","code_information":[{"code":"83036","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.71,"maximum":17.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.1,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.39,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.88,"additional_payer_notes":"APC"}]}]},{"description":"Glycosylated hb home device","code_information":[{"code":"83037","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.71,"maximum":17.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.1,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.39,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.88,"additional_payer_notes":"APC"}]}]},{"description":"Blood methemoglobin test","code_information":[{"code":"83045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.49,"maximum":11.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.68,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.94,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.27,"additional_payer_notes":"APC"}]}]},{"description":"Blood methemoglobin assay","code_information":[{"code":"83050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.2,"maximum":14.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.77,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.69,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.77,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.18,"additional_payer_notes":"APC"}]}]},{"description":"Assay of plasma hemoglobin","code_information":[{"code":"83051","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.31,"maximum":13.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.31,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.19,"additional_payer_notes":"APC"}]}]},{"description":"Blood sulfhemoglobin assay","code_information":[{"code":"83060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.8,"maximum":16.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.42,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.86,"additional_payer_notes":"APC"}]}]},{"description":"Assay of hemoglobin heat","code_information":[{"code":"83065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.0,"maximum":16.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.08,"additional_payer_notes":"APC"}]}]},{"description":"Hemoglobin stability screen","code_information":[{"code":"83068","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.47,"maximum":17.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.75,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.13,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.12,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.61,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine hemoglobin","code_information":[{"code":"83069","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.95,"maximum":7.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.19,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.22,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.42,"additional_payer_notes":"APC"}]}]},{"description":"Assay of hemosiderin qual","code_information":[{"code":"83070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.75,"maximum":8.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.94,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.75,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.08,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":8.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.32,"additional_payer_notes":"APC"}]}]},{"description":"Assay of b hexosaminidase","code_information":[{"code":"83080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.87,"maximum":30.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.03,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.89,"additional_payer_notes":"APC"}]}]},{"description":"Assay of histamine","code_information":[{"code":"83088","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.53,"maximum":53.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.42,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.6,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":53.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.07,"additional_payer_notes":"APC"}]}]},{"description":"Assay Of Homocystine","code_information":[{"code":"83090","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.92,"maximum":32.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.46,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.17,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.07,"additional_payer_notes":"APC"}]}]},{"description":"Assay of homovanillic acid","code_information":[{"code":"83150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.41,"maximum":40.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.41,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.08,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":40.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.1,"additional_payer_notes":"APC"}]}]},{"description":"Assay of corticosteroids 17","code_information":[{"code":"83491","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.9,"maximum":32.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"APC"}]}]},{"description":"Assay of 5-hiaa","code_information":[{"code":"83497","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.9,"maximum":23.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.29,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.8,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.79,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.45,"additional_payer_notes":"APC"}]}]},{"description":"Assay of progesterone 17-d","code_information":[{"code":"83498","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.17,"maximum":49.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.07,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":49.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.43,"additional_payer_notes":"APC"}]}]},{"description":"Assay free hydroxyproline","code_information":[{"code":"83500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.65,"maximum":41.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.65,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":41.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.21,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.37,"additional_payer_notes":"APC"}]}]},{"description":"Assay total hydroxyproline","code_information":[{"code":"83505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.3,"maximum":44.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.03,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":44.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.22,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay nonantibody","code_information":[{"code":"83516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.53,"maximum":21.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.33,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.91,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay dipstick","code_information":[{"code":"83518","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.64,"maximum":17.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.93,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.31,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.8,"additional_payer_notes":"APC"}]}]},{"description":"Ria nonantibody","code_information":[{"code":"83519","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.4,"maximum":33.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.4,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.69,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.5,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.67,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.61,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay quant nos nonab","code_information":[{"code":"83520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.27,"maximum":31.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.48,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":31.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.46,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.34,"additional_payer_notes":"APC"}]}]},{"description":"Ig light chains free each","code_information":[{"code":"83521","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.27,"maximum":31.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.48,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":31.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.46,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.34,"additional_payer_notes":"APC"}]}]},{"description":"Assay of insulin","code_information":[{"code":"83525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.43,"maximum":20.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.77,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.8,"additional_payer_notes":"APC"}]}]},{"description":"Assay of insulin","code_information":[{"code":"83527","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.95,"maximum":23.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.47,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.86,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.65,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.84,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.5,"additional_payer_notes":"APC"}]}]},{"description":"Assay of intrinsic factor","code_information":[{"code":"83528","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.82,"maximum":36.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.41,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.21,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.2,"additional_payer_notes":"APC"}]}]},{"description":"Asay of interleukin-6 (il-6)","code_information":[{"code":"83529","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.27,"maximum":31.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.48,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":31.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.46,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.34,"additional_payer_notes":"APC"}]}]},{"description":"Assay of iron","code_information":[{"code":"83540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.47,"maximum":11.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.25,"additional_payer_notes":"APC"}]}]},{"description":"Iron binding test","code_information":[{"code":"83550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.74,"maximum":15.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.74,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.35,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.34,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.79,"additional_payer_notes":"APC"}]}]},{"description":"Assay of idh enzyme","code_information":[{"code":"83570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.85,"maximum":16.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.85,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.46,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.91,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ketogenic steroids","code_information":[{"code":"83582","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.47,"maximum":28.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.93,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.33,"additional_payer_notes":"APC"}]}]},{"description":"Assay 17- ketosteroids","code_information":[{"code":"83586","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.8,"maximum":23.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.57,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.68,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.34,"additional_payer_notes":"APC"}]}]},{"description":"Fractionation ketosteroids","code_information":[{"code":"83593","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.5,"maximum":52.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29.36,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":52.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.47,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.92,"additional_payer_notes":"APC"}]}]},{"description":"Assay of lactic acid","code_information":[{"code":"83605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.57,"maximum":21.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.57,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.92,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.96,"additional_payer_notes":"APC"}]}]},{"description":"Lactate (LD) (LDH) enzyme","code_information":[{"code":"83615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.04,"maximum":11.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.04,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.22,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.46,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.76,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ldh enzymes","code_information":[{"code":"83625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.79,"maximum":23.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.79,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.69,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.67,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.32,"additional_payer_notes":"APC"}]}]},{"description":"Lactoferrin fecal (qual)","code_information":[{"code":"83630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.7,"maximum":35.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.29,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.08,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":35.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.06,"additional_payer_notes":"APC"}]}]},{"description":"Lactoferrin fecal (quant)","code_information":[{"code":"83631","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.63,"maximum":35.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.42,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.22,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":35.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.99,"additional_payer_notes":"APC"}]}]},{"description":"Placental lactogen","code_information":[{"code":"83632","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.22,"maximum":36.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.83,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.65,"additional_payer_notes":"APC"}]}]},{"description":"Test urine for lactose","code_information":[{"code":"83633","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.25,"maximum":20.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.59,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.04,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.03,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.6,"additional_payer_notes":"APC"}]}]},{"description":"Assay of lead","code_information":[{"code":"83655","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.11,"maximum":22.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.11,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.84,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.95,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.56,"additional_payer_notes":"APC"}]}]},{"description":"L/s ratio fetal lung","code_information":[{"code":"83661","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.99,"maximum":40.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.87,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.53,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":40.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.63,"additional_payer_notes":"APC"}]}]},{"description":"Foam stability fetal lung","code_information":[{"code":"83662","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.91,"maximum":34.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.48,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.21,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.18,"additional_payer_notes":"APC"}]}]},{"description":"Fluoro polarize fetal lung","code_information":[{"code":"83663","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.91,"maximum":34.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.48,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.21,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.18,"additional_payer_notes":"APC"}]}]},{"description":"Lamellar bdy fetal lung","code_information":[{"code":"83664","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.32,"maximum":35.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.9,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":35.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.64,"additional_payer_notes":"APC"}]}]},{"description":"Assay of lap enzyme","code_information":[{"code":"83670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.81,"maximum":17.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.1,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.49,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.99,"additional_payer_notes":"APC"}]}]},{"description":"Assay of lipase","code_information":[{"code":"83690","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.89,"maximum":12.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.89,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.1,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.72,"additional_payer_notes":"APC"}]}]},{"description":"Assay of lipoprotein(a)","code_information":[{"code":"83695","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.32,"maximum":26.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.75,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.04,"additional_payer_notes":"APC"}]}]},{"description":"Assay Lipoprotein Pla2","code_information":[{"code":"83698","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":46.31,"maximum":84.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46.31,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":47.7,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":47.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":84.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":49.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51.87,"additional_payer_notes":"APC"}]}]},{"description":"Lipopro bld electrophoretic","code_information":[{"code":"83700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.26,"maximum":20.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.61,"additional_payer_notes":"APC"}]}]},{"description":"Lipoprotein bld hr fraction","code_information":[{"code":"83701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.86,"maximum":61.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35.21,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":61.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.2,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.92,"additional_payer_notes":"APC"}]}]},{"description":"Lipoprotein bld quan part","code_information":[{"code":"83704","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34.19,"maximum":62.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.22,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.58,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.55,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38.29,"additional_payer_notes":"APC"}]}]},{"description":"Assay of lipoprotein","code_information":[{"code":"83718","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.19,"maximum":14.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.76,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.17,"additional_payer_notes":"APC"}]}]},{"description":"Assay of blood lipoprotein","code_information":[{"code":"83719","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.75,"maximum":23.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.75,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.28,"additional_payer_notes":"APC"}]}]},{"description":"Assay of blood lipoprotein","code_information":[{"code":"83721","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.5,"maximum":19.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.82,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.22,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.76,"additional_payer_notes":"APC"}]}]},{"description":"Lipoprtn dir meas sd ldl chl","code_information":[{"code":"83722","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34.19,"maximum":62.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.22,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.58,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.55,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38.29,"additional_payer_notes":"APC"}]}]},{"description":"Assay of lrh hormone","code_information":[{"code":"83727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.19,"maximum":31.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.71,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.39,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":31.39,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.25,"additional_payer_notes":"APC"}]}]},{"description":"Assay of magnesium","code_information":[{"code":"83735","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.7,"maximum":12.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.97,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.9,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.17,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12.23,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.5,"additional_payer_notes":"APC"}]}]},{"description":"Assay malate dehydrogenase","code_information":[{"code":"83775","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.37,"maximum":13.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.59,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.89,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.88,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.25,"additional_payer_notes":"APC"}]}]},{"description":"Assay of manganese","code_information":[{"code":"83785","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.65,"maximum":48.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.65,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.52,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":48.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.25,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.49,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.85,"additional_payer_notes":"APC"}]}]},{"description":"Mass spectrometry qual/quan","code_information":[{"code":"83789","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.11,"maximum":44.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.11,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24.83,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.8,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":44.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.77,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.0,"additional_payer_notes":"APC"}]}]},{"description":"Assay of mercury","code_information":[{"code":"83825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.26,"maximum":29.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.75,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.4,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":29.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.21,"additional_payer_notes":"APC"}]}]},{"description":"Assay of metanephrines","code_information":[{"code":"83835","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.94,"maximum":30.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.13,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.11,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.97,"additional_payer_notes":"APC"}]}]},{"description":"Assay of methemalbumin","code_information":[{"code":"83857","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.74,"maximum":19.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.74,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.03,"additional_payer_notes":"APC"}]}]},{"description":"Microfluid analy tears","code_information":[{"code":"83861","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.48,"maximum":41.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.15,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":41.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.83,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.03,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.18,"additional_payer_notes":"APC"}]}]},{"description":"Mucopolysaccharides","code_information":[{"code":"83864","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.5,"maximum":52.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29.36,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":52.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.47,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.92,"additional_payer_notes":"APC"}]}]},{"description":"Assay synovial fluid mucin","code_information":[{"code":"83872","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.86,"maximum":10.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.04,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.56,"additional_payer_notes":"APC"}]}]},{"description":"Assay of csf protein","code_information":[{"code":"83873","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.2,"maximum":31.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.72,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.4,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.39,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.26,"additional_payer_notes":"APC"}]}]},{"description":"Assay of myoglobin","code_information":[{"code":"83874","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.92,"maximum":23.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.44,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.31,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.47,"additional_payer_notes":"APC"}]}]},{"description":"Assay myeloperoxidase","code_information":[{"code":"83876","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":50.86,"maximum":92.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":52.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":51.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":92.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":53.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56.96,"additional_payer_notes":"APC"}]}]},{"description":"Assay of natriuretic peptide","code_information":[{"code":"83880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.26,"maximum":71.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42.01,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.97,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.97,"additional_payer_notes":"APC"}]}]},{"description":"Assay nephelometry not spec","code_information":[{"code":"83883","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.6,"maximum":24.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.42,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.23,"additional_payer_notes":"APC"}]}]},{"description":"Assay neurflmnt light chain","code_information":[{"code":"83884","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.23,"maximum":212.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":120.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.23,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":119.72,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":124.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":118.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":212.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":123.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":124.25,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":130.18,"additional_payer_notes":"APC"}]}]},{"description":"Assay of nickel","code_information":[{"code":"83885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.51,"maximum":44.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":44.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.2,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.45,"additional_payer_notes":"APC"}]}]},{"description":"Assay of nucleotidase","code_information":[{"code":"83915","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.15,"maximum":20.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.48,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.49,"additional_payer_notes":"APC"}]}]},{"description":"Oligoclonal bands","code_information":[{"code":"83916","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.39,"maximum":50.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.31,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":50.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.68,"additional_payer_notes":"APC"}]}]},{"description":"Organic acids total quant","code_information":[{"code":"83918","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.6,"maximum":43.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24.31,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":43.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.43,"additional_payer_notes":"APC"}]}]},{"description":"Organic acids qual each","code_information":[{"code":"83919","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.45,"maximum":30.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.94,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.6,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.59,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.42,"additional_payer_notes":"APC"}]}]},{"description":"Organic acid single quant","code_information":[{"code":"83921","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.21,"maximum":38.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.69,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":38.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.67,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.76,"additional_payer_notes":"APC"}]}]},{"description":"Assay of blood osmolality","code_information":[{"code":"83930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.61,"maximum":12.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.87,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.61,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.81,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.07,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.07,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.4,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine osmolality","code_information":[{"code":"83935","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.82,"maximum":12.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.3,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.64,"additional_payer_notes":"APC"}]}]},{"description":"Assay of osteocalcin","code_information":[{"code":"83937","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.85,"maximum":54.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.85,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.75,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":54.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.64,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.91,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.43,"additional_payer_notes":"APC"}]}]},{"description":"Assay of oxalate","code_information":[{"code":"83945","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.45,"maximum":26.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26.39,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.18,"additional_payer_notes":"APC"}]}]},{"description":"Oncoprotein her-2/neu","code_information":[{"code":"83950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.41,"maximum":117.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":66.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64.41,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":66.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":68.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":117.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":68.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":68.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":72.14,"additional_payer_notes":"APC"}]}]},{"description":"Oncoprotein dcp","code_information":[{"code":"83951","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.41,"maximum":117.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":66.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64.41,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":66.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":68.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":117.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":68.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":68.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":72.14,"additional_payer_notes":"APC"}]}]},{"description":"Assay of parathormone","code_information":[{"code":"83970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.28,"maximum":75.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.28,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":42.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44.17,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":42.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":75.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44.13,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46.23,"additional_payer_notes":"APC"}]}]},{"description":"Assay ph body fluid nos","code_information":[{"code":"83986","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.58,"maximum":6.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3.69,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.83,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.01,"additional_payer_notes":"APC"}]}]},{"description":"Exhaled breath condensate","code_information":[{"code":"83987","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.58,"maximum":6.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3.69,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.83,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.01,"additional_payer_notes":"APC"}]}]},{"description":"Assay for calprotectin fecal","code_information":[{"code":"83993","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.63,"maximum":35.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.42,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.22,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":35.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.99,"additional_payer_notes":"APC"}]}]},{"description":"Assay of blood pku","code_information":[{"code":"84030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.5,"maximum":10.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.88,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.83,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.88,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.16,"additional_payer_notes":"APC"}]}]},{"description":"Assay of phenylketones","code_information":[{"code":"84035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.98,"maximum":7.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.1,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.26,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.25,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.46,"additional_payer_notes":"APC"}]}]},{"description":"Assay acid phosphatase","code_information":[{"code":"84060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.64,"maximum":13.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.87,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.17,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.56,"additional_payer_notes":"APC"}]}]},{"description":"Assay prostate phosphatase","code_information":[{"code":"84066","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.66,"maximum":17.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.66,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.34,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.33,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.82,"additional_payer_notes":"APC"}]}]},{"description":"Assay alkaline phosphatase","code_information":[{"code":"84075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.18,"maximum":9.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.18,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.54,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.8,"additional_payer_notes":"APC"}]}]},{"description":"Assay alkaline phosphatase","code_information":[{"code":"84078","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.26,"maximum":15.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.51,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.25,"additional_payer_notes":"APC"}]}]},{"description":"Assay alkaline phosphatases","code_information":[{"code":"84080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.78,"maximum":26.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.37,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.22,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.81,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.55,"additional_payer_notes":"APC"}]}]},{"description":"Assay phosphatidylglycerol","code_information":[{"code":"84081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.52,"maximum":30.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.51,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.5,"additional_payer_notes":"APC"}]}]},{"description":"Assay of rbc pg6d enzyme","code_information":[{"code":"84085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.44,"maximum":17.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.72,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.09,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.57,"additional_payer_notes":"APC"}]}]},{"description":"Assay phosphohexose enzymes","code_information":[{"code":"84087","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.73,"maximum":19.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.48,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.47,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.02,"additional_payer_notes":"APC"}]}]},{"description":"Assay of phosphorus","code_information":[{"code":"84100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.74,"maximum":8.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.74,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.07,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":8.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.07,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.31,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine phosphorus","code_information":[{"code":"84105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.78,"maximum":10.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10.55,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.18,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"APC"}]}]},{"description":"Test for porphobilinogen","code_information":[{"code":"84106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.82,"maximum":10.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.17,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.22,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.52,"additional_payer_notes":"APC"}]}]},{"description":"Assay of porphobilinogen","code_information":[{"code":"84110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.44,"maximum":15.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.69,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.03,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.02,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.45,"additional_payer_notes":"APC"}]}]},{"description":"Eval amniotic fluid protein","code_information":[{"code":"84112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":98.11,"maximum":179.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":102.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98.11,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":101.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":104.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":100.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":179.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":104.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":104.88,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":109.88,"additional_payer_notes":"APC"}]}]},{"description":"Test urine for porphyrins","code_information":[{"code":"84119","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.36,"maximum":24.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.36,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.3,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.96,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine porphyrins","code_information":[{"code":"84120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.71,"maximum":26.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.15,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.72,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.48,"additional_payer_notes":"APC"}]}]},{"description":"Assay of feces porphyrins","code_information":[{"code":"84126","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.11,"maximum":71.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.11,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.8,"additional_payer_notes":"APC"}]}]},{"description":"Assay of serum potassium","code_information":[{"code":"84132","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.76,"maximum":8.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.76,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.9,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":8.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.09,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.33,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine potassium","code_information":[{"code":"84133","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.73,"maximum":8.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.87,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":8.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.3,"additional_payer_notes":"APC"}]}]},{"description":"Assay of prealbumin","code_information":[{"code":"84134","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.59,"maximum":26.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.03,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.47,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.6,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.34,"additional_payer_notes":"APC"}]}]},{"description":"Assay of pregnanediol","code_information":[{"code":"84135","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.27,"maximum":38.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.27,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.91,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":38.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.74,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.82,"additional_payer_notes":"APC"}]}]},{"description":"Assay of pregnanetriol","code_information":[{"code":"84138","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.05,"maximum":38.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.68,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.52,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":38.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.58,"additional_payer_notes":"APC"}]}]},{"description":"Assay of pregnenolone","code_information":[{"code":"84140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.67,"maximum":37.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.67,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.29,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.12,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":37.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.15,"additional_payer_notes":"APC"}]}]},{"description":"Assay of 17-hydroxypregneno","code_information":[{"code":"84143","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.81,"maximum":41.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.49,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.41,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":41.65,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.55,"additional_payer_notes":"APC"}]}]},{"description":"Assay of progesterone","code_information":[{"code":"84144","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.86,"maximum":38.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.49,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":38.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.3,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.36,"additional_payer_notes":"APC"}]}]},{"description":"Procalcitonin (PCT)","code_information":[{"code":"84145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.22,"maximum":49.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.04,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.13,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":49.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.49,"additional_payer_notes":"APC"}]}]},{"description":"Assay of prolactin","code_information":[{"code":"84146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.38,"maximum":35.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.38,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.96,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":35.39,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.72,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.71,"additional_payer_notes":"APC"}]}]},{"description":"Assay of prostaglandin","code_information":[{"code":"84150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.77,"maximum":76.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.44,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.77,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44.69,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":42.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":76.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46.78,"additional_payer_notes":"APC"}]}]},{"description":"Assay of psa complexed","code_information":[{"code":"84152","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.39,"maximum":33.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.94,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.6,"additional_payer_notes":"APC"}]}]},{"description":"Assay of psa total","code_information":[{"code":"84153","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.39,"maximum":33.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.94,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.6,"additional_payer_notes":"APC"}]}]},{"description":"Assay of psa free","code_information":[{"code":"84154","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.39,"maximum":33.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.94,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.6,"additional_payer_notes":"APC"}]}]},{"description":"Assay of protein serum","code_information":[{"code":"84155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.67,"maximum":6.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.67,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3.78,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.11,"additional_payer_notes":"APC"}]}]},{"description":"Assay of protein urine","code_information":[{"code":"84156","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.67,"maximum":6.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.67,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3.78,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.11,"additional_payer_notes":"APC"}]}]},{"description":"Assay of protein other","code_information":[{"code":"84157","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.0,"maximum":7.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.28,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.48,"additional_payer_notes":"APC"}]}]},{"description":"Assay of protein any source","code_information":[{"code":"84160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.61,"maximum":10.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.61,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.78,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.28,"additional_payer_notes":"APC"}]}]},{"description":"Pappa serum","code_information":[{"code":"84163","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.05,"maximum":27.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.09,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.86,"additional_payer_notes":"APC"}]}]},{"description":"Protein e-phoresis serum","code_information":[{"code":"84165","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.74,"maximum":19.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.74,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.03,"additional_payer_notes":"APC"}]}]},{"description":"Protein e-phoresis/urine/csf","code_information":[{"code":"84166","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.83,"maximum":32.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.83,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.36,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.08,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.9,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.97,"additional_payer_notes":"APC"}]}]},{"description":"Western blot test","code_information":[{"code":"84181","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.03,"maximum":31.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.54,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.22,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":31.1,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.21,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.07,"additional_payer_notes":"APC"}]}]},{"description":"Protein western blot test","code_information":[{"code":"84182","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.21,"maximum":53.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.09,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":53.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.72,"additional_payer_notes":"APC"}]}]},{"description":"Assay RBC protoporphyrin","code_information":[{"code":"84202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.35,"maximum":26.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.78,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.35,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.34,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.07,"additional_payer_notes":"APC"}]}]},{"description":"Test RBC protoporphyrin","code_information":[{"code":"84203","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.74,"maximum":17.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.74,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.03,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.42,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.91,"additional_payer_notes":"APC"}]}]},{"description":"Assay of proinsulin","code_information":[{"code":"84206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.69,"maximum":48.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.69,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.49,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.56,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":48.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.89,"additional_payer_notes":"APC"}]}]},{"description":"Assay of vitamin b-6","code_information":[{"code":"84207","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.1,"maximum":51.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.22,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28.1,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.94,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.07,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":51.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.47,"additional_payer_notes":"APC"}]}]},{"description":"Assay of pyruvate","code_information":[{"code":"84210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.48,"maximum":26.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.91,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.22,"additional_payer_notes":"APC"}]}]},{"description":"Assay of pyruvate kinase","code_information":[{"code":"84220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.44,"maximum":17.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.72,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.09,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.57,"additional_payer_notes":"APC"}]}]},{"description":"Assay of quinine","code_information":[{"code":"84228","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.63,"maximum":21.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.1,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.44,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.43,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.03,"additional_payer_notes":"APC"}]}]},{"description":"Assay of estrogen","code_information":[{"code":"84233","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":87.88,"maximum":160.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":91.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":87.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":90.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":94.03,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":89.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":160.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":93.94,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":98.43,"additional_payer_notes":"APC"}]}]},{"description":"Assay of progesterone","code_information":[{"code":"84234","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.88,"maximum":118.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":67.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":66.83,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.42,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":66.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":118.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":68.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":72.67,"additional_payer_notes":"APC"}]}]},{"description":"Assay of endocrine hormone","code_information":[{"code":"84235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":71.23,"maximum":130.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":74.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71.23,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":73.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":76.22,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":72.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":130.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":75.5,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":76.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":79.78,"additional_payer_notes":"APC"}]}]},{"description":"Assay nonendocrine receptor","code_information":[{"code":"84238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.57,"maximum":66.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36.57,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.13,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":66.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.09,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.96,"additional_payer_notes":"APC"}]}]},{"description":"Assay of renin","code_information":[{"code":"84244","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.99,"maximum":40.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.87,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.53,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":40.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.63,"additional_payer_notes":"APC"}]}]},{"description":"Assay of vitamin b-2","code_information":[{"code":"84252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.24,"maximum":36.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.24,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.67,"additional_payer_notes":"APC"}]}]},{"description":"Assay of selenium","code_information":[{"code":"84255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.53,"maximum":46.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.55,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.3,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":46.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.59,"additional_payer_notes":"APC"}]}]},{"description":"Assay of serotonin","code_information":[{"code":"84260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.98,"maximum":56.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.22,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.91,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":56.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.84,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.12,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34.7,"additional_payer_notes":"APC"}]}]},{"description":"Assay of sex hormone globul","code_information":[{"code":"84270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.73,"maximum":39.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":39.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.34,"additional_payer_notes":"APC"}]}]},{"description":"Assay of sialic acid","code_information":[{"code":"84275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.44,"maximum":24.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.98,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.25,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.05,"additional_payer_notes":"APC"}]}]},{"description":"Assay of silica","code_information":[{"code":"84285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.21,"maximum":46.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.22,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.97,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":46.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.95,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.24,"additional_payer_notes":"APC"}]}]},{"description":"Assay of serum sodium","code_information":[{"code":"84295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.81,"maximum":8.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":8.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.39,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine sodium","code_information":[{"code":"84300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.06,"maximum":9.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.41,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.67,"additional_payer_notes":"APC"}]}]},{"description":"Assay of sweat sodium","code_information":[{"code":"84302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.86,"maximum":8.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":8.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.2,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.44,"additional_payer_notes":"APC"}]}]},{"description":"Assay of somatomedin","code_information":[{"code":"84305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.26,"maximum":38.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.9,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":38.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.81,"additional_payer_notes":"APC"}]}]},{"description":"Assay of somatostatin","code_information":[{"code":"84307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.28,"maximum":33.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.28,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.83,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.56,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.47,"additional_payer_notes":"APC"}]}]},{"description":"Spectrophotometry","code_information":[{"code":"84311","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.1,"maximum":14.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.42,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.1,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.07,"additional_payer_notes":"APC"}]}]},{"description":"Body fluid specific gravity","code_information":[{"code":"84315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.28,"maximum":5.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.28,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.51,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.67,"additional_payer_notes":"APC"}]}]},{"description":"Chromatogram assay sugars","code_information":[{"code":"84375","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.0,"maximum":71.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.73,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.68,"additional_payer_notes":"APC"}]}]},{"description":"Sugars single qual","code_information":[{"code":"84376","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.5,"maximum":10.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.88,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.83,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.88,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.16,"additional_payer_notes":"APC"}]}]},{"description":"Sugars multiple qual","code_information":[{"code":"84377","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.5,"maximum":10.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.88,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.83,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.88,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.16,"additional_payer_notes":"APC"}]}]},{"description":"Sugars single quant","code_information":[{"code":"84378","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.53,"maximum":21.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.33,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.91,"additional_payer_notes":"APC"}]}]},{"description":"Sugars multiple quant","code_information":[{"code":"84379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.53,"maximum":21.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.33,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.91,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine sulfate","code_information":[{"code":"84392","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.49,"maximum":10.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.87,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.87,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.15,"additional_payer_notes":"APC"}]}]},{"description":"Tau phosphorylated ea","code_information":[{"code":"84393","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":128.92,"maximum":235.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":134.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":137.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":131.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":235.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":136.66,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":137.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.39,"additional_payer_notes":"APC"}]}]},{"description":"Total tau","code_information":[{"code":"84394","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":128.92,"maximum":235.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":134.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":137.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":131.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":235.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":136.66,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":137.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.39,"additional_payer_notes":"APC"}]}]},{"description":"Assay of free testosterone","code_information":[{"code":"84402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.47,"maximum":46.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.23,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":46.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.53,"additional_payer_notes":"APC"}]}]},{"description":"Assay of total testosterone","code_information":[{"code":"84403","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.81,"maximum":47.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.58,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":47.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.59,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.91,"additional_payer_notes":"APC"}]}]},{"description":"Testosterone bioavailable","code_information":[{"code":"84410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.28,"maximum":93.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53.33,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51.28,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":52.82,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.87,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":52.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":93.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":54.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57.43,"additional_payer_notes":"APC"}]}]},{"description":"Assay of vitamin b-1","code_information":[{"code":"84425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.23,"maximum":38.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.23,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.87,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.72,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":38.77,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.5,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.78,"additional_payer_notes":"APC"}]}]},{"description":"Assay of thiocyanate","code_information":[{"code":"84430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.63,"maximum":21.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.1,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.44,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.43,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.03,"additional_payer_notes":"APC"}]}]},{"description":"Thromboxane urine","code_information":[{"code":"84431","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.11,"maximum":64.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.11,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.32,"additional_payer_notes":"APC"}]}]},{"description":"Assay of thyroglobulin","code_information":[{"code":"84432","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.06,"maximum":29.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.54,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":29.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.99,"additional_payer_notes":"APC"}]}]},{"description":"Asy thiopurin s-mthyltrnsfrs","code_information":[{"code":"84433","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.17,"maximum":40.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.72,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":40.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.5,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.83,"additional_payer_notes":"APC"}]}]},{"description":"Assay of total thyroxine","code_information":[{"code":"84436","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.87,"maximum":12.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.08,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.35,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.34,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.69,"additional_payer_notes":"APC"}]}]},{"description":"Assay of neonatal thyroxine","code_information":[{"code":"84437","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.47,"maximum":11.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.25,"additional_payer_notes":"APC"}]}]},{"description":"Assay of free thyroxine","code_information":[{"code":"84439","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.02,"maximum":16.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.02,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.29,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.1,"additional_payer_notes":"APC"}]}]},{"description":"Assay of thyroid activity","code_information":[{"code":"84442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.78,"maximum":26.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.37,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.22,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.81,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.55,"additional_payer_notes":"APC"}]}]},{"description":"Assay thyroid stim hormone","code_information":[{"code":"84443","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.8,"maximum":30.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.47,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.3,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.82,"additional_payer_notes":"APC"}]}]},{"description":"Assay of tsi globulin","code_information":[{"code":"84445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":50.86,"maximum":92.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":52.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":51.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":92.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":53.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56.96,"additional_payer_notes":"APC"}]}]},{"description":"Assay of vitamin e","code_information":[{"code":"84446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.18,"maximum":25.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.18,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.17,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.88,"additional_payer_notes":"APC"}]}]},{"description":"Assay of transcortin","code_information":[{"code":"84449","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.0,"maximum":32.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.26,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.08,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.24,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.16,"additional_payer_notes":"APC"}]}]},{"description":"Transferase (AST) (SGOT)","code_information":[{"code":"84450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.18,"maximum":9.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.18,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.54,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.8,"additional_payer_notes":"APC"}]}]},{"description":"Alanine amino (ALT) (SGPT)","code_information":[{"code":"84460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.3,"maximum":9.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.46,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.67,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.94,"additional_payer_notes":"APC"}]}]},{"description":"Assay of transferrin","code_information":[{"code":"84466","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.76,"maximum":23.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.76,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.29,"additional_payer_notes":"APC"}]}]},{"description":"Assay of triglycerides","code_information":[{"code":"84478","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.74,"maximum":10.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.97,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.74,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.91,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.08,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.43,"additional_payer_notes":"APC"}]}]},{"description":"Assay of thyroid (t3 or t4)","code_information":[{"code":"84479","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.47,"maximum":11.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.25,"additional_payer_notes":"APC"}]}]},{"description":"Assay triiodothyronine (t3)","code_information":[{"code":"84480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.18,"maximum":25.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.18,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.17,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.88,"additional_payer_notes":"APC"}]}]},{"description":"Free assay (FT-3)","code_information":[{"code":"84481","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.94,"maximum":30.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.13,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.11,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.97,"additional_payer_notes":"APC"}]}]},{"description":"T3 reverse","code_information":[{"code":"84482","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.76,"maximum":28.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.76,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.23,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.86,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.65,"additional_payer_notes":"APC"}]}]},{"description":"Assay of troponin quant","code_information":[{"code":"84484","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.47,"maximum":22.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.97,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.34,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.77,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.33,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.97,"additional_payer_notes":"APC"}]}]},{"description":"Assay duodenal fluid trypsin","code_information":[{"code":"84485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.2,"maximum":13.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.42,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.06,"additional_payer_notes":"APC"}]}]},{"description":"Test feces for trypsin","code_information":[{"code":"84488","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.3,"maximum":13.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.81,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.18,"additional_payer_notes":"APC"}]}]},{"description":"Assay of feces for trypsin","code_information":[{"code":"84490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.93,"maximum":18.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.33,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.93,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.23,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.12,"additional_payer_notes":"APC"}]}]},{"description":"Assay of tyrosine","code_information":[{"code":"84510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.63,"maximum":19.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.91,"additional_payer_notes":"APC"}]}]},{"description":"Assay of troponin qual","code_information":[{"code":"84512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.09,"maximum":18.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.8,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.79,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.3,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urea nitrogen","code_information":[{"code":"84520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.95,"maximum":7.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.19,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.22,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.42,"additional_payer_notes":"APC"}]}]},{"description":"Urea nitrogen semi-quant","code_information":[{"code":"84525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.13,"maximum":9.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.13,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.75,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine/urea-n","code_information":[{"code":"84540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.56,"maximum":10.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.95,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.94,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.23,"additional_payer_notes":"APC"}]}]},{"description":"Urea-N clearance test","code_information":[{"code":"84545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.2,"maximum":13.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.42,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.06,"additional_payer_notes":"APC"}]}]},{"description":"Assay of blood/uric acid","code_information":[{"code":"84550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.52,"maximum":8.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":8.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.06,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine/uric acid","code_information":[{"code":"84560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.08,"maximum":9.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.08,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.23,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.44,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.43,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.69,"additional_payer_notes":"APC"}]}]},{"description":"Assay of feces/urobilinogen","code_information":[{"code":"84577","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.8,"maximum":30.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.47,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.3,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.82,"additional_payer_notes":"APC"}]}]},{"description":"Test urine urobilinogen","code_information":[{"code":"84578","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.47,"maximum":8.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":8.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.78,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.01,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine urobilinogen","code_information":[{"code":"84580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.55,"maximum":17.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.55,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.22,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.21,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.7,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine urobilinogen","code_information":[{"code":"84583","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.05,"maximum":11.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.23,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.78,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine vma","code_information":[{"code":"84585","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.5,"maximum":28.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.96,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.58,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.36,"additional_payer_notes":"APC"}]}]},{"description":"Assay of vip","code_information":[{"code":"84586","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.33,"maximum":64.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.8,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.77,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.57,"additional_payer_notes":"APC"}]}]},{"description":"Assay of vasopressin","code_information":[{"code":"84588","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.94,"maximum":61.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34.96,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":61.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38.01,"additional_payer_notes":"APC"}]}]},{"description":"Assay of vitamin a","code_information":[{"code":"84590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.61,"maximum":21.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.61,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.96,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.42,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.0,"additional_payer_notes":"APC"}]}]},{"description":"Assay Of Nos Vitamin","code_information":[{"code":"84591","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.06,"maximum":31.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":31.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.08,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.24,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.11,"additional_payer_notes":"APC"}]}]},{"description":"Assay of vitamin k","code_information":[{"code":"84597","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.72,"maximum":25.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.72,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.67,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.37,"additional_payer_notes":"APC"}]}]},{"description":"Assay of volatiles","code_information":[{"code":"84600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.11,"maximum":31.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.11,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.31,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":31.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.16,"additional_payer_notes":"APC"}]}]},{"description":"Xylose tolerance test","code_information":[{"code":"84620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.91,"maximum":23.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.3,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.81,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.46,"additional_payer_notes":"APC"}]}]},{"description":"Assay of zinc","code_information":[{"code":"84630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.39,"maximum":20.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.19,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.07,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.18,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.76,"additional_payer_notes":"APC"}]}]},{"description":"Assay of c-peptide","code_information":[{"code":"84681","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.81,"maximum":38.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":38.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.25,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.31,"additional_payer_notes":"APC"}]}]},{"description":"Chorionic gonadotropin test","code_information":[{"code":"84702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.05,"maximum":27.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.09,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.86,"additional_payer_notes":"APC"}]}]},{"description":"Chorionic gonadotropin assay","code_information":[{"code":"84703","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.52,"maximum":13.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.75,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.42,"additional_payer_notes":"APC"}]}]},{"description":"Hcg free betachain test","code_information":[{"code":"84704","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.29,"maximum":27.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.75,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.36,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.35,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.12,"additional_payer_notes":"APC"}]}]},{"description":"Ovulation tests","code_information":[{"code":"84830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.7,"maximum":23.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.21,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.08,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.58,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.22,"additional_payer_notes":"APC"}]}]},{"description":"Bleeding time test","code_information":[{"code":"85002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.82,"maximum":8.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.96,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":8.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.4,"additional_payer_notes":"APC"}]}]},{"description":"Automated diff wbc count","code_information":[{"code":"85004","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.47,"maximum":11.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.25,"additional_payer_notes":"APC"}]}]},{"description":"Bl smear w/diff wbc count","code_information":[{"code":"85007","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.8,"maximum":6.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3.91,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.07,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.26,"additional_payer_notes":"APC"}]}]},{"description":"Bl smear w/o diff wbc count","code_information":[{"code":"85008","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.43,"maximum":6.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":6.26,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3.64,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.67,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.84,"additional_payer_notes":"APC"}]}]},{"description":"Manual diff wbc count b-coat","code_information":[{"code":"85009","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.07,"maximum":9.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.07,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.22,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.42,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9.26,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.68,"additional_payer_notes":"APC"}]}]},{"description":"Spun microhematocrit","code_information":[{"code":"85013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.0,"maximum":12.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.42,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.84,"additional_payer_notes":"APC"}]}]},{"description":"Hematocrit","code_information":[{"code":"85014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2.37,"maximum":4.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2.54,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":4.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2.51,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2.65,"additional_payer_notes":"APC"}]}]},{"description":"Hemoglobin","code_information":[{"code":"85018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2.37,"maximum":4.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2.54,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":4.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2.51,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2.65,"additional_payer_notes":"APC"}]}]},{"description":"Complete cbc w/auto diff wbc","code_information":[{"code":"85025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.77,"maximum":14.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.77,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.31,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.7,"additional_payer_notes":"APC"}]}]},{"description":"Complete cbc automated","code_information":[{"code":"85027","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.47,"maximum":11.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.25,"additional_payer_notes":"APC"}]}]},{"description":"Manual cell count each","code_information":[{"code":"85032","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.31,"maximum":7.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.31,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.57,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.61,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.83,"additional_payer_notes":"APC"}]}]},{"description":"Automated rbc count","code_information":[{"code":"85041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.02,"maximum":5.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.02,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":5.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":3.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.38,"additional_payer_notes":"APC"}]}]},{"description":"Manual reticulocyte count","code_information":[{"code":"85044","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.31,"maximum":7.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.31,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.57,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.61,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.83,"additional_payer_notes":"APC"}]}]},{"description":"Automated reticulocyte count","code_information":[{"code":"85045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.99,"maximum":7.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.27,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.47,"additional_payer_notes":"APC"}]}]},{"description":"Reticyte/hgb concentrate","code_information":[{"code":"85046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.57,"maximum":10.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.79,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.57,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.74,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.9,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.95,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.24,"additional_payer_notes":"APC"}]}]},{"description":"Automated leukocyte count","code_information":[{"code":"85048","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2.54,"maximum":4.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2.62,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2.72,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":4.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2.69,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2.72,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2.84,"additional_payer_notes":"APC"}]}]},{"description":"Automated platelet count","code_information":[{"code":"85049","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.48,"maximum":8.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.79,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":8.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.79,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.02,"additional_payer_notes":"APC"}]}]},{"description":"Reticulated platelet assay","code_information":[{"code":"85055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.74,"maximum":65.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.74,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.81,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":65.26,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38.21,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.03,"additional_payer_notes":"APC"}]}]},{"description":"Chromogenic substrate assay","code_information":[{"code":"85130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.89,"maximum":21.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.37,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.89,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.72,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.71,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.71,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.32,"additional_payer_notes":"APC"}]}]},{"description":"Blood clot retraction","code_information":[{"code":"85170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.3,"maximum":29.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.44,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":29.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.26,"additional_payer_notes":"APC"}]}]},{"description":"Blood clot lysis time","code_information":[{"code":"85175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.37,"maximum":37.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.18,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.98,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.8,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.78,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.81,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor ii prothrom spec","code_information":[{"code":"85210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.98,"maximum":23.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.89,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.88,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.54,"additional_payer_notes":"APC"}]}]},{"description":"Blooc clot factor v test","code_information":[{"code":"85220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.65,"maximum":32.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.65,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.89,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32.23,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.87,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.77,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor vii proconvertin","code_information":[{"code":"85230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.9,"maximum":32.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor viii ahg 1 stage","code_information":[{"code":"85240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.9,"maximum":32.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor viii reltd antgn","code_information":[{"code":"85244","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.42,"maximum":37.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.03,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":37.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.65,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.87,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor viii vw ristoctn","code_information":[{"code":"85245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.94,"maximum":41.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.63,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":41.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.52,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.69,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor viii vw antigen","code_information":[{"code":"85246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.94,"maximum":41.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.63,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":41.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.52,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.69,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor viii multimetric","code_information":[{"code":"85247","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.94,"maximum":41.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.63,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":41.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.52,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.69,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor ix ptc/chrstmas","code_information":[{"code":"85250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.04,"maximum":34.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.04,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.61,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34.77,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.35,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.32,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor x stuart-power","code_information":[{"code":"85260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.9,"maximum":32.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor xi pta","code_information":[{"code":"85270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.9,"maximum":32.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor xii hageman","code_information":[{"code":"85280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.35,"maximum":35.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.93,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":35.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.51,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.67,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor xiii fibrin stab","code_information":[{"code":"85290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.34,"maximum":29.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.83,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.48,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":29.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.47,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.3,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor xiii fibrin scrn","code_information":[{"code":"85291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.11,"maximum":16.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.47,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.11,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.66,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.74,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.2,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor fletcher fact","code_information":[{"code":"85292","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.93,"maximum":34.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.93,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.26,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.07,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.24,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.2,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor wght kininogen","code_information":[{"code":"85293","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.93,"maximum":34.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.93,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.26,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.07,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.24,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.2,"additional_payer_notes":"APC"}]}]},{"description":"Antithrombin iii activity","code_information":[{"code":"85300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.85,"maximum":21.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.85,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.67,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.27,"additional_payer_notes":"APC"}]}]},{"description":"Antithrombin iii antigen","code_information":[{"code":"85301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.81,"maximum":19.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.11,"additional_payer_notes":"APC"}]}]},{"description":"Clot inhibit prot c antigen","code_information":[{"code":"85302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.01,"maximum":21.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.84,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.45,"additional_payer_notes":"APC"}]}]},{"description":"Clot inhibit prot c activity","code_information":[{"code":"85303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.84,"maximum":25.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.84,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.26,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.81,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.79,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.5,"additional_payer_notes":"APC"}]}]},{"description":"Clot inhibit prot s total","code_information":[{"code":"85305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.61,"maximum":21.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.61,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.96,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.42,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.0,"additional_payer_notes":"APC"}]}]},{"description":"Clot inhibit prot s free","code_information":[{"code":"85306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.32,"maximum":27.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.78,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.39,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.16,"additional_payer_notes":"APC"}]}]},{"description":"Assay Activated Protein C","code_information":[{"code":"85307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.32,"maximum":27.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.78,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.39,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.16,"additional_payer_notes":"APC"}]}]},{"description":"Factor inhibitor test","code_information":[{"code":"85335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.87,"maximum":23.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.26,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.77,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.64,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.76,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.41,"additional_payer_notes":"APC"}]}]},{"description":"Thrombomodulin","code_information":[{"code":"85337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.27,"maximum":31.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.48,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":31.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.46,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.34,"additional_payer_notes":"APC"}]}]},{"description":"Coagulation time lee & white","code_information":[{"code":"85345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.69,"maximum":8.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.69,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.83,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":8.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.01,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.25,"additional_payer_notes":"APC"}]}]},{"description":"Coagulation time activated","code_information":[{"code":"85347","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.28,"maximum":7.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.28,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.41,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.58,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.58,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.79,"additional_payer_notes":"APC"}]}]},{"description":"Coagulation time otr method","code_information":[{"code":"85348","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.49,"maximum":8.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.62,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.8,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":8.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.03,"additional_payer_notes":"APC"}]}]},{"description":"Euglobulin lysis","code_information":[{"code":"85360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.41,"maximum":15.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.41,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.99,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.42,"additional_payer_notes":"APC"}]}]},{"description":"Fibrin degradation products","code_information":[{"code":"85362","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.89,"maximum":12.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.89,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.1,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.72,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinogen test","code_information":[{"code":"85366","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.46,"maximum":146.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":83.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":82.87,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":86.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":82.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":146.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":85.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":86.01,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":90.12,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinogen test","code_information":[{"code":"85370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.43,"maximum":22.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.3,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.92,"additional_payer_notes":"APC"}]}]},{"description":"Fibrin degrade semiquant","code_information":[{"code":"85378","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.72,"maximum":17.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.72,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.4,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17.75,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.39,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.89,"additional_payer_notes":"APC"}]}]},{"description":"Fibrin degradation quant","code_information":[{"code":"85379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.18,"maximum":18.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.18,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.49,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.89,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.88,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.4,"additional_payer_notes":"APC"}]}]},{"description":"Fibrin degradj d-dimer","code_information":[{"code":"85380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.18,"maximum":18.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.18,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.49,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.89,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.88,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.4,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinogen activity","code_information":[{"code":"85384","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.72,"maximum":17.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.72,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.4,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17.75,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.39,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.89,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinogen antigen","code_information":[{"code":"85385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.46,"maximum":26.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.46,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.2,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinolysins screen i&r","code_information":[{"code":"85390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.48,"maximum":28.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.1,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.94,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.56,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.55,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.34,"additional_payer_notes":"APC"}]}]},{"description":"Clotting funct activity","code_information":[{"code":"85397","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.86,"maximum":56.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":56.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.99,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34.56,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinolytic plasmin","code_information":[{"code":"85400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.71,"maximum":14.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.02,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.94,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.17,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.24,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.64,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinolytic antiplasmin","code_information":[{"code":"85410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.71,"maximum":14.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.02,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.94,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.17,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.24,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.64,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinolytic plasminogen","code_information":[{"code":"85415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.19,"maximum":31.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.71,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.39,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":31.39,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.25,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinolytic plasminogen","code_information":[{"code":"85420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.53,"maximum":11.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.79,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.31,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinolytic plasminogen","code_information":[{"code":"85421","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.18,"maximum":18.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.18,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.49,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.89,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.88,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.4,"additional_payer_notes":"APC"}]}]},{"description":"Heinz bodies direct","code_information":[{"code":"85441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.2,"maximum":7.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.37,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.49,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.7,"additional_payer_notes":"APC"}]}]},{"description":"Heinz bodies induced","code_information":[{"code":"85445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.82,"maximum":12.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.3,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.64,"additional_payer_notes":"APC"}]}]},{"description":"Hemoglobin fetal","code_information":[{"code":"85460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.73,"maximum":14.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.96,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.19,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.66,"additional_payer_notes":"APC"}]}]},{"description":"Hemoglobin fetal","code_information":[{"code":"85461","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.36,"maximum":17.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.36,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.01,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.48,"additional_payer_notes":"APC"}]}]},{"description":"Hemolysin acid","code_information":[{"code":"85475","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.87,"maximum":16.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.22,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.93,"additional_payer_notes":"APC"}]}]},{"description":"Heparin assay","code_information":[{"code":"85520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.09,"maximum":23.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.48,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.01,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.99,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.66,"additional_payer_notes":"APC"}]}]},{"description":"Heparin neutralization","code_information":[{"code":"85525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.84,"maximum":21.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.84,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.26,"additional_payer_notes":"APC"}]}]},{"description":"Heparin-protamine tolerance","code_information":[{"code":"85530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.09,"maximum":23.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.48,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.01,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.99,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.66,"additional_payer_notes":"APC"}]}]},{"description":"Iron Stain Peripheral Blood","code_information":[{"code":"85536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.88,"maximum":12.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.09,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.36,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.35,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.71,"additional_payer_notes":"APC"}]}]},{"description":"Wbc alkaline phosphatase","code_information":[{"code":"85540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.6,"maximum":15.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.94,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.86,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.63,"additional_payer_notes":"APC"}]}]},{"description":"RBC mechanical fragility","code_information":[{"code":"85547","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.6,"maximum":15.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.94,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.86,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.63,"additional_payer_notes":"APC"}]}]},{"description":"Muramidase","code_information":[{"code":"85549","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.75,"maximum":34.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.75,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.31,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":34.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.0,"additional_payer_notes":"APC"}]}]},{"description":"RBC osmotic fragility","code_information":[{"code":"85555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.47,"maximum":13.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.69,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.99,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.37,"additional_payer_notes":"APC"}]}]},{"description":"RBC osmotic fragility","code_information":[{"code":"85557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.36,"maximum":24.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.36,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.3,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.96,"additional_payer_notes":"APC"}]}]},{"description":"Blood platelet aggregation","code_information":[{"code":"85576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.91,"maximum":45.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":45.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.9,"additional_payer_notes":"APC"}]}]},{"description":"Phospholipid pltlt neutraliz","code_information":[{"code":"85597","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.98,"maximum":32.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.22,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.14,"additional_payer_notes":"APC"}]}]},{"description":"Hexagnal phosph pltlt neutrl","code_information":[{"code":"85598","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.98,"maximum":32.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.22,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.14,"additional_payer_notes":"APC"}]}]},{"description":"Prothrombin time","code_information":[{"code":"85610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.29,"maximum":7.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.42,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.59,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.59,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.8,"additional_payer_notes":"APC"}]}]},{"description":"Prothrombin test","code_information":[{"code":"85611","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.94,"maximum":7.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.1,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.22,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.21,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.41,"additional_payer_notes":"APC"}]}]},{"description":"Viper venom prothrombin time","code_information":[{"code":"85612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.49,"maximum":31.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.19,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.71,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":31.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.59,"additional_payer_notes":"APC"}]}]},{"description":"Russell viper venom diluted","code_information":[{"code":"85613","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.58,"maximum":17.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.87,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.24,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.73,"additional_payer_notes":"APC"}]}]},{"description":"Reptilase test","code_information":[{"code":"85635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.85,"maximum":17.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.85,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.15,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.54,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.03,"additional_payer_notes":"APC"}]}]},{"description":"Rbc sed rate nonautomated","code_information":[{"code":"85651","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.27,"maximum":7.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.44,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.27,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.78,"additional_payer_notes":"APC"}]}]},{"description":"Rbc sed rate automated","code_information":[{"code":"85652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2.7,"maximum":4.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2.78,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2.89,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":4.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":2.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":2.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":3.02,"additional_payer_notes":"APC"}]}]},{"description":"RBC sickle cell test","code_information":[{"code":"85660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.51,"maximum":10.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.68,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.9,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10.06,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.84,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.17,"additional_payer_notes":"APC"}]}]},{"description":"Thrombin time plasma","code_information":[{"code":"85670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.77,"maximum":10.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.77,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.94,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.17,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.46,"additional_payer_notes":"APC"}]}]},{"description":"Thrombin time titer","code_information":[{"code":"85675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.85,"maximum":12.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.85,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.33,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.32,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.67,"additional_payer_notes":"APC"}]}]},{"description":"Thromboplastin inhibition","code_information":[{"code":"85705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.63,"maximum":17.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.02,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.92,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.3,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.79,"additional_payer_notes":"APC"}]}]},{"description":"Thromboplastin time partial","code_information":[{"code":"85730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.01,"maximum":10.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.43,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.42,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.73,"additional_payer_notes":"APC"}]}]},{"description":"Thromboplastin time partial","code_information":[{"code":"85732","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.47,"maximum":11.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.25,"additional_payer_notes":"APC"}]}]},{"description":"Blood viscosity examination","code_information":[{"code":"85810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.67,"maximum":21.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.67,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.07,"additional_payer_notes":"APC"}]}]},{"description":"Agglutinins febrile antigen","code_information":[{"code":"86000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.98,"maximum":12.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12.75,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.46,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.82,"additional_payer_notes":"APC"}]}]},{"description":"Allergen Specific Igg","code_information":[{"code":"86001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.82,"maximum":14.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.76,"additional_payer_notes":"APC"}]}]},{"description":"Allergen specific IgE","code_information":[{"code":"86003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.22,"maximum":9.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.59,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.58,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.85,"additional_payer_notes":"APC"}]}]},{"description":"Allergen specific IgE","code_information":[{"code":"86005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.97,"maximum":14.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.97,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.53,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14.55,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.52,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.93,"additional_payer_notes":"APC"}]}]},{"description":"Allg spec ige recomb ea","code_information":[{"code":"86008","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.93,"maximum":32.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.93,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.19,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.08,"additional_payer_notes":"APC"}]}]},{"description":"Actin antibody each","code_information":[{"code":"86015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.05,"maximum":22.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.89,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.88,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.5,"additional_payer_notes":"APC"}]}]},{"description":"WBC antibody identification","code_information":[{"code":"86021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.05,"maximum":27.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.09,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.86,"additional_payer_notes":"APC"}]}]},{"description":"Platelet antibodies","code_information":[{"code":"86022","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.37,"maximum":33.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.1,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.92,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.47,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.57,"additional_payer_notes":"APC"}]}]},{"description":"Immunoglobulin assay","code_information":[{"code":"86023","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.46,"maximum":22.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.83,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.33,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.75,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.32,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.96,"additional_payer_notes":"APC"}]}]},{"description":"Anca screen each antibody","code_information":[{"code":"86036","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.05,"maximum":22.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.89,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.88,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.5,"additional_payer_notes":"APC"}]}]},{"description":"Anca titer each antibody","code_information":[{"code":"86037","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.05,"maximum":22.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.89,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.88,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.5,"additional_payer_notes":"APC"}]}]},{"description":"Antinuclear antibodies","code_information":[{"code":"86038","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.09,"maximum":22.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.54,"additional_payer_notes":"APC"}]}]},{"description":"Antinuclear antibodies (ANA)","code_information":[{"code":"86039","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.16,"maximum":20.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.16,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.49,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.83,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.5,"additional_payer_notes":"APC"}]}]},{"description":"Acetylcholn rcptr bndng antb","code_information":[{"code":"86041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.4,"maximum":33.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.4,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.69,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.5,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.67,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.61,"additional_payer_notes":"APC"}]}]},{"description":"Acetylcholn rcptr blckg antb","code_information":[{"code":"86042","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.4,"maximum":33.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.4,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.69,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.5,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.67,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.61,"additional_payer_notes":"APC"}]}]},{"description":"Acetylcholn rcptr modlg antb","code_information":[{"code":"86043","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.05,"maximum":22.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.89,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.88,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.5,"additional_payer_notes":"APC"}]}]},{"description":"Aquaporin-4 antb elisa","code_information":[{"code":"86051","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.53,"maximum":21.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.33,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.91,"additional_payer_notes":"APC"}]}]},{"description":"Aquaporin-4 antb cba each","code_information":[{"code":"86052","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.05,"maximum":22.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.89,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.88,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.5,"additional_payer_notes":"APC"}]}]},{"description":"Aqaprn-4 antb flo cytmtry ea","code_information":[{"code":"86053","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.73,"maximum":68.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38.86,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":68.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.33,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42.26,"additional_payer_notes":"APC"}]}]},{"description":"Antistreptolysin o titer","code_information":[{"code":"86060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.3,"maximum":13.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.81,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.18,"additional_payer_notes":"APC"}]}]},{"description":"Antistreptolysin o screen","code_information":[{"code":"86063","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.77,"maximum":10.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.77,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.94,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.17,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.46,"additional_payer_notes":"APC"}]}]},{"description":"C-reactive protein","code_information":[{"code":"86140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.18,"maximum":9.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.18,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.54,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.8,"additional_payer_notes":"APC"}]}]},{"description":"C-reactive protein hs","code_information":[{"code":"86141","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.95,"maximum":23.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.47,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.86,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.65,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.84,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.5,"additional_payer_notes":"APC"}]}]},{"description":"Beta-2 glycoprotein antibody","code_information":[{"code":"86146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.45,"maximum":46.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.47,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":46.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.21,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.5,"additional_payer_notes":"APC"}]}]},{"description":"Cardiolipin antibody ea ig","code_information":[{"code":"86147","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.45,"maximum":46.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.47,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":46.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.21,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.5,"additional_payer_notes":"APC"}]}]},{"description":"Anti-phospholipid antibody","code_information":[{"code":"86148","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.07,"maximum":29.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.07,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.55,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.19,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":29.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.18,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.0,"additional_payer_notes":"APC"}]}]},{"description":"Cell enumeration & id","code_information":[{"code":"86152","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":250.78,"maximum":457.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":260.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":250.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":258.3,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":268.33,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":255.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":457.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.83,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":268.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":280.87,"additional_payer_notes":"APC"}]}]},{"description":"Chemotaxis assay","code_information":[{"code":"86155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.99,"maximum":29.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":29.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.09,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.91,"additional_payer_notes":"APC"}]}]},{"description":"Cold agglutinin screen","code_information":[{"code":"86156","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.07,"maximum":14.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.07,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.31,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.04,"additional_payer_notes":"APC"}]}]},{"description":"Cold agglutinin titer","code_information":[{"code":"86157","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.06,"maximum":14.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.3,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.03,"additional_payer_notes":"APC"}]}]},{"description":"Complement antigen","code_information":[{"code":"86160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.0,"maximum":21.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.36,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.44,"additional_payer_notes":"APC"}]}]},{"description":"Complement/function activity","code_information":[{"code":"86161","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.0,"maximum":21.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.36,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.44,"additional_payer_notes":"APC"}]}]},{"description":"Complement total (ch50)","code_information":[{"code":"86162","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.32,"maximum":37.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.93,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":37.1,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.72,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.76,"additional_payer_notes":"APC"}]}]},{"description":"Complement fixation each","code_information":[{"code":"86171","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.01,"maximum":18.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.31,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.71,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.21,"additional_payer_notes":"APC"}]}]},{"description":"Ccp antibody","code_information":[{"code":"86200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.95,"maximum":23.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.47,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.86,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.65,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.84,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.5,"additional_payer_notes":"APC"}]}]},{"description":"Deoxyribonuclease antibody","code_information":[{"code":"86215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.25,"maximum":24.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.84,"additional_payer_notes":"APC"}]}]},{"description":"Dna antibody native","code_information":[{"code":"86225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.74,"maximum":25.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.74,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.15,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.39,"additional_payer_notes":"APC"}]}]},{"description":"Dna antibody single strand","code_information":[{"code":"86226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.11,"maximum":22.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.11,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.84,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.95,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.56,"additional_payer_notes":"APC"}]}]},{"description":"Ema each ig class","code_information":[{"code":"86231","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.09,"maximum":22.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.54,"additional_payer_notes":"APC"}]}]},{"description":"Nuclear antigen antibody","code_information":[{"code":"86235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.93,"maximum":32.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.93,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.19,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.08,"additional_payer_notes":"APC"}]}]},{"description":"Fluorescent antibody screen","code_information":[{"code":"86255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.05,"maximum":22.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.89,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.88,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.5,"additional_payer_notes":"APC"}]}]},{"description":"Fluorescent antibody titer","code_information":[{"code":"86256","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.05,"maximum":22.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.89,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.88,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.5,"additional_payer_notes":"APC"}]}]},{"description":"Dgp antibody each ig class","code_information":[{"code":"86258","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.05,"maximum":22.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.89,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.88,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.5,"additional_payer_notes":"APC"}]}]},{"description":"Growth hormone antibody","code_information":[{"code":"86277","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.74,"maximum":28.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.37,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.74,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.83,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.63,"additional_payer_notes":"APC"}]}]},{"description":"Hemagglutination inhibition","code_information":[{"code":"86280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.19,"maximum":14.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.76,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.17,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay tumor qual","code_information":[{"code":"86294","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.57,"maximum":46.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.57,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.36,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":46.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.1,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.33,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.64,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay tumor ca 15-3","code_information":[{"code":"86300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.81,"maximum":38.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":38.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.25,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.31,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay tumor ca 19-9","code_information":[{"code":"86301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.81,"maximum":38.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":38.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.25,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.31,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay tumor ca 125","code_information":[{"code":"86304","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.81,"maximum":38.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":38.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.25,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.31,"additional_payer_notes":"APC"}]}]},{"description":"Human epididymis protein 4","code_information":[{"code":"86305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.81,"maximum":38.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":38.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.25,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.31,"additional_payer_notes":"APC"}]}]},{"description":"Heterophile antibody screen","code_information":[{"code":"86308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.18,"maximum":9.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.18,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.54,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.8,"additional_payer_notes":"APC"}]}]},{"description":"Heterophile antibody titer","code_information":[{"code":"86309","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.47,"maximum":11.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.25,"additional_payer_notes":"APC"}]}]},{"description":"Heterophile antibody absrbj","code_information":[{"code":"86310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.37,"maximum":13.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.59,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.89,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.88,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.25,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay tumor other","code_information":[{"code":"86316","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.81,"maximum":38.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":38.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.25,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.31,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay infectious agent","code_information":[{"code":"86317","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.99,"maximum":27.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.04,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.02,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.79,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay infectious agent","code_information":[{"code":"86318","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.09,"maximum":33.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.63,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.36,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.34,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.26,"additional_payer_notes":"APC"}]}]},{"description":"Serum immunoelectrophoresis","code_information":[{"code":"86320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.92,"maximum":54.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.82,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.01,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":54.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.51,"additional_payer_notes":"APC"}]}]},{"description":"Other immunoelectrophoresis","code_information":[{"code":"86325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.13,"maximum":42.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23.13,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.82,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":42.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.91,"additional_payer_notes":"APC"}]}]},{"description":"Ia nfct ab sarscov2 covid19","code_information":[{"code":"86328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":45.28,"maximum":82.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45.28,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":46.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":46.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":82.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":48.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50.71,"additional_payer_notes":"APC"}]}]},{"description":"Immunodiffusion nes","code_information":[{"code":"86329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.05,"maximum":25.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.03,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.02,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.74,"additional_payer_notes":"APC"}]}]},{"description":"Immunodiffusion ouchterlony","code_information":[{"code":"86331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":21.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"}]}]},{"description":"Immune complex assay","code_information":[{"code":"86332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.37,"maximum":44.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.1,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.08,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":44.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.83,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.29,"additional_payer_notes":"APC"}]}]},{"description":"Immunofix e-phoresis serum","code_information":[{"code":"86334","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.34,"maximum":40.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.9,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":40.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.88,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.02,"additional_payer_notes":"APC"}]}]},{"description":"Immunfix e-phorsis/urine/csf","code_information":[{"code":"86335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.35,"maximum":53.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.23,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.4,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":53.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.87,"additional_payer_notes":"APC"}]}]},{"description":"Inhibin A","code_information":[{"code":"86336","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.59,"maximum":28.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.21,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.67,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.46,"additional_payer_notes":"APC"}]}]},{"description":"Insulin antibodies","code_information":[{"code":"86337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.41,"maximum":39.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.27,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.41,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.91,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":39.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.69,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.89,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.98,"additional_payer_notes":"APC"}]}]},{"description":"Intrinsic factor antibody","code_information":[{"code":"86340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.08,"maximum":27.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.68,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.08,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.12,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.89,"additional_payer_notes":"APC"}]}]},{"description":"Islet cell antibody","code_information":[{"code":"86341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.57,"maximum":43.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23.57,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.22,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":43.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.2,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.4,"additional_payer_notes":"APC"}]}]},{"description":"Leukocyte histamine release","code_information":[{"code":"86343","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.46,"maximum":22.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.83,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.33,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.75,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.32,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.96,"additional_payer_notes":"APC"}]}]},{"description":"Leukocyte phagocytosis","code_information":[{"code":"86344","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.39,"maximum":18.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.7,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.12,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.11,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.64,"additional_payer_notes":"APC"}]}]},{"description":"Cell function assay w/stim","code_information":[{"code":"86352","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":135.86,"maximum":248.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":141.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":135.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":139.94,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":248.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":144.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":152.16,"additional_payer_notes":"APC"}]}]},{"description":"Lymphocyte transformation","code_information":[{"code":"86353","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.03,"maximum":89.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":50.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.46,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":50.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":89.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":51.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.91,"additional_payer_notes":"APC"}]}]},{"description":"B cells total count","code_information":[{"code":"86355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.73,"maximum":68.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38.86,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":68.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.33,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42.26,"additional_payer_notes":"APC"}]}]},{"description":"Mononuclear cell antigen","code_information":[{"code":"86356","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.78,"maximum":48.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.58,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":48.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.99,"additional_payer_notes":"APC"}]}]},{"description":"Nk cells total count","code_information":[{"code":"86357","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.73,"maximum":68.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38.86,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":68.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.33,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42.26,"additional_payer_notes":"APC"}]}]},{"description":"T cells total count","code_information":[{"code":"86359","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.73,"maximum":68.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38.86,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":68.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.33,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42.26,"additional_payer_notes":"APC"}]}]},{"description":"T cell absolute count/ratio","code_information":[{"code":"86360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":46.98,"maximum":85.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":48.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":47.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":85.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":49.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50.22,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.62,"additional_payer_notes":"APC"}]}]},{"description":"T cell absolute count","code_information":[{"code":"86361","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.78,"maximum":48.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.58,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":48.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.99,"additional_payer_notes":"APC"}]}]},{"description":"Mog-igg1 antb cba each","code_information":[{"code":"86362","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.05,"maximum":22.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.89,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.88,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.5,"additional_payer_notes":"APC"}]}]},{"description":"Mog-igg1 antb flo cytmtry ea","code_information":[{"code":"86363","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.73,"maximum":68.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38.86,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":68.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.33,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42.26,"additional_payer_notes":"APC"}]}]},{"description":"Tiss trnsgltmnase ea ig clas","code_information":[{"code":"86364","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.53,"maximum":21.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.33,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.91,"additional_payer_notes":"APC"}]}]},{"description":"Muscle-specific kinase antb","code_information":[{"code":"86366","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.4,"maximum":33.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.14,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.4,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.69,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.5,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.67,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.61,"additional_payer_notes":"APC"}]}]},{"description":"Stem cells total count","code_information":[{"code":"86367","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":77.78,"maximum":142.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":80.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":80.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":83.22,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":79.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":142.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":82.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":83.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":87.11,"additional_payer_notes":"APC"}]}]},{"description":"Microsomal antibody each","code_information":[{"code":"86376","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.55,"maximum":26.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.55,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.42,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.55,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.3,"additional_payer_notes":"APC"}]}]},{"description":"Mitochondrial antibody each","code_information":[{"code":"86381","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.45,"maximum":46.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.47,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":46.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.21,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.5,"additional_payer_notes":"APC"}]}]},{"description":"Neutralization test viral","code_information":[{"code":"86382","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.91,"maximum":30.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.42,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.94,"additional_payer_notes":"APC"}]}]},{"description":"Nitroblue tetrazolium dye","code_information":[{"code":"86384","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.61,"maximum":24.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.61,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.56,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.55,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.24,"additional_payer_notes":"APC"}]}]},{"description":"Nuclear matrix protein 22","code_information":[{"code":"86386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.78,"maximum":39.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.3,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":39.77,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.39,"additional_payer_notes":"APC"}]}]},{"description":"Particle agglut antbdy scrn","code_information":[{"code":"86403","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.54,"maximum":21.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.35,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.92,"additional_payer_notes":"APC"}]}]},{"description":"Particle agglut antbdy titr","code_information":[{"code":"86406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.64,"maximum":19.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.96,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.92,"additional_payer_notes":"APC"}]}]},{"description":"Neutrlzg antb sarscov2 scr","code_information":[{"code":"86408","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.13,"maximum":76.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.13,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.08,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":42.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":76.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44.66,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47.19,"additional_payer_notes":"APC"}]}]},{"description":"Neutrlzg antb sarscov2 titer","code_information":[{"code":"86409","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":79.61,"maximum":145.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":82.79,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79.61,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":82.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":85.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":81.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":145.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":84.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":85.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":89.16,"additional_payer_notes":"APC"}]}]},{"description":"Sars-cov-2 antb quantitative","code_information":[{"code":"86413","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.43,"maximum":93.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":52.97,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":55.03,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":52.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":93.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":54.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57.6,"additional_payer_notes":"APC"}]}]},{"description":"Rheumatoid factor test qual","code_information":[{"code":"86430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.14,"maximum":11.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.51,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.88,"additional_payer_notes":"APC"}]}]},{"description":"Rheumatoid factor quant","code_information":[{"code":"86431","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.67,"maximum":10.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.67,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.07,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.35,"additional_payer_notes":"APC"}]}]},{"description":"Tb test cell immun measure","code_information":[{"code":"86480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.98,"maximum":113.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":66.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":113.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":66.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.42,"additional_payer_notes":"APC"}]}]},{"description":"Tb ag response t-cell susp","code_information":[{"code":"86481","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":100.0,"maximum":182.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":104.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":103.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":107.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":102.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":182.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":106.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":106.9,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":112.0,"additional_payer_notes":"APC"}]}]},{"description":"Strptcs pneum antb serot ia","code_information":[{"code":"86581","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.03,"maximum":168.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":95.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":94.79,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":98.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":93.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":168.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":97.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":98.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":103.07,"additional_payer_notes":"APC"}]}]},{"description":"Streptokinase antibody","code_information":[{"code":"86590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.66,"maximum":23.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.66,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.04,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.12,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.18,"additional_payer_notes":"APC"}]}]},{"description":"Syphilis test non-trep qual","code_information":[{"code":"86592","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.27,"maximum":7.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.44,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.27,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.78,"additional_payer_notes":"APC"}]}]},{"description":"Syphilis test non-trep quant","code_information":[{"code":"86593","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.4,"maximum":8.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.71,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":8.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.66,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.93,"additional_payer_notes":"APC"}]}]},{"description":"Voltage-gtd ca chnl antb ea","code_information":[{"code":"86596","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.05,"maximum":22.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.89,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.88,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.5,"additional_payer_notes":"APC"}]}]},{"description":"Antinomyces antibody","code_information":[{"code":"86602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.18,"maximum":18.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.18,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.49,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.89,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.88,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.4,"additional_payer_notes":"APC"}]}]},{"description":"Adenovirus antibody","code_information":[{"code":"86603","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.87,"maximum":23.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.26,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.77,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.64,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.76,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.41,"additional_payer_notes":"APC"}]}]},{"description":"Aspergillus antibody","code_information":[{"code":"86606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.05,"maximum":27.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.65,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.09,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.86,"additional_payer_notes":"APC"}]}]},{"description":"Bacterium antibody","code_information":[{"code":"86609","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.88,"maximum":23.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.65,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.77,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.43,"additional_payer_notes":"APC"}]}]},{"description":"Bartonella Antibody","code_information":[{"code":"86611","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.18,"maximum":18.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.18,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.49,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.89,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.88,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.4,"additional_payer_notes":"APC"}]}]},{"description":"Blastomyces antibody","code_information":[{"code":"86612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.9,"maximum":23.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.29,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.8,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.79,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.45,"additional_payer_notes":"APC"}]}]},{"description":"Bordetella antibody","code_information":[{"code":"86615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.19,"maximum":24.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.77,"additional_payer_notes":"APC"}]}]},{"description":"Lyme disease antibody","code_information":[{"code":"86617","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.49,"maximum":28.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.42,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.35,"additional_payer_notes":"APC"}]}]},{"description":"Lyme disease antibody","code_information":[{"code":"86618","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.03,"maximum":31.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.54,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.22,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":31.1,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.21,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.07,"additional_payer_notes":"APC"}]}]},{"description":"Borrelia antibody","code_information":[{"code":"86619","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.38,"maximum":24.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.92,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.38,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.78,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.3,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.99,"additional_payer_notes":"APC"}]}]},{"description":"Brucella antibody","code_information":[{"code":"86622","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.93,"maximum":16.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.93,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.56,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.47,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.55,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.0,"additional_payer_notes":"APC"}]}]},{"description":"Campylobacter antibody","code_information":[{"code":"86625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.12,"maximum":23.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.12,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.51,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.04,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.03,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.69,"additional_payer_notes":"APC"}]}]},{"description":"Candida antibody","code_information":[{"code":"86628","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.01,"maximum":21.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.84,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.45,"additional_payer_notes":"APC"}]}]},{"description":"Chlamydia antibody","code_information":[{"code":"86631","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.82,"maximum":21.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.24,"additional_payer_notes":"APC"}]}]},{"description":"Chlamydia igm antibody","code_information":[{"code":"86632","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.68,"maximum":23.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.55,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.2,"additional_payer_notes":"APC"}]}]},{"description":"Coccidioides antibody","code_information":[{"code":"86635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.47,"maximum":20.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.81,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.85,"additional_payer_notes":"APC"}]}]},{"description":"Q fever antibody","code_information":[{"code":"86638","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.12,"maximum":22.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.12,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.48,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.57,"additional_payer_notes":"APC"}]}]},{"description":"Cryptococcus antibody","code_information":[{"code":"86641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.41,"maximum":26.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.41,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.42,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.14,"additional_payer_notes":"APC"}]}]},{"description":"CMV antibody","code_information":[{"code":"86644","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.39,"maximum":26.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.97,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.82,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.4,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.25,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.12,"additional_payer_notes":"APC"}]}]},{"description":"Cmv antibody igm","code_information":[{"code":"86645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.85,"maximum":30.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.85,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.36,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.03,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30.77,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.01,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.87,"additional_payer_notes":"APC"}]}]},{"description":"Diphtheria antibody","code_information":[{"code":"86648","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.21,"maximum":27.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27.77,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.04,"additional_payer_notes":"APC"}]}]},{"description":"Encephalitis californ antbdy","code_information":[{"code":"86651","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.19,"maximum":24.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.77,"additional_payer_notes":"APC"}]}]},{"description":"Encephaltis east eqne anbdy","code_information":[{"code":"86652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.19,"maximum":24.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.77,"additional_payer_notes":"APC"}]}]},{"description":"Encephaltis st louis antbody","code_information":[{"code":"86653","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.19,"maximum":24.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.77,"additional_payer_notes":"APC"}]}]},{"description":"Encephaltis west eqne antbdy","code_information":[{"code":"86654","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.19,"maximum":24.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.77,"additional_payer_notes":"APC"}]}]},{"description":"Enterovirus antibody","code_information":[{"code":"86658","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.03,"maximum":23.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.55,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.59,"additional_payer_notes":"APC"}]}]},{"description":"Epstein-barr antibody","code_information":[{"code":"86663","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.12,"maximum":23.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.12,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.51,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.04,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.03,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.69,"additional_payer_notes":"APC"}]}]},{"description":"Epstein-barr nuclear antigen","code_information":[{"code":"86664","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.29,"maximum":27.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.75,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.36,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.35,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.12,"additional_payer_notes":"APC"}]}]},{"description":"Epstein-barr capsid vca","code_information":[{"code":"86665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.14,"maximum":33.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.87,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.68,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.41,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33.12,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.39,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.32,"additional_payer_notes":"APC"}]}]},{"description":"Ehrlichia Antibody","code_information":[{"code":"86666","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.18,"maximum":18.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.18,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.49,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.89,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.88,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.4,"additional_payer_notes":"APC"}]}]},{"description":"Francisella tularensis","code_information":[{"code":"86668","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.16,"maximum":25.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.16,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.58,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.86,"additional_payer_notes":"APC"}]}]},{"description":"Fungus nes antibody","code_information":[{"code":"86671","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.25,"maximum":22.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.62,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.72,"additional_payer_notes":"APC"}]}]},{"description":"Giardia lamblia antibody","code_information":[{"code":"86674","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.72,"maximum":26.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.72,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.74,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.49,"additional_payer_notes":"APC"}]}]},{"description":"Helicobacter pylori antibody","code_information":[{"code":"86677","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.85,"maximum":30.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.85,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.36,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.03,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30.77,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.01,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.87,"additional_payer_notes":"APC"}]}]},{"description":"Helminth antibody","code_information":[{"code":"86682","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.01,"maximum":23.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.91,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.57,"additional_payer_notes":"APC"}]}]},{"description":"Hemophilus influenza antibdy","code_information":[{"code":"86684","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.84,"maximum":28.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.47,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.84,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.95,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.93,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.74,"additional_payer_notes":"APC"}]}]},{"description":"Htlv-i antibody","code_information":[{"code":"86687","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.09,"maximum":16.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.36,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.73,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.64,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.72,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.18,"additional_payer_notes":"APC"}]}]},{"description":"Htlv-ii antibody","code_information":[{"code":"86688","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.0,"maximum":25.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.42,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.84,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.97,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.68,"additional_payer_notes":"APC"}]}]},{"description":"Htlv/hiv confirmj antibody","code_information":[{"code":"86689","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.35,"maximum":35.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.93,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":35.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.51,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.67,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis delta agent antbdy","code_information":[{"code":"86692","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.16,"maximum":31.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.16,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.36,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":31.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.19,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.34,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.22,"additional_payer_notes":"APC"}]}]},{"description":"Herpes simplex nes antbdy","code_information":[{"code":"86694","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.39,"maximum":26.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.97,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.82,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.4,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.25,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.12,"additional_payer_notes":"APC"}]}]},{"description":"Herpes simplex type 1 test","code_information":[{"code":"86695","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.19,"maximum":24.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.77,"additional_payer_notes":"APC"}]}]},{"description":"Herpes simplex type 2 test","code_information":[{"code":"86696","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.35,"maximum":35.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.93,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":35.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.51,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.67,"additional_payer_notes":"APC"}]}]},{"description":"Histoplasma antibody","code_information":[{"code":"86698","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.79,"maximum":25.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.79,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.74,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.44,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-1antibody","code_information":[{"code":"86701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.89,"maximum":16.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.25,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.89,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.51,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16.23,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.42,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.96,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-2 antibody","code_information":[{"code":"86702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.52,"maximum":24.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.93,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.14,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-1/hiv-2 1 result antbdy","code_information":[{"code":"86703","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.71,"maximum":25.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.67,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.36,"additional_payer_notes":"APC"}]}]},{"description":"Hep b core antibody total","code_information":[{"code":"86704","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.05,"maximum":22.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.89,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.88,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.5,"additional_payer_notes":"APC"}]}]},{"description":"Hep b core antibody igm","code_information":[{"code":"86705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.77,"maximum":21.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.77,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.59,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.58,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.18,"additional_payer_notes":"APC"}]}]},{"description":"Hep b surface antibody","code_information":[{"code":"86706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.74,"maximum":19.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.74,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.03,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis be antibody","code_information":[{"code":"86707","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.57,"maximum":21.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.03,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.57,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.92,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.96,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis a antibody","code_information":[{"code":"86708","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.39,"maximum":22.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.26,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.24,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.88,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis a igm antibody","code_information":[{"code":"86709","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.26,"maximum":20.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.61,"additional_payer_notes":"APC"}]}]},{"description":"Influenza virus antibody","code_information":[{"code":"86710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.55,"maximum":24.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.55,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.96,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.5,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.18,"additional_payer_notes":"APC"}]}]},{"description":"John cunningham antibody","code_information":[{"code":"86711","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.89,"maximum":30.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.89,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.07,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.9,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.92,"additional_payer_notes":"APC"}]}]},{"description":"Legionella antibody","code_information":[{"code":"86713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.3,"maximum":27.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.36,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.14,"additional_payer_notes":"APC"}]}]},{"description":"Leishmania antibody","code_information":[{"code":"86717","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.25,"maximum":22.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.62,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.72,"additional_payer_notes":"APC"}]}]},{"description":"Leptospira antibody","code_information":[{"code":"86720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.2,"maximum":29.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.69,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.33,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":29.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.17,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.32,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.14,"additional_payer_notes":"APC"}]}]},{"description":"Listeria monocytogenes","code_information":[{"code":"86723","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.19,"maximum":24.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.77,"additional_payer_notes":"APC"}]}]},{"description":"Lymph choriomeningitis ab","code_information":[{"code":"86727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.87,"maximum":23.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.26,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.77,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.64,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.76,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.41,"additional_payer_notes":"APC"}]}]},{"description":"Mucormycosis antibody","code_information":[{"code":"86732","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.0,"maximum":27.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27.39,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.9,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.8,"additional_payer_notes":"APC"}]}]},{"description":"Mumps antibody","code_information":[{"code":"86735","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.05,"maximum":23.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.83,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.95,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.62,"additional_payer_notes":"APC"}]}]},{"description":"Mycoplasma antibody","code_information":[{"code":"86738","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.24,"maximum":24.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.24,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.17,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.83,"additional_payer_notes":"APC"}]}]},{"description":"Neisseria meningitidis","code_information":[{"code":"86741","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.19,"maximum":24.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.77,"additional_payer_notes":"APC"}]}]},{"description":"Nocardia antibody","code_information":[{"code":"86744","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.99,"maximum":29.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":29.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.09,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.91,"additional_payer_notes":"APC"}]}]},{"description":"Parvovirus antibody","code_information":[{"code":"86747","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.03,"maximum":27.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.48,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.08,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.07,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.83,"additional_payer_notes":"APC"}]}]},{"description":"Malaria antibody","code_information":[{"code":"86750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.19,"maximum":24.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.77,"additional_payer_notes":"APC"}]}]},{"description":"Protozoa antibody nos","code_information":[{"code":"86753","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.39,"maximum":22.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.89,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.76,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.26,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.24,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.88,"additional_payer_notes":"APC"}]}]},{"description":"Respiratory virus antibody","code_information":[{"code":"86756","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.89,"maximum":29.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.89,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":29.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.84,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.99,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.8,"additional_payer_notes":"APC"}]}]},{"description":"Rickettsia Antibody","code_information":[{"code":"86757","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.35,"maximum":35.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.93,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.7,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":35.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.51,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.67,"additional_payer_notes":"APC"}]}]},{"description":"Rotavirus antibody","code_information":[{"code":"86759","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.23,"maximum":33.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.23,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.78,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.51,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.49,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.42,"additional_payer_notes":"APC"}]}]},{"description":"Rubella antibody","code_information":[{"code":"86762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.39,"maximum":26.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.97,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.82,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.4,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.25,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.12,"additional_payer_notes":"APC"}]}]},{"description":"Rubeola antibody","code_information":[{"code":"86765","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.88,"maximum":23.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.65,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.77,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.43,"additional_payer_notes":"APC"}]}]},{"description":"Salmonella antibody","code_information":[{"code":"86768","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.19,"maximum":24.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.77,"additional_payer_notes":"APC"}]}]},{"description":"Sars-cov-2 covid-19 antibody","code_information":[{"code":"86769","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.13,"maximum":76.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.13,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.08,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":42.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":76.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44.66,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47.19,"additional_payer_notes":"APC"}]}]},{"description":"Shigella antibody","code_information":[{"code":"86771","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.48,"maximum":44.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.19,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":44.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.42,"additional_payer_notes":"APC"}]}]},{"description":"Tetanus antibody","code_information":[{"code":"86774","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.8,"maximum":27.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.24,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.69,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.58,"additional_payer_notes":"APC"}]}]},{"description":"Toxoplasma antibody","code_information":[{"code":"86777","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.39,"maximum":26.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.97,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.82,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.4,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.25,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.12,"additional_payer_notes":"APC"}]}]},{"description":"Toxoplasma antibody igm","code_information":[{"code":"86778","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.41,"maximum":26.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.41,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.42,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.14,"additional_payer_notes":"APC"}]}]},{"description":"Treponema pallidum","code_information":[{"code":"86780","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.24,"maximum":24.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.24,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.17,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.83,"additional_payer_notes":"APC"}]}]},{"description":"Trichinella antibody","code_information":[{"code":"86784","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.56,"maximum":22.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.94,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.44,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.43,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.07,"additional_payer_notes":"APC"}]}]},{"description":"Varicella-zoster antibody","code_information":[{"code":"86787","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.88,"maximum":23.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.65,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.77,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.43,"additional_payer_notes":"APC"}]}]},{"description":"West nile virus ab igm","code_information":[{"code":"86788","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.85,"maximum":30.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.85,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.36,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.03,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30.77,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.01,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.87,"additional_payer_notes":"APC"}]}]},{"description":"West Nile Virus Antibody","code_information":[{"code":"86789","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.39,"maximum":26.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.97,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.82,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.4,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.25,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.12,"additional_payer_notes":"APC"}]}]},{"description":"Virus antibody nos","code_information":[{"code":"86790","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.88,"maximum":23.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.65,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.77,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.43,"additional_payer_notes":"APC"}]}]},{"description":"Yersinia antibody","code_information":[{"code":"86793","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.19,"maximum":24.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.77,"additional_payer_notes":"APC"}]}]},{"description":"Zika virus igm antibody","code_information":[{"code":"86794","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.85,"maximum":30.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.52,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.85,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.36,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.03,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30.77,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.01,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.87,"additional_payer_notes":"APC"}]}]},{"description":"Thyroglobulin antibody","code_information":[{"code":"86800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.91,"maximum":29.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.55,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":29.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.01,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.82,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis c ab test","code_information":[{"code":"86803","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.27,"maximum":26.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.27,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.7,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26.06,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.25,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.98,"additional_payer_notes":"APC"}]}]},{"description":"Hep c ab test confirm","code_information":[{"code":"86804","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.49,"maximum":28.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.42,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.35,"additional_payer_notes":"APC"}]}]},{"description":"Lymphocytotoxicity assay","code_information":[{"code":"86805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":189.51,"maximum":346.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":197.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":189.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":195.2,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":202.78,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":193.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":346.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":200.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":202.59,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":212.25,"additional_payer_notes":"APC"}]}]},{"description":"Lymphocytotoxicity assay","code_information":[{"code":"86806","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.59,"maximum":86.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":49.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":48.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":86.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":50.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50.87,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53.3,"additional_payer_notes":"APC"}]}]},{"description":"Cytotoxic antibody screening","code_information":[{"code":"86807","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":78.65,"maximum":143.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":81.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78.65,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":81.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":84.16,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":80.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":143.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":83.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":84.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":88.09,"additional_payer_notes":"APC"}]}]},{"description":"Cytotoxic antibody screening","code_information":[{"code":"86808","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.68,"maximum":54.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.87,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":54.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.24,"additional_payer_notes":"APC"}]}]},{"description":"Hla typing a b or c","code_information":[{"code":"86812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.81,"maximum":47.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.58,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":47.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.59,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.91,"additional_payer_notes":"APC"}]}]},{"description":"Hla typing a b or c","code_information":[{"code":"86813","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.0,"maximum":105.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":59.74,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":62.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":59.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":105.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":61.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":62.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.96,"additional_payer_notes":"APC"}]}]},{"description":"Hla typing dr/dq","code_information":[{"code":"86816","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.17,"maximum":55.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.08,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.28,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":55.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.25,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.79,"additional_payer_notes":"APC"}]}]},{"description":"Hla typing dr/dq","code_information":[{"code":"86817","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":106.14,"maximum":193.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":110.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":109.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":108.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":193.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.51,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.46,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":118.88,"additional_payer_notes":"APC"}]}]},{"description":"Lymphocyte culture mixed","code_information":[{"code":"86821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.56,"maximum":66.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38.02,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.12,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":66.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.95,"additional_payer_notes":"APC"}]}]},{"description":"Hla x-math non-cytotoxic","code_information":[{"code":"86825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.49,"maximum":199.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":113.87,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":109.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":112.77,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":117.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":111.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":199.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":116.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":117.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.63,"additional_payer_notes":"APC"}]}]},{"description":"Hla x-match noncytotoxc addl","code_information":[{"code":"86826","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.53,"maximum":66.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.63,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":66.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.91,"additional_payer_notes":"APC"}]}]},{"description":"Hla class i&ii antibody qual","code_information":[{"code":"86828","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.19,"maximum":117.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":66.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":66.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":68.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":117.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":68.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":68.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":71.89,"additional_payer_notes":"APC"}]}]},{"description":"Hla class i/ii antibody qual","code_information":[{"code":"86829","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.19,"maximum":117.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":66.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":66.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":68.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":117.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":68.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":68.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":71.89,"additional_payer_notes":"APC"}]}]},{"description":"Hla class i phenotype qual","code_information":[{"code":"86830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":95.52,"maximum":174.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":99.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":98.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":102.21,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":97.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":174.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":101.25,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":102.11,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":106.98,"additional_payer_notes":"APC"}]}]},{"description":"Hla class ii phenotype qual","code_information":[{"code":"86831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":81.88,"maximum":149.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":85.16,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":84.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":87.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":83.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":149.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":86.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":87.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":91.71,"additional_payer_notes":"APC"}]}]},{"description":"Hla class i high defin qual","code_information":[{"code":"86832","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":323.75,"maximum":591.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":336.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":323.75,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":346.41,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":330.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":591.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":343.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":346.09,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":362.6,"additional_payer_notes":"APC"}]}]},{"description":"Hla class ii high defin qual","code_information":[{"code":"86833","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":325.8,"maximum":594.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":338.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":325.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":335.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":348.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":332.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":594.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":345.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":348.28,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":364.9,"additional_payer_notes":"APC"}]}]},{"description":"Hla class i semiquant panel","code_information":[{"code":"86834","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":357.56,"maximum":652.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":371.86,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":357.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":368.29,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":382.59,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":364.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":652.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":379.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":382.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":400.47,"additional_payer_notes":"APC"}]}]},{"description":"Hla class ii semiquant panel","code_information":[{"code":"86835","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":322.96,"maximum":589.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":335.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":322.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":332.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":345.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":329.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":589.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":342.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":345.24,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":361.72,"additional_payer_notes":"APC"}]}]},{"description":"Hemolysins/agglutinins auto","code_information":[{"code":"86940","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.77,"maximum":16.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.77,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.03,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.38,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.82,"additional_payer_notes":"APC"}]}]},{"description":"Hemolysins/agglutinins","code_information":[{"code":"86941","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.11,"maximum":22.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.11,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.84,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.95,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.56,"additional_payer_notes":"APC"}]}]},{"description":"Small animal inoculation","code_information":[{"code":"87003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.84,"maximum":30.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.84,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30.75,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.86,"additional_payer_notes":"APC"}]}]},{"description":"Specimen infect agnt concntj","code_information":[{"code":"87015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.68,"maximum":12.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.08,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.48,"additional_payer_notes":"APC"}]}]},{"description":"Blood culture for bacteria","code_information":[{"code":"87040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.32,"maximum":18.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.63,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.04,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.03,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.56,"additional_payer_notes":"APC"}]}]},{"description":"Feces culture aerobic bact","code_information":[{"code":"87045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.44,"maximum":17.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.72,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.09,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.57,"additional_payer_notes":"APC"}]}]},{"description":"Stool cultr aerobic bact ea","code_information":[{"code":"87046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.44,"maximum":17.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.72,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.09,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.57,"additional_payer_notes":"APC"}]}]},{"description":"Culture othr specimn aerobic","code_information":[{"code":"87070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.62,"maximum":15.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.62,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.22,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.21,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.65,"additional_payer_notes":"APC"}]}]},{"description":"Culture aerobic quant other","code_information":[{"code":"87071","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.89,"maximum":18.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.29,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.89,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.58,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18.06,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.08,"additional_payer_notes":"APC"}]}]},{"description":"Culture Bacteria Anaerobic","code_information":[{"code":"87073","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.66,"maximum":17.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.66,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.34,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.33,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.82,"additional_payer_notes":"APC"}]}]},{"description":"Cultr bacteria except blood","code_information":[{"code":"87075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.47,"maximum":17.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.75,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.13,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.12,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.61,"additional_payer_notes":"APC"}]}]},{"description":"Culture anaerobe ident each","code_information":[{"code":"87076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.08,"maximum":14.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.08,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14.75,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.05,"additional_payer_notes":"APC"}]}]},{"description":"Culture Aerobic Identify","code_information":[{"code":"87077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.08,"maximum":14.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.08,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14.75,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.05,"additional_payer_notes":"APC"}]}]},{"description":"Culture screen only","code_information":[{"code":"87081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.63,"maximum":12.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.83,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.09,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.43,"additional_payer_notes":"APC"}]}]},{"description":"Culture of specimen by kit","code_information":[{"code":"87084","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.07,"maximum":49.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.07,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":49.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.69,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.94,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.32,"additional_payer_notes":"APC"}]}]},{"description":"Urine culture/colony count","code_information":[{"code":"87086","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.07,"maximum":14.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.07,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.31,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.04,"additional_payer_notes":"APC"}]}]},{"description":"Urine bacteria culture","code_information":[{"code":"87088","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.09,"maximum":14.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.41,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14.77,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.65,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.06,"additional_payer_notes":"APC"}]}]},{"description":"Skin fungi culture","code_information":[{"code":"87101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.71,"maximum":14.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.02,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.94,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.17,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.24,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.64,"additional_payer_notes":"APC"}]}]},{"description":"Fungus isolation culture","code_information":[{"code":"87102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.41,"maximum":15.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.41,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.99,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.42,"additional_payer_notes":"APC"}]}]},{"description":"Blood fungus culture","code_information":[{"code":"87103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.46,"maximum":37.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.89,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":37.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.69,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.87,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.92,"additional_payer_notes":"APC"}]}]},{"description":"Fungi identification yeast","code_information":[{"code":"87106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.32,"maximum":18.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.63,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.04,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.03,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.56,"additional_payer_notes":"APC"}]}]},{"description":"Fungi identification mold","code_information":[{"code":"87107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.32,"maximum":18.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.63,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.04,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.03,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.56,"additional_payer_notes":"APC"}]}]},{"description":"Mycoplasma","code_information":[{"code":"87109","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.39,"maximum":28.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28.1,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.24,"additional_payer_notes":"APC"}]}]},{"description":"Chlamydia culture","code_information":[{"code":"87110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.6,"maximum":35.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.19,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.97,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.95,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.95,"additional_payer_notes":"APC"}]}]},{"description":"Mycobacteria culture","code_information":[{"code":"87116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.8,"maximum":19.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.56,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.55,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.1,"additional_payer_notes":"APC"}]}]},{"description":"Mycobacteric identification","code_information":[{"code":"87118","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.61,"maximum":26.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.19,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.61,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.63,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.36,"additional_payer_notes":"APC"}]}]},{"description":"Culture type immunofluoresc","code_information":[{"code":"87140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.57,"maximum":10.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.79,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.57,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.74,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.9,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.95,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.24,"additional_payer_notes":"APC"}]}]},{"description":"Culture typing glc/hplc","code_information":[{"code":"87143","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.52,"maximum":22.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.02,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.9,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.4,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.02,"additional_payer_notes":"APC"}]}]},{"description":"Culture type immunologic","code_information":[{"code":"87147","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.18,"maximum":9.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.18,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.54,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.8,"additional_payer_notes":"APC"}]}]},{"description":"Dna/rna direct probe","code_information":[{"code":"87149","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.05,"maximum":36.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.25,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.43,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.46,"additional_payer_notes":"APC"}]}]},{"description":"Dna/rna amplified probe","code_information":[{"code":"87150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Culture Type Pulse Field Gel","code_information":[{"code":"87152","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.74,"maximum":14.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.74,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.97,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.28,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.27,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.67,"additional_payer_notes":"APC"}]}]},{"description":"Dna/rna sequencing","code_information":[{"code":"87153","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":115.36,"maximum":210.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":119.97,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":115.36,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":118.82,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":123.44,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":117.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":210.65,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":123.32,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":129.2,"additional_payer_notes":"APC"}]}]},{"description":"Cul typ id bld pthgn 6+ trgt","code_information":[{"code":"87154","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":218.06,"maximum":398.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":226.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":218.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":224.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":233.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":398.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":231.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":233.11,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":244.23,"additional_payer_notes":"APC"}]}]},{"description":"Culture typing added method","code_information":[{"code":"87158","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.74,"maximum":14.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.74,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.97,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.28,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.27,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.67,"additional_payer_notes":"APC"}]}]},{"description":"Dark field examination","code_information":[{"code":"87164","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.74,"maximum":19.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.74,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.48,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.03,"additional_payer_notes":"APC"}]}]},{"description":"Dark field examination","code_information":[{"code":"87166","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.3,"maximum":20.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":20.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.66,"additional_payer_notes":"APC"}]}]},{"description":"Macroscopic Exam Arthropod","code_information":[{"code":"87168","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.27,"maximum":7.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.44,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.27,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.78,"additional_payer_notes":"APC"}]}]},{"description":"Macroscopic exam parasite","code_information":[{"code":"87169","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.31,"maximum":7.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.31,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.57,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.61,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.83,"additional_payer_notes":"APC"}]}]},{"description":"Pinworm Exam","code_information":[{"code":"87172","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.27,"maximum":7.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.44,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.27,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.78,"additional_payer_notes":"APC"}]}]},{"description":"Tissue homogenization cultr","code_information":[{"code":"87176","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.88,"maximum":10.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.59,"additional_payer_notes":"APC"}]}]},{"description":"Ova and parasites smears","code_information":[{"code":"87177","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.9,"maximum":16.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.26,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.52,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":16.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.97,"additional_payer_notes":"APC"}]}]},{"description":"Microbe susceptible diffuse","code_information":[{"code":"87181","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.75,"maximum":8.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.94,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.75,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.08,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":8.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.32,"additional_payer_notes":"APC"}]}]},{"description":"Sc std carbapenem resist gen","code_information":[{"code":"87183","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Microbe susceptible disk","code_information":[{"code":"87184","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.48,"maximum":13.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.7,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.0,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.38,"additional_payer_notes":"APC"}]}]},{"description":"Microbe susceptible enzyme","code_information":[{"code":"87185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.75,"maximum":8.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.94,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.75,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.08,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":8.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.08,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.32,"additional_payer_notes":"APC"}]}]},{"description":"Microbe susceptible mic","code_information":[{"code":"87186","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.65,"maximum":15.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.65,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.91,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.26,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.17,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.25,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.69,"additional_payer_notes":"APC"}]}]},{"description":"Microbe susceptible mlc","code_information":[{"code":"87187","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.17,"maximum":73.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":73.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":42.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42.94,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44.99,"additional_payer_notes":"APC"}]}]},{"description":"Microbe suscept macrobroth","code_information":[{"code":"87188","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.64,"maximum":12.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":12.12,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.44,"additional_payer_notes":"APC"}]}]},{"description":"Microbe suscept mycobacteri","code_information":[{"code":"87190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.31,"maximum":13.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.31,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.53,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.19,"additional_payer_notes":"APC"}]}]},{"description":"Bactericidal level serum","code_information":[{"code":"87197","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.02,"maximum":27.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.02,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.07,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.82,"additional_payer_notes":"APC"}]}]},{"description":"Smear gram stain","code_information":[{"code":"87205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.27,"maximum":7.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.44,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.27,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.78,"additional_payer_notes":"APC"}]}]},{"description":"Smear fluorescent/acid stai","code_information":[{"code":"87206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.39,"maximum":9.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.55,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.77,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.76,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.04,"additional_payer_notes":"APC"}]}]},{"description":"Smear special stain","code_information":[{"code":"87207","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.99,"maximum":10.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.41,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.71,"additional_payer_notes":"APC"}]}]},{"description":"Smear complex stain","code_information":[{"code":"87209","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.98,"maximum":32.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.22,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.14,"additional_payer_notes":"APC"}]}]},{"description":"Smear wet mount saline/ink","code_information":[{"code":"87210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.82,"maximum":10.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.05,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.17,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.22,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.52,"additional_payer_notes":"APC"}]}]},{"description":"Tissue exam for fungi","code_information":[{"code":"87220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.27,"maximum":7.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.44,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.27,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.78,"additional_payer_notes":"APC"}]}]},{"description":"Assay toxin or antitoxin","code_information":[{"code":"87230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.74,"maximum":36.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.74,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.12,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.11,"additional_payer_notes":"APC"}]}]},{"description":"Virus inoculate eggs/animal","code_information":[{"code":"87250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.56,"maximum":35.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.15,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":35.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.91,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.91,"additional_payer_notes":"APC"}]}]},{"description":"Virus inoculation tissue","code_information":[{"code":"87252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.07,"maximum":47.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.07,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.89,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":47.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.87,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.2,"additional_payer_notes":"APC"}]}]},{"description":"Virus inoculate tissue addl","code_information":[{"code":"87253","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.2,"maximum":36.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.59,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.62,"additional_payer_notes":"APC"}]}]},{"description":"Virus inoculation shell via","code_information":[{"code":"87254","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.56,"maximum":35.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.15,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.93,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":35.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.73,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.91,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.91,"additional_payer_notes":"APC"}]}]},{"description":"Genet virus isolate hsv","code_information":[{"code":"87255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.86,"maximum":61.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35.21,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33.86,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":61.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.2,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.92,"additional_payer_notes":"APC"}]}]},{"description":"Adenovirus ag if","code_information":[{"code":"87260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.43,"maximum":26.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.86,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.44,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.43,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.16,"additional_payer_notes":"APC"}]}]},{"description":"Pertussis ag if","code_information":[{"code":"87265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":21.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"}]}]},{"description":"Enterovirus antibody dfa","code_information":[{"code":"87267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.42,"maximum":24.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.82,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.36,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.35,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.03,"additional_payer_notes":"APC"}]}]},{"description":"Giardia ag if","code_information":[{"code":"87269","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.61,"maximum":24.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.61,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.02,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.56,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.55,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.24,"additional_payer_notes":"APC"}]}]},{"description":"Chlamydia trachomatis ag if","code_information":[{"code":"87270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":21.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"}]}]},{"description":"Cytomegalovirus dfa","code_information":[{"code":"87271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.42,"maximum":24.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.82,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.36,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.35,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.03,"additional_payer_notes":"APC"}]}]},{"description":"Cryptosporidium ag if","code_information":[{"code":"87272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":21.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"}]}]},{"description":"Herpes simplex 2 ag if","code_information":[{"code":"87273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":21.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"}]}]},{"description":"Herpes simplex 1 ag if","code_information":[{"code":"87274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":21.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"}]}]},{"description":"Influenza b ag if","code_information":[{"code":"87275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.25,"maximum":22.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.62,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.72,"additional_payer_notes":"APC"}]}]},{"description":"Influenza a ag if","code_information":[{"code":"87276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.07,"maximum":29.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.07,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.55,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.19,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":29.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.18,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.0,"additional_payer_notes":"APC"}]}]},{"description":"Legion pneumophilia ag if","code_information":[{"code":"87278","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.6,"maximum":28.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.22,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.69,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.68,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.47,"additional_payer_notes":"APC"}]}]},{"description":"Parainfluenza ag if","code_information":[{"code":"87279","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.43,"maximum":30.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.92,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.58,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.42,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.4,"additional_payer_notes":"APC"}]}]},{"description":"Respiratory syncytial ag if","code_information":[{"code":"87280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.42,"maximum":24.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.82,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.36,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.35,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.03,"additional_payer_notes":"APC"}]}]},{"description":"Pneumocystis carinii ag if","code_information":[{"code":"87281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":21.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"}]}]},{"description":"Rubeola ag if","code_information":[{"code":"87283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":60.8,"maximum":111.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":63.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.62,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":111.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":64.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":68.1,"additional_payer_notes":"APC"}]}]},{"description":"Treponema pallidum ag if","code_information":[{"code":"87285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.18,"maximum":22.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.18,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.55,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.03,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.02,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.64,"additional_payer_notes":"APC"}]}]},{"description":"Varicella zoster ag if","code_information":[{"code":"87290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.42,"maximum":24.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.82,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.36,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.35,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.03,"additional_payer_notes":"APC"}]}]},{"description":"Antibody detection nos if","code_information":[{"code":"87299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.1,"maximum":29.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.1,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.58,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.23,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":29.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.07,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.21,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.03,"additional_payer_notes":"APC"}]}]},{"description":"Ag detection polyval if","code_information":[{"code":"87300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":21.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"}]}]},{"description":"Adenovirus ag ia","code_information":[{"code":"87301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":21.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"}]}]},{"description":"Aspergillus ag ia","code_information":[{"code":"87305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":21.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"}]}]},{"description":"Chylmd trach ag ia","code_information":[{"code":"87320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.0,"maximum":27.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.6,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27.39,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.9,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.8,"additional_payer_notes":"APC"}]}]},{"description":"Clostridium ag ia","code_information":[{"code":"87324","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":21.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"}]}]},{"description":"Cryptococcus neoform ag ia","code_information":[{"code":"87327","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.42,"maximum":24.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.82,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.36,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.35,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.03,"additional_payer_notes":"APC"}]}]},{"description":"Cryptosporidium ag ia","code_information":[{"code":"87328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.82,"maximum":25.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.37,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.23,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.79,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.65,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.77,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.48,"additional_payer_notes":"APC"}]}]},{"description":"Giardia ag ia","code_information":[{"code":"87329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":21.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"}]}]},{"description":"Cytomegalovirus ag ia","code_information":[{"code":"87332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":21.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"}]}]},{"description":"E coli 0157 ag ia","code_information":[{"code":"87335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.66,"maximum":23.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.66,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.04,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.12,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.18,"additional_payer_notes":"APC"}]}]},{"description":"Entamoeb hist dispr ag ia","code_information":[{"code":"87336","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.0,"maximum":29.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.48,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.12,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":29.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.92,"additional_payer_notes":"APC"}]}]},{"description":"Entamoeb hist group ag ia","code_information":[{"code":"87337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":21.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"}]}]},{"description":"Hpylori stool ia","code_information":[{"code":"87338","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.38,"maximum":26.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.38,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.81,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.39,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26.26,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.11,"additional_payer_notes":"APC"}]}]},{"description":"H pylori ag ia","code_information":[{"code":"87339","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.0,"maximum":29.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.48,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.12,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":29.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.92,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis b surface ag ia","code_information":[{"code":"87340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.33,"maximum":18.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.57,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis b surface ag ia","code_information":[{"code":"87341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.33,"maximum":18.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.64,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.57,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis be ag ia","code_information":[{"code":"87350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.53,"maximum":21.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.33,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.91,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis delta ag ia","code_information":[{"code":"87380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.36,"maximum":33.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.09,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.36,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.56,"additional_payer_notes":"APC"}]}]},{"description":"Histoplasma capsul ag ia","code_information":[{"code":"87385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.25,"maximum":24.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":24.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.04,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.84,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-1 ag w/hiv-1 & hiv-2 ab","code_information":[{"code":"87389","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.08,"maximum":43.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.08,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.77,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":43.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.74,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.97,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-1 ag ia","code_information":[{"code":"87390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.06,"maximum":43.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.02,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24.78,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":43.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.5,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.72,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.95,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-2 ag ia","code_information":[{"code":"87391","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.9,"maximum":39.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.56,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.43,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":39.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.53,"additional_payer_notes":"APC"}]}]},{"description":"Influenza a/b ag ia","code_information":[{"code":"87400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.13,"maximum":25.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.13,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.55,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.12,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.83,"additional_payer_notes":"APC"}]}]},{"description":"Resp syncytial ag ia","code_information":[{"code":"87420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.91,"maximum":25.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.47,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.88,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":25.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.87,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.58,"additional_payer_notes":"APC"}]}]},{"description":"Rotavirus ag ia","code_information":[{"code":"87425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":21.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"}]}]},{"description":"Coronavirus ag ia","code_information":[{"code":"87426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.33,"maximum":64.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.8,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.77,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.57,"additional_payer_notes":"APC"}]}]},{"description":"Shiga-like toxin ag ia","code_information":[{"code":"87427","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":21.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"}]}]},{"description":"Sarscov & inf vir a&b ag ia","code_information":[{"code":"87428","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":70.29,"maximum":128.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":73.1,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":72.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":75.21,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":71.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":128.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":74.51,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":75.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":78.72,"additional_payer_notes":"APC"}]}]},{"description":"Strep a ag ia","code_information":[{"code":"87430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.81,"maximum":30.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.48,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.31,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.97,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.83,"additional_payer_notes":"APC"}]}]},{"description":"Ag detect nos ia mult","code_information":[{"code":"87449","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":21.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"}]}]},{"description":"Ag detect polyval ia mult","code_information":[{"code":"87451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.51,"maximum":19.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.93,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.83,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.24,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.77,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis b surface ag quan","code_information":[{"code":"87467","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.32,"maximum":46.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.33,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.08,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":46.23,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.84,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.07,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.36,"additional_payer_notes":"APC"}]}]},{"description":"Anaplsma phgcytophlm amp prb","code_information":[{"code":"87468","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Babesia microti amp prb","code_information":[{"code":"87469","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Bartonella dna amp probe","code_information":[{"code":"87471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Bartonella dna quant","code_information":[{"code":"87472","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.84,"maximum":78.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44.55,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":78.23,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":45.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47.98,"additional_payer_notes":"APC"}]}]},{"description":"Lyme dis dna dir probe","code_information":[{"code":"87475","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.05,"maximum":36.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.25,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.43,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.46,"additional_payer_notes":"APC"}]}]},{"description":"Lyme dis dna amp probe","code_information":[{"code":"87476","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Borrelia miyamotoi amp prb","code_information":[{"code":"87478","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Candida dna dir probe","code_information":[{"code":"87480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.05,"maximum":36.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.25,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.43,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.46,"additional_payer_notes":"APC"}]}]},{"description":"Candida dna amp probe","code_information":[{"code":"87481","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Candida dna quant","code_information":[{"code":"87482","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":55.74,"maximum":101.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57.97,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55.74,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":57.41,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":59.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":56.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":101.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":59.08,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":59.59,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":62.43,"additional_payer_notes":"APC"}]}]},{"description":"Cns dna amp probe type 12-25","code_information":[{"code":"87483","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":761.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":761.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":445.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":466.79,"additional_payer_notes":"APC"}]}]},{"description":"Ehrlicha chaffeensis amp prb","code_information":[{"code":"87484","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Chylmd pneum dna dir probe","code_information":[{"code":"87485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.05,"maximum":36.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.25,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.43,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.46,"additional_payer_notes":"APC"}]}]},{"description":"Chylmd pneum dna amp probe","code_information":[{"code":"87486","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Chylmd pneum dna quant","code_information":[{"code":"87487","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.84,"maximum":78.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44.55,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":78.23,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":45.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47.98,"additional_payer_notes":"APC"}]}]},{"description":"Chylmd trach dna dir probe","code_information":[{"code":"87490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.75,"maximum":41.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.66,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22.75,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.43,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.34,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":41.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.32,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.48,"additional_payer_notes":"APC"}]}]},{"description":"Chylmd trach dna amp probe","code_information":[{"code":"87491","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Chylmd trach dna quant","code_information":[{"code":"87492","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":53.47,"maximum":97.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":55.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":55.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57.21,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":54.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":97.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":56.68,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":59.89,"additional_payer_notes":"APC"}]}]},{"description":"C diff amplified probe","code_information":[{"code":"87493","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.27,"maximum":68.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37.27,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38.39,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.88,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":68.06,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":39.51,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.84,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.74,"additional_payer_notes":"APC"}]}]},{"description":"Chlmy trch&neisra gonor mult","code_information":[{"code":"87494","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":70.18,"maximum":128.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":72.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70.18,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":72.29,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":75.09,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":71.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":128.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":74.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":75.02,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":78.6,"additional_payer_notes":"APC"}]}]},{"description":"Cytomeg dna dir probe","code_information":[{"code":"87495","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.03,"maximum":54.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.93,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.13,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":54.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.83,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.63,"additional_payer_notes":"APC"}]}]},{"description":"Cytomeg dna amp probe","code_information":[{"code":"87496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Cytomeg dna quant","code_information":[{"code":"87497","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.84,"maximum":78.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44.55,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":78.23,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":45.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47.98,"additional_payer_notes":"APC"}]}]},{"description":"Enterovirus probe&revrs trns","code_information":[{"code":"87498","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Vanomycin dna amp probe","code_information":[{"code":"87500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Influenza dna amp prob 1+","code_information":[{"code":"87501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.31,"maximum":93.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51.31,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":52.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.9,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":52.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":93.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":54.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57.47,"additional_payer_notes":"APC"}]}]},{"description":"Influenza dna amp probe","code_information":[{"code":"87502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":95.8,"maximum":174.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":99.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":98.67,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":102.51,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":97.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":174.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":101.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":102.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":107.3,"additional_payer_notes":"APC"}]}]},{"description":"Influenza dna amp prob addl","code_information":[{"code":"87503","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.22,"maximum":53.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.1,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":53.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.24,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.73,"additional_payer_notes":"APC"}]}]},{"description":"Nfct agent detection gi","code_information":[{"code":"87505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":128.29,"maximum":234.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":133.42,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":137.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":130.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":234.26,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":135.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":137.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":143.68,"additional_payer_notes":"APC"}]}]},{"description":"Iadna-dna/rna probe tq 6-11","code_information":[{"code":"87506","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":262.99,"maximum":480.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":273.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":262.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":270.88,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":281.4,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":268.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":480.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":278.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":281.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":294.55,"additional_payer_notes":"APC"}]}]},{"description":"Iadna-dna/rna probe tq 12-25","code_information":[{"code":"87507","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":761.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":761.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":445.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":466.79,"additional_payer_notes":"APC"}]}]},{"description":"Gardner vag dna dir probe","code_information":[{"code":"87510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.05,"maximum":36.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.25,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.43,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.46,"additional_payer_notes":"APC"}]}]},{"description":"Gardner vag dna amp probe","code_information":[{"code":"87511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Gardner vag dna quant","code_information":[{"code":"87512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.76,"maximum":76.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.76,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":42.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":76.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46.77,"additional_payer_notes":"APC"}]}]},{"description":"H pylri clrthmcn rst amp prb","code_information":[{"code":"87513","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis b dna amp probe","code_information":[{"code":"87516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis b dna quant","code_information":[{"code":"87517","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.84,"maximum":78.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44.55,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":78.23,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":45.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47.98,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis c rna dir probe","code_information":[{"code":"87520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":31.22,"maximum":57.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.47,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.41,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":57.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34.97,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis c probe&rvrs trnsc","code_information":[{"code":"87521","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis c revrs trnscrpj","code_information":[{"code":"87522","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.84,"maximum":78.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44.55,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":78.23,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":45.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47.98,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis d quantification","code_information":[{"code":"87523","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.84,"maximum":78.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44.55,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":78.23,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":45.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47.98,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis g dna dir probe","code_information":[{"code":"87525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.8,"maximum":54.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29.8,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.69,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.89,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":54.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.86,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.38,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis g dna amp probe","code_information":[{"code":"87526","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.26,"maximum":71.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.83,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.44,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42.01,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":40.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":71.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":41.97,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.97,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis g dna quant","code_information":[{"code":"87527","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.76,"maximum":76.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.76,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":42.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":76.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46.77,"additional_payer_notes":"APC"}]}]},{"description":"Hsv dna dir probe","code_information":[{"code":"87528","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.05,"maximum":36.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.25,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.43,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.46,"additional_payer_notes":"APC"}]}]},{"description":"Hsv dna amp probe","code_information":[{"code":"87529","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Hsv dna quant","code_information":[{"code":"87530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.84,"maximum":78.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44.55,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":78.23,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":45.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47.98,"additional_payer_notes":"APC"}]}]},{"description":"Hhv-6 dna dir probe","code_information":[{"code":"87531","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.0,"maximum":105.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60.32,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":59.74,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":62.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":59.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":105.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":61.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":62.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.96,"additional_payer_notes":"APC"}]}]},{"description":"Hhv-6 dna amp probe","code_information":[{"code":"87532","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Hhv-6 dna quant","code_information":[{"code":"87533","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.76,"maximum":76.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.76,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":42.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":76.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46.77,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-1 dna dir probe","code_information":[{"code":"87534","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.92,"maximum":40.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.58,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":40.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.43,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.55,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-1 probe&reverse trnscrpj","code_information":[{"code":"87535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-1 quant&revrse trnscrpj","code_information":[{"code":"87536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":85.1,"maximum":155.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":88.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85.1,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":87.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":91.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":86.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":155.39,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":90.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":90.97,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":95.31,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-2 dna dir probe","code_information":[{"code":"87537","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.92,"maximum":40.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.58,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":40.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.43,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.55,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-2 probe&revrse trnscripj","code_information":[{"code":"87538","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-2 quant&revrse trnscripj","code_information":[{"code":"87539","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.62,"maximum":107.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":60.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58.62,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":60.38,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":62.72,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":59.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":107.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":62.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":62.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":65.65,"additional_payer_notes":"APC"}]}]},{"description":"Legion pneumo dna dir prob","code_information":[{"code":"87540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.05,"maximum":36.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.25,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.43,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.46,"additional_payer_notes":"APC"}]}]},{"description":"Legion pneumo dna amp prob","code_information":[{"code":"87541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Legion pneumo dna quant","code_information":[{"code":"87542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.76,"maximum":76.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.76,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":42.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":76.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46.77,"additional_payer_notes":"APC"}]}]},{"description":"Mycobacteria dna dir probe","code_information":[{"code":"87550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.05,"maximum":36.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.25,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.43,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.46,"additional_payer_notes":"APC"}]}]},{"description":"Mycobacteria dna amp probe","code_information":[{"code":"87551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.24,"maximum":88.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":50.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48.24,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":49.69,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":49.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":88.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":51.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.03,"additional_payer_notes":"APC"}]}]},{"description":"Mycobacteria dna quant","code_information":[{"code":"87552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.84,"maximum":78.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44.55,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":78.23,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":45.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47.98,"additional_payer_notes":"APC"}]}]},{"description":"M.tuberculo dna dir probe","code_information":[{"code":"87555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.88,"maximum":49.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.69,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":49.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.11,"additional_payer_notes":"APC"}]}]},{"description":"M.tuberculo dna amp probe","code_information":[{"code":"87556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.68,"maximum":76.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.35,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.68,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":42.93,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44.6,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":42.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":76.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46.68,"additional_payer_notes":"APC"}]}]},{"description":"M.tuberculo dna quant","code_information":[{"code":"87557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.84,"maximum":78.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44.55,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":78.23,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":45.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47.98,"additional_payer_notes":"APC"}]}]},{"description":"M.avium-intra dna dir prob","code_information":[{"code":"87560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.29,"maximum":49.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":49.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.17,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.56,"additional_payer_notes":"APC"}]}]},{"description":"M.avium-intra dna amp prob","code_information":[{"code":"87561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"M.avium-intra dna quant","code_information":[{"code":"87562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.84,"maximum":78.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44.55,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":78.23,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":45.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47.98,"additional_payer_notes":"APC"}]}]},{"description":"M. genitalium amp probe","code_information":[{"code":"87563","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Mtb rifampin rst amp prb tq","code_information":[{"code":"87564","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":76.77,"maximum":140.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":79.84,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76.77,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":79.07,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":82.14,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":78.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":140.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":81.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":82.07,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":85.98,"additional_payer_notes":"APC"}]}]},{"description":"M.pneumon dna dir probe","code_information":[{"code":"87580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.05,"maximum":36.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.25,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.43,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.46,"additional_payer_notes":"APC"}]}]},{"description":"M.pneumon dna amp probe","code_information":[{"code":"87581","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"M.pneumon dna quant","code_information":[{"code":"87582","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":302.62,"maximum":552.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":314.72,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":302.62,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":311.7,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":323.8,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":308.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":552.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":320.78,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":323.5,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":338.93,"additional_payer_notes":"APC"}]}]},{"description":"N.gonorrhoeae dna dir prob","code_information":[{"code":"87590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.88,"maximum":49.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.69,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":49.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.11,"additional_payer_notes":"APC"}]}]},{"description":"N.gonorrhoeae dna amp prob","code_information":[{"code":"87591","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"N.gonorrhoeae dna quant","code_information":[{"code":"87592","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.84,"maximum":78.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44.55,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":78.23,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":45.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47.98,"additional_payer_notes":"APC"}]}]},{"description":"Orthopoxvirus amp prb each","code_information":[{"code":"87593","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.31,"maximum":93.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51.31,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":52.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.9,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":52.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":93.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":54.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57.47,"additional_payer_notes":"APC"}]}]},{"description":"Pneumcysts jirovecii amp prb","code_information":[{"code":"87594","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Hpv low-risk types","code_information":[{"code":"87623","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Hpv high-risk types","code_information":[{"code":"87624","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Hpv types 16 & 18 only","code_information":[{"code":"87625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.55,"maximum":74.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42.17,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40.55,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.77,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.39,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":74.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":42.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.35,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.42,"additional_payer_notes":"APC"}]}]},{"description":"Hpv sep hi-rsk typ&pool rslt","code_information":[{"code":"87626","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":70.2,"maximum":128.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":73.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":72.31,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":75.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":71.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":128.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":74.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":75.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":78.62,"additional_payer_notes":"APC"}]}]},{"description":"Jt spc pthgn&rx rsist gen26+","code_information":[{"code":"87627","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":679.77,"maximum":1241.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":706.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":679.77,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":700.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":727.35,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":693.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":1241.26,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":720.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":726.67,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":761.34,"additional_payer_notes":"APC"}]}]},{"description":"Resp virus 3-5 targets","code_information":[{"code":"87631","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.63,"maximum":260.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":146.91,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":152.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":145.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":260.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":151.19,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":152.47,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":159.75,"additional_payer_notes":"APC"}]}]},{"description":"Resp virus 6-11 targets","code_information":[{"code":"87632","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":218.06,"maximum":398.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":226.78,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":218.06,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":224.6,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":233.32,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":222.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":398.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":231.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":233.11,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":244.23,"additional_payer_notes":"APC"}]}]},{"description":"Resp virus 12-25 targets","code_information":[{"code":"87633","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":416.78,"maximum":761.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":425.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":761.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":445.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":466.79,"additional_payer_notes":"APC"}]}]},{"description":"Rsv dna/rna amp probe","code_information":[{"code":"87634","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":70.2,"maximum":128.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":73.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":72.31,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":75.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":71.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":128.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":74.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":75.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":78.62,"additional_payer_notes":"APC"}]}]},{"description":"Sars-cov-2 covid-19 amp prb","code_information":[{"code":"87635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.31,"maximum":93.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51.31,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":52.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.9,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":52.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":93.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":54.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57.47,"additional_payer_notes":"APC"}]}]},{"description":"Sarscov2 & inf a&b amp prb","code_information":[{"code":"87636","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.63,"maximum":260.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":146.91,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":152.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":145.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":260.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":151.19,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":152.47,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":159.75,"additional_payer_notes":"APC"}]}]},{"description":"Sarscov2&inf a&b&rsv amp prb","code_information":[{"code":"87637","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.63,"maximum":260.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":148.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":146.91,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":152.61,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":145.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":260.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":151.19,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":152.47,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":159.75,"additional_payer_notes":"APC"}]}]},{"description":"Staph a dna amp probe","code_information":[{"code":"87640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Mr-staph dna amp probe","code_information":[{"code":"87641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Strep a dna dir probe","code_information":[{"code":"87650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.05,"maximum":36.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.25,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.43,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.46,"additional_payer_notes":"APC"}]}]},{"description":"Strep a dna amp probe","code_information":[{"code":"87651","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Strep a dna quant","code_information":[{"code":"87652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.76,"maximum":76.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.43,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.76,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43.01,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":42.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":76.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46.77,"additional_payer_notes":"APC"}]}]},{"description":"Strep b dna amp probe","code_information":[{"code":"87653","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Trichomonas vagin dir probe","code_information":[{"code":"87660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.05,"maximum":36.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.45,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.25,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.43,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.46,"additional_payer_notes":"APC"}]}]},{"description":"Trichomonas vaginalis amplif","code_information":[{"code":"87661","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Zika virus dna/rna amp probe","code_information":[{"code":"87662","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.31,"maximum":93.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51.31,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":52.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.9,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":52.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":93.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":54.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57.47,"additional_payer_notes":"APC"}]}]},{"description":"Detect agent nos dna dir","code_information":[{"code":"87797","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.03,"maximum":54.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.93,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.13,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":30.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":54.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":31.83,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":32.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.63,"additional_payer_notes":"APC"}]}]},{"description":"Detect agent nos dna amp","code_information":[{"code":"87798","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Detect agent nos dna quant","code_information":[{"code":"87799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.84,"maximum":78.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44.55,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":78.23,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":45.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.8,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47.98,"additional_payer_notes":"APC"}]}]},{"description":"Detect agnt mult dna direc","code_information":[{"code":"87800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":43.67,"maximum":79.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.42,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43.67,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44.98,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46.73,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":79.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":46.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46.68,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48.91,"additional_payer_notes":"APC"}]}]},{"description":"Detect agnt mult dna ampli","code_information":[{"code":"87801","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":70.2,"maximum":128.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":73.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70.2,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":72.31,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":75.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":71.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":128.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":74.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":75.04,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":78.62,"additional_payer_notes":"APC"}]}]},{"description":"Strep b assay w/optic","code_information":[{"code":"87802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.73,"maximum":23.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.11,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.62,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.49,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.61,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.26,"additional_payer_notes":"APC"}]}]},{"description":"Clostridium toxin a w/optic","code_information":[{"code":"87803","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.0,"maximum":29.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.64,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.48,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.12,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":29.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.92,"additional_payer_notes":"APC"}]}]},{"description":"Influenza assay w/optic","code_information":[{"code":"87804","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.55,"maximum":30.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.21,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.55,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.05,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.71,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.54,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"APC"}]}]},{"description":"Hiv antigen w/hiv antibodies","code_information":[{"code":"87806","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.77,"maximum":59.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32.77,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33.75,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35.06,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":59.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35.03,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.7,"additional_payer_notes":"APC"}]}]},{"description":"Rsv assay w/optic","code_information":[{"code":"87807","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.1,"maximum":23.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.1,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.49,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.02,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.67,"additional_payer_notes":"APC"}]}]},{"description":"Trichomonas assay w/optic","code_information":[{"code":"87808","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.29,"maximum":27.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.9,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.75,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.36,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.35,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.12,"additional_payer_notes":"APC"}]}]},{"description":"Adenovirus assay w/optic","code_information":[{"code":"87809","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.76,"maximum":39.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.76,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.41,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.28,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":39.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.07,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.26,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.37,"additional_payer_notes":"APC"}]}]},{"description":"Chylmd trach assay w/optic","code_information":[{"code":"87810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.29,"maximum":64.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.35,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.76,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.41,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.73,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.52,"additional_payer_notes":"APC"}]}]},{"description":"Sars-cov-2 covid19 w/optic","code_information":[{"code":"87811","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.38,"maximum":75.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41.38,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":42.62,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44.28,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":42.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":75.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44.24,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":46.35,"additional_payer_notes":"APC"}]}]},{"description":"Sarscov2&inf typ a&b w/optic","code_information":[{"code":"87812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":74.48,"maximum":136.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":77.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74.48,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":76.71,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":79.69,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":75.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":136.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":78.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":79.62,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":83.42,"additional_payer_notes":"APC"}]}]},{"description":"N. gonorrhoeae assay w/optic","code_information":[{"code":"87850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.56,"maximum":44.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.54,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.3,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.28,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":44.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.25,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.51,"additional_payer_notes":"APC"}]}]},{"description":"Strep a assay w/optic","code_information":[{"code":"87880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.53,"maximum":30.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.19,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.03,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.69,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":30.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.67,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.51,"additional_payer_notes":"APC"}]}]},{"description":"Agent nos assay w/optic","code_information":[{"code":"87899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.07,"maximum":29.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16.07,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.55,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.19,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":29.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":17.03,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.18,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.0,"additional_payer_notes":"APC"}]}]},{"description":"Phenotype infect agent drug","code_information":[{"code":"87900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":130.35,"maximum":238.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":135.56,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":130.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":134.26,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":238.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":138.17,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":139.34,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":145.99,"additional_payer_notes":"APC"}]}]},{"description":"Genotype dna hiv reverse t","code_information":[{"code":"87901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.45,"maximum":470.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.1,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":272.9,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.21,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.34,"additional_payer_notes":"APC"}]}]},{"description":"Genotype dna/rna hep c","code_information":[{"code":"87902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.45,"maximum":470.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.1,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":272.9,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.21,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.34,"additional_payer_notes":"APC"}]}]},{"description":"Phenotype dna hiv w/culture","code_information":[{"code":"87903","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":488.66,"maximum":892.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":508.21,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":488.66,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":503.32,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":522.87,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":498.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":892.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":517.98,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":522.38,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":547.3,"additional_payer_notes":"APC"}]}]},{"description":"Phenotype dna hiv w/clt add","code_information":[{"code":"87904","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.07,"maximum":47.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.07,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.89,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":47.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.87,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.2,"additional_payer_notes":"APC"}]}]},{"description":"Sialidase enzyme assay","code_information":[{"code":"87905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.22,"maximum":22.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.59,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.08,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.06,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.69,"additional_payer_notes":"APC"}]}]},{"description":"Genotype dna/rna hiv","code_information":[{"code":"87906","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":128.73,"maximum":235.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":133.88,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":128.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":132.59,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":137.74,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":131.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":235.06,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":136.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":137.61,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":144.18,"additional_payer_notes":"APC"}]}]},{"description":"Genotype cytomegalovirus","code_information":[{"code":"87910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.45,"maximum":470.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.1,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":272.9,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.21,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.34,"additional_payer_notes":"APC"}]}]},{"description":"Genotype dna hepatitis b","code_information":[{"code":"87912","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":257.45,"maximum":470.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":267.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":257.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":265.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":262.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":470.1,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":272.9,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":275.21,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":288.34,"additional_payer_notes":"APC"}]}]},{"description":"Sex chromatin identification","code_information":[{"code":"88130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.98,"maximum":32.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.7,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.52,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.22,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.14,"additional_payer_notes":"APC"}]}]},{"description":"Sex chromatin identification","code_information":[{"code":"88140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.99,"maximum":14.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.23,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.47,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.54,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.95,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v thin layer","code_information":[{"code":"88142","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.26,"maximum":36.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.87,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.69,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v thin layer redo","code_information":[{"code":"88143","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.04,"maximum":42.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.96,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23.04,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":23.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":42.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24.42,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.63,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.8,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v automated","code_information":[{"code":"88147","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":50.56,"maximum":92.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":52.58,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":52.08,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.1,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":51.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":92.32,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":53.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":56.63,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v auto rescreen","code_information":[{"code":"88148","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.54,"maximum":33.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.1,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.65,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.76,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v manual","code_information":[{"code":"88150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.54,"maximum":33.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.1,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.65,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.76,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v auto redo","code_information":[{"code":"88152","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.64,"maximum":50.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.75,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":50.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.55,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.96,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v redo","code_information":[{"code":"88153","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.03,"maximum":43.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":24.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24.75,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.71,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":43.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.47,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.69,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.91,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v index add-on","code_information":[{"code":"88155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.65,"maximum":26.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14.65,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.09,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":14.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":26.75,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":15.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.41,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath tbs c/v manual","code_information":[{"code":"88164","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.54,"maximum":33.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.1,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.65,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.76,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath tbs c/v redo","code_information":[{"code":"88165","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.22,"maximum":77.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43.49,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":77.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.13,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47.29,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath tbs c/v auto redo","code_information":[{"code":"88166","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.54,"maximum":33.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.1,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.65,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.76,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath tbs c/v select","code_information":[{"code":"88167","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.54,"maximum":33.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.1,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.65,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.76,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v auto in fluid","code_information":[{"code":"88174","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.37,"maximum":46.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.38,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.13,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.15,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":46.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.12,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.41,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v auto fluid redo","code_information":[{"code":"88175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.61,"maximum":48.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.67,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.61,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.41,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.47,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":48.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.8,"additional_payer_notes":"APC"}]}]},{"description":"Tissue culture lymphocyte","code_information":[{"code":"88230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.49,"maximum":212.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":121.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":116.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":119.98,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":124.64,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":118.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":212.71,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":123.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":124.53,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":130.47,"additional_payer_notes":"APC"}]}]},{"description":"Tissue culture skin/biopsy","code_information":[{"code":"88233","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":140.73,"maximum":256.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":146.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":140.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":144.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.58,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":143.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":256.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":149.17,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.44,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":157.62,"additional_payer_notes":"APC"}]}]},{"description":"Tissue culture placenta","code_information":[{"code":"88235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":150.3,"maximum":274.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":156.31,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":150.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":154.81,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":160.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":153.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":274.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":159.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":160.67,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":168.34,"additional_payer_notes":"APC"}]}]},{"description":"Tissue culture bone marrow","code_information":[{"code":"88237","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":143.75,"maximum":262.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":149.5,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":143.75,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":148.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":153.81,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":146.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":262.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":152.38,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":153.67,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":161.0,"additional_payer_notes":"APC"}]}]},{"description":"Tissue culture tumor","code_information":[{"code":"88239","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":147.52,"maximum":269.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":153.42,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":147.52,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":151.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":157.85,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":150.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":269.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":156.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":157.7,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":165.22,"additional_payer_notes":"APC"}]}]},{"description":"Cell cryopreserve/storage","code_information":[{"code":"88240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.07,"maximum":23.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13.07,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.46,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.98,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":23.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.97,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":14.64,"additional_payer_notes":"APC"}]}]},{"description":"Frozen cell preparation","code_information":[{"code":"88241","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.09,"maximum":22.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.57,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.54,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome analysis 20-25","code_information":[{"code":"88245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":173.17,"maximum":316.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":180.1,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":173.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":178.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":176.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":316.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.12,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":193.95,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome analysis 50-100","code_information":[{"code":"88248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":173.17,"maximum":316.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":180.1,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":173.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":178.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":176.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":316.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.12,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":193.95,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome analysis 100","code_information":[{"code":"88249","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":173.17,"maximum":316.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":180.1,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":173.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":178.37,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":176.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":316.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":183.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.12,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":193.95,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome analysis 5","code_information":[{"code":"88261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.34,"maximum":482.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":274.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":272.27,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":282.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":269.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":482.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":280.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":282.58,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":296.06,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome analysis 15-20","code_information":[{"code":"88262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":125.49,"maximum":229.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":130.51,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":125.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":129.25,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":134.27,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":128.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":229.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":133.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":134.15,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":140.55,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome analysis 45","code_information":[{"code":"88263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":150.29,"maximum":274.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":156.3,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":150.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":154.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":160.81,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":153.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":274.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":159.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":160.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":168.32,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome analysis 20-25","code_information":[{"code":"88264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":144.61,"maximum":264.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":150.39,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":144.61,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":148.95,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":154.73,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":147.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":264.06,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":153.29,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":154.59,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":161.96,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome analys placenta","code_information":[{"code":"88267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":188.57,"maximum":344.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":196.11,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":188.57,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":194.23,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":201.77,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":192.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":344.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":199.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":201.58,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":211.2,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome analys amniotic","code_information":[{"code":"88269","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":173.66,"maximum":317.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":180.61,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":173.66,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":178.87,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":177.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":317.1,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":184.08,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":185.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":194.5,"additional_payer_notes":"APC"}]}]},{"description":"Cytogenetics dna probe","code_information":[{"code":"88271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.42,"maximum":39.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":39.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":22.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.9,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":23.99,"additional_payer_notes":"APC"}]}]},{"description":"Cytogenetics 3-5","code_information":[{"code":"88272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.7,"maximum":74.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":42.33,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.92,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":41.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":74.32,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":43.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.58,"additional_payer_notes":"APC"}]}]},{"description":"Cytogenetics 10-30","code_information":[{"code":"88273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34.81,"maximum":63.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":63.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.9,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.21,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38.99,"additional_payer_notes":"APC"}]}]},{"description":"Cytogenetics 25-99","code_information":[{"code":"88274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.38,"maximum":77.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":44.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42.38,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.35,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":43.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":77.39,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44.92,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.3,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47.47,"additional_payer_notes":"APC"}]}]},{"description":"Cytogenetics 100-300","code_information":[{"code":"88275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.19,"maximum":93.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53.24,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":52.73,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.77,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":52.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":93.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":54.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.72,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57.33,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome karyotype study","code_information":[{"code":"88280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.47,"maximum":61.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34.47,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35.81,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":34.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":61.12,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35.78,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.49,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome banding study","code_information":[{"code":"88283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.6,"maximum":125.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":71.34,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":68.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":70.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":73.4,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":69.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":125.26,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":72.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":73.33,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":76.83,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome count additional","code_information":[{"code":"88285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.91,"maximum":49.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.99,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.72,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.79,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":49.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.77,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.14,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome study additional","code_information":[{"code":"88289","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34.43,"maximum":62.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35.81,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.46,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":62.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.5,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38.56,"additional_payer_notes":"APC"}]}]},{"description":"Bilirubin total transcut","code_information":[{"code":"88720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.02,"maximum":9.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.22,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.02,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.62,"additional_payer_notes":"APC"}]}]},{"description":"Hgb quant transcutaneous","code_information":[{"code":"88738","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.02,"maximum":9.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.22,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.02,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.17,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.37,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.37,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.62,"additional_payer_notes":"APC"}]}]},{"description":"Transcutaneous carboxyhb","code_information":[{"code":"88740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.37,"maximum":17.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.03,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.02,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.49,"additional_payer_notes":"APC"}]}]},{"description":"Transcutaneous methb","code_information":[{"code":"88741","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.37,"maximum":17.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.74,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.37,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.65,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.03,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.02,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.49,"additional_payer_notes":"APC"}]}]},{"description":"Body fluid cell count","code_information":[{"code":"89050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.72,"maximum":8.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.91,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.72,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.86,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":8.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.05,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.29,"additional_payer_notes":"APC"}]}]},{"description":"Body fluid cell count","code_information":[{"code":"89051","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.6,"maximum":10.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.82,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.77,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10.23,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.99,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.27,"additional_payer_notes":"APC"}]}]},{"description":"Leukocyte assessment fecal","code_information":[{"code":"89055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.27,"maximum":7.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.44,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.27,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.78,"additional_payer_notes":"APC"}]}]},{"description":"Exam synovial fluid crystals","code_information":[{"code":"89060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.33,"maximum":13.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.62,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.55,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":13.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.84,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.21,"additional_payer_notes":"APC"}]}]},{"description":"Specimen fat stain","code_information":[{"code":"89125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.88,"maximum":10.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.06,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.29,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.59,"additional_payer_notes":"APC"}]}]},{"description":"Exam feces for meat fibers","code_information":[{"code":"89160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.85,"maximum":8.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.85,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.19,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":8.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.18,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.43,"additional_payer_notes":"APC"}]}]},{"description":"Nasal smear for eosinophils","code_information":[{"code":"89190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.79,"maximum":10.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.02,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.79,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.96,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.19,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.48,"additional_payer_notes":"APC"}]}]},{"description":"Semen analysis w/huhner","code_information":[{"code":"89300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.84,"maximum":17.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.23,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.84,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.53,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.52,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.02,"additional_payer_notes":"APC"}]}]},{"description":"Semen analysis w/count","code_information":[{"code":"89310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.61,"maximum":15.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.95,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8.61,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.87,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.21,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":15.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.2,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.64,"additional_payer_notes":"APC"}]}]},{"description":"Semen anal vol/count/mot","code_information":[{"code":"89320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.31,"maximum":22.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.31,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.68,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.17,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":13.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.16,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.79,"additional_payer_notes":"APC"}]}]},{"description":"Semen anal sperm detection","code_information":[{"code":"89321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.05,"maximum":22.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.89,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":22.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.88,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.5,"additional_payer_notes":"APC"}]}]},{"description":"Semen anal strict criteria","code_information":[{"code":"89322","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.5,"maximum":28.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.12,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.96,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.58,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":15.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":28.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":16.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":16.57,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":17.36,"additional_payer_notes":"APC"}]}]},{"description":"Sperm antibody test","code_information":[{"code":"89325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.67,"maximum":19.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.1,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.67,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.99,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.42,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":19.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.31,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.95,"additional_payer_notes":"APC"}]}]},{"description":"Sperm evaluation test","code_information":[{"code":"89329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.59,"maximum":35.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.37,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":35.77,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.94,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.94,"additional_payer_notes":"APC"}]}]},{"description":"Evaluation cervical mucus","code_information":[{"code":"89330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.38,"maximum":18.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10.38,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.69,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.11,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":18.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":11.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.1,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":11.63,"additional_payer_notes":"APC"}]}]},{"description":"Retrograde ejaculation anal","code_information":[{"code":"89331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.59,"maximum":35.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.37,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.18,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":35.77,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.94,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.94,"additional_payer_notes":"APC"}]}]},{"description":"Semen analysis","code_information":[{"code":"G0027","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.5,"maximum":11.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.76,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.7,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.96,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.95,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.28,"additional_payer_notes":"APC"}]}]},{"description":"PSA Screening","code_information":[{"code":"G0103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.31,"maximum":35.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.31,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.89,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.66,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":35.26,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.47,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.64,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.63,"additional_payer_notes":"APC"}]}]},{"description":"Screen cerv/vag thin layer","code_information":[{"code":"G0123","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.26,"maximum":36.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.07,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.87,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.68,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":36.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":21.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.66,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":22.69,"additional_payer_notes":"APC"}]}]},{"description":"Scr c/v cyto,thinlayer,rescr","code_information":[{"code":"G0143","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.05,"maximum":49.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.86,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":49.39,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.3,"additional_payer_notes":"APC"}]}]},{"description":"Scr c/v cyto,thinlayer,rescr","code_information":[{"code":"G0144","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":43.97,"maximum":80.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":45.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43.97,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":45.29,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47.05,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":44.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":80.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":46.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":47.0,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49.25,"additional_payer_notes":"APC"}]}]},{"description":"Scr c/v cyto,thinlayer,rescr","code_information":[{"code":"G0145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.49,"maximum":48.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":27.55,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.28,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.34,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":27.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":48.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.08,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.32,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.67,"additional_payer_notes":"APC"}]}]},{"description":"Scr c/v cyto, automated sys","code_information":[{"code":"G0147","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.54,"maximum":33.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.1,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.65,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.76,"additional_payer_notes":"APC"}]}]},{"description":"Scr c/v cyto, autosys, rescr","code_information":[{"code":"G0148","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":31.94,"maximum":58.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":33.22,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31.94,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34.18,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":32.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":58.32,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":33.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":34.14,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":35.77,"additional_payer_notes":"APC"}]}]},{"description":"CBC/diffwbc w/o platelet","code_information":[{"code":"G0306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.77,"maximum":14.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.08,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7.77,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.31,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":7.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":14.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":8.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.31,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":8.7,"additional_payer_notes":"APC"}]}]},{"description":"CBC without platelet","code_information":[{"code":"G0307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.47,"maximum":11.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.73,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.66,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.92,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":11.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.86,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":7.25,"additional_payer_notes":"APC"}]}]},{"description":"Fecal blood scrn immunoassay","code_information":[{"code":"G0328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.05,"maximum":32.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":18.77,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.05,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.59,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.31,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":32.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.3,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.22,"additional_payer_notes":"APC"}]}]},{"description":"EIA HIV-1/HIV-2 screen","code_information":[{"code":"G0432","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.57,"maximum":35.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.35,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19.57,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.16,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.94,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":35.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":20.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.92,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":21.92,"additional_payer_notes":"APC"}]}]},{"description":"ELISA HIV-1/HIV-2 screen","code_information":[{"code":"G0433","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.29,"maximum":33.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.02,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.29,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.84,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.55,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.48,"additional_payer_notes":"APC"}]}]},{"description":"Oral hiv-1/hiv-2 screen","code_information":[{"code":"G0435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.98,"maximum":21.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":21.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":12.81,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"}]}]},{"description":"Hep c screen high risk/other","code_information":[{"code":"G0472","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":46.35,"maximum":84.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":48.2,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":47.74,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49.59,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":47.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":84.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":49.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":49.55,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":51.91,"additional_payer_notes":"APC"}]}]},{"description":"Hiv combination assay","code_information":[{"code":"G0475","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.08,"maximum":43.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.04,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24.08,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24.8,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.77,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":24.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":43.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":25.74,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.97,"additional_payer_notes":"APC"}]}]},{"description":"Hpv combo assay ca screen","code_information":[{"code":"G0476","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Drug test def 1-7 classes","code_information":[{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":114.43,"maximum":208.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":119.01,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":114.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":117.86,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.44,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":116.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":208.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":121.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":122.33,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":128.16,"additional_payer_notes":"APC"}]}]},{"description":"Drug test def 8-14 classes","code_information":[{"code":"G0481","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":156.59,"maximum":285.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":162.85,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":156.59,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":161.29,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":167.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":159.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":285.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":165.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":167.39,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":175.38,"additional_payer_notes":"APC"}]}]},{"description":"Drug test def 15-21 classes","code_information":[{"code":"G0482","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":198.74,"maximum":362.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":206.69,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":198.74,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":204.7,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":212.65,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":202.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":362.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":210.66,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":212.45,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":222.59,"additional_payer_notes":"APC"}]}]},{"description":"Drug test def 22+ classes","code_information":[{"code":"G0483","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":246.92,"maximum":450.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":256.8,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":246.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":254.33,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":264.2,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":251.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":450.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":261.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":263.96,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":276.55,"additional_payer_notes":"APC"}]}]},{"description":"Hepb screen high risk indiv","code_information":[{"code":"G0499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.27,"maximum":51.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":29.4,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28.27,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29.12,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.25,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":28.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":51.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":29.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":30.22,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":31.66,"additional_payer_notes":"APC"}]}]},{"description":"Screening Hep C detect","code_information":[{"code":"G0567","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.09,"maximum":64.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":35.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.51,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":39.3,"additional_payer_notes":"APC"}]}]},{"description":"Drug test def simple all cl","code_information":[{"code":"G0659","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":62.14,"maximum":113.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":64.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":64.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":66.49,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":63.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":113.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":65.87,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":66.43,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":69.6,"additional_payer_notes":"APC"}]}]},{"description":"Cephalin floculation test","code_information":[{"code":"P2028","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.95,"maximum":9.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.1,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.3,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.25,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.54,"additional_payer_notes":"APC"}]}]},{"description":"Congo red blood test","code_information":[{"code":"P2029","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.95,"maximum":9.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.1,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.3,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.25,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.54,"additional_payer_notes":"APC"}]}]},{"description":"Blood thymol turbidity","code_information":[{"code":"P2033","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.95,"maximum":9.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.1,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.3,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.25,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.54,"additional_payer_notes":"APC"}]}]},{"description":"Blood mucoprotein","code_information":[{"code":"P2038","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.95,"maximum":9.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.15,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.1,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.3,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":9.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.25,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.29,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":5.54,"additional_payer_notes":"APC"}]}]},{"description":"Screen pap by tech w md supv","code_information":[{"code":"P3000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.54,"maximum":33.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.1,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.65,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.76,"additional_payer_notes":"APC"}]}]},{"description":"Catheterize for urine spec","code_information":[{"code":"P9612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.34,"maximum":17.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.71,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.62,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.99,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.9,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":9.98,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.46,"additional_payer_notes":"APC"}]}]},{"description":"Wet mounts/ w preparations","code_information":[{"code":"Q0111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.54,"maximum":33.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.28,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.1,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.84,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":33.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":19.65,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":19.82,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":20.76,"additional_payer_notes":"APC"}]}]},{"description":"Potassium hydroxide preps","code_information":[{"code":"Q0112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.83,"maximum":10.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.06,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5.83,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.24,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":5.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":10.65,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":6.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.23,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":6.53,"additional_payer_notes":"APC"}]}]},{"description":"Pinworm examinations","code_information":[{"code":"Q0113","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.27,"maximum":7.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.44,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4.27,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.57,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":7.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":4.53,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.56,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":4.78,"additional_payer_notes":"APC"}]}]},{"description":"Fern test","code_information":[{"code":"Q0114","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.74,"maximum":17.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.13,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9.74,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.03,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.42,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":9.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":10.32,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.41,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":10.91,"additional_payer_notes":"APC"}]}]},{"description":"Post-coital mucous exam","code_information":[{"code":"Q0115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.0,"maximum":45.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.0,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.75,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.75,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":25.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":45.65,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":26.5,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":26.72,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":28.0,"additional_payer_notes":"APC"}]}]},{"description":"2019 nCoV diagnostic P","code_information":[{"code":"U0001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.92,"maximum":65.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":37.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":37.0,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38.43,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":36.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":65.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":38.08,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":38.4,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":40.23,"additional_payer_notes":"APC"}]}]},{"description":"COVID-19 lab test non-CDC","code_information":[{"code":"U0002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.31,"maximum":93.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":53.36,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51.31,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":52.85,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.9,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":52.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":93.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":54.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":54.85,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":57.47,"additional_payer_notes":"APC"}]}]},{"description":"Cntct lens hydrophil photoch","code_information":[{"code":"V2524","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":154.45,"maximum":282.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":160.63,"additional_payer_notes":"APC"},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":154.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":159.08,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":165.26,"additional_payer_notes":"APC"},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":157.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual EPO","methodology":"fee schedule","standard_charge_dollar":282.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","methodology":"fee schedule","standard_charge_dollar":163.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":165.11,"additional_payer_notes":"APC"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"fee schedule","standard_charge_dollar":172.98,"additional_payer_notes":"APC"}]}]}],"modifier_information":[{"description":"Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities","code":"TC","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alignment Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Individual EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]}]}